Labour pains

For the individual, pain’s economic impact is direct. Here’s how workplace culture can help make or break a person’s chronic pain

In the pitch black before dawn, as students in uniform crowd a Sengkang light rail car, Muhammad Hisham leans against an emergency door.

The 41-year-old is exhausted; it’s only his second day at work, but he is already down with a cold. But Hisham doesn’t want to take a sick day.

“I find it not be natural to be away from work, unless it’s really an emergency,” he says.

Hisham’s hour-long commute to his workplace, a small company in an industrial building at Kallang Bahru, is made worse by his gout, which makes him limp as his ankles swell and hurt.

The train trundles into the station and he shuffles out toward the escalators, the crowd of early-risers flowing around him.

The IT support engineer spent three months from November 2017 looking for work, sending over 300 applications to companies and interviewing with 15 companies.

This is Hisham’s eighth job; his other jobs include being an assistant IT manager to a junior executive at a marketing communication company.

He was asked to leave his position at a government school in 2007 when he exceeded his allotted 14-day paid outpatient sick leave.

“For them, they were looking at it from an operational point of view. They needed someone to be there, and I wasn’t,” Hisham says.

Back then, he had been more “negligent,” and felt helpless because he couldn’t do anything about it then. Now, he manages his gout with medication.

“I took steps later on to remedy that, so the reasons for leaving later jobs weren’t related to medical problems,” he adds.

Hisham, whose brother and father also suffer from the condition, says that former colleagues have usually been understanding towards him.

“It’s only when the impact of my absence on operations is clear — that’s when they bring me into a room to discuss how they can proceed,” he says. “Sometimes they’ll give me another month or so to see if there’s a way I can work.”

For chronic pain patients like Hisham, losing their jobs represent a direct economic impact.

A 2016 study of a low-income rental flat population in Singapore found that chronic pain was associated with unemployment.

While chronic pain may not the only reason why sufferers cannot find work, a person’s capacity for work will be affected if they are suffering from untreated chronic pain, says Dr Tjan, senior consultant at the Pain Management Clinic in Tan Tock Seng Hospital.

“A job obviously requires concentration, it requires participation, it requires some amount of physical contribution,” Dr Tjan adds. 

For some, a negative workplace culture might also be a barrier towards proper rest, as employer expectations all but prohibit employees from taking sick leave without affecting their employment.

Missing work days could reflect badly on employment, says Timothy Soh, a 30-year-old operations manager at a printing company.

“Many companies in this country take a relatively unforgiving attitude towards their employees,” Soh, who suffers from a set of slipped discs and dislocation of both knees, adds. “They tend to think that employees lie about their pain, and use it as an excuse to skip work.”

Though Soh hasn’t experienced this first-hand, he says that “appearance” was very important at a previous job where he worked as a building manager for a large palm oil plantation company. Soh had to make rounds twice a day to inspect facilities, which took a toll on his knees.

He says that when the pain started, he would just bear with it and do his work, because if tenants knew about his condition, they would tell him he needs to leave his job and get someone else.

“It’s just the way it is,” Soh says.

Workplace cultures differ

Still, some chronic pain patients say that their workplace has been welcoming, and that it has helped them with their condition.

“My office is very open about our problems,” says Evon Toh, who has chronic pain from scoliosis. “So there’s nothing for us to hide from one another.”

Out of 11 employees at her office — part of the National Institute of Education’s consultancy arm, NIE International — three to four suffer from chronic pain.

“I think nobody really pays much attention, because it is quite a daily thing for us,” Toh adds.

Colleagues will be helping one another, be it pasting pain relief patches on each other’s backs, confiding in each other about their aches and pains, or massaging each other, Toh says.

She would also share alternative treatment methods, like yoga therapy and even reiki, Japanese energy therapy, with interested colleagues.

At one point, when Toh’s pain got too severe, she found that lying down in a small meeting room on four office chairs helped.

Lim Hwei Ming, a business development manager in Toh’s office, says that colleagues often noticed her pain, even if she didn’t mention it. “I think they know because from the way we walk and how we can neither sit nor stand, or lie down,” the 38-year-old says. “They would know, even if I don’t tell.”

“I think overall our colleagues here, they have a sense of empathy,” she adds. “They understand our pain; I think at work we do not feel that much stress.”

Toh, who had to urgently call in sick at one point because of her chronic back pain, says that even though colleagues had to take over some parts of her work on urgent notice, “everybody has been very helpful.”

“I do feel bad having them to share my workload because I’m down due to pain,” Toh says.

But resentment and judgment from colleagues are scarce. “Most of the people I’ve met in NIE are actually very accepting and understanding. People are very open to talk about their disabilities.”

Lim — who is one of Toh’s managers — adds that she would find additional help if staff have to go on emergency medical leave. “We help one another, because nobody is perfect in health 365 days in a year,” she says.

Employers usually understand

Psychosocial interventions are offered to some chronic pain sufferers to help them ease back into employment, says TTSH’s Dr Tjan.

These interventions usually involve a multi-disciplinary team with pain psychologists, pain nurses and social workers. “When we talk about psychological treatment, we usually mean cognitive training and counselling,” Dr Tjan adds. The treatment is designed to help sufferers express themselves better.

Doctors will also intervene to advocate for the sufferer in the workplace, with their consent, to find out more about the sufferer’s job requirements and inform employers of the sufferer’s pain diagnosis.

“Most of the time employers in Singapore, in our experience, are quite supportive,” Dr Tjan says. “Some of them offer temporary adjustment of the work and some of them have even allowed us to visit them with the patient to see exactly what the patient does.”

Other changes employers have offered include offering part-time work and negotiating for a return to work only after treatment is complete.

More than half the time, Dr Tjan says that the psychosocial intervention works out.

But some sufferers still leave their jobs because their companies could not match their capabilities, even after sufferers are trained for other work. “We do have companies and employees that end up terminating their relationship with one another.”

To tell, or not to tell?

Despite these options, some sufferers may not be willing to tell the people they work for about their condition, until it becomes absolutely necessary.

Shawn Danker, a 39-year-old freelance photographer, usually keeps his chronic condition hidden from the clients he works for, including some online magazines and news sites.

“The way I structure things when I work for them — I ensure that I don’t strain myself too much and I give myself enough time to recover,” he adds. “They don’t know I have a chronic condition.”

Dr Yang Su-yin, clinical lead for pain psychology at TTSH, says that there was a year during an economic recession where chronic pain sufferers requested that doctors not write memos or approach their employers in case these were used as a reason to lay them off after an appraisal.

“For those that are working, they don’t want to be seen as lesser than their counterparts or their peers,” she adds.

And still, others say there’s not much to conceal.

Hisham says that he has “nothing to hide” at his new workplace, ever since he told HR about his chronic pain. Most of his friends on Facebook already know about his chronic condition, and he adds that he would still accept friend requests from his colleagues.

“I don’t have any issues,” he says. “I mean, if the HR or management knows about it, and everyone else knows about it, I don’t have a problem dealing with them.”

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