Protecting Employees Beyond Our Borders

Managing the health and safety of employees is hard enough. Implementing a plan for employees in developing parts of the world is an even more formidable challenge.

PERHAPS never before have the challenges facing occupational health and safety professionals been so starkly defined and potentially consequential. A rapidly expanding global marketplace is creating opportunities in places that could scarcely have been foreseen a decade earlier. But those opportunities carry with them a degree of risk that requires more exhaustive planning and preparation than most OSHA professionals historically have had to undertake. Moreover, simply providing routine and required occupational health services in many parts of the developing world represents a formidable challenge.

Corporations doing business overseas must determine how to provide essential health services to their employees along with mandated programs including drug and alcohol testing and compliance with corporate, national, and international health and labor standards. The threshold requirement is to identify and assess current health issues in the areas where company employees will be located or required to visit. Once the health risk identification and assessment is completed, the information is used to develop plans and procedures that will mitigate the health risks.

Using the health risk assessment as a guide, the corporation must determine how it will provide instruction and training that is appropriate to the risks presented by working in a specific location, as well as first aid and medical treatment for employees who may fall victim to sickness or injury. It must also devise a program to promote good health practices, monitor sicknesses, provide employee assistance and rehabilitation, and carry out the record keeping and case management associated with good occupational health programs. These services can run the gamut from emergency evacuations in times of crisis to Western standards of medical care that cover long-term health needs as well as occupational health and safety needs.

Good Plans in Action
Two examples from our records illustrate the vast and disparate challenges faced by today's OSH professionals. On Aug. 19, 2003, there was a suicide truck bombing at United Nations' headquarters in Baghdad, Iraq. We immediately activated crisis teams across four Alarm Centers--Geneva, Paris, London, and Philadelphia. Security, medical, and sales teams worked together to assess the situation quickly and understand the level of client involvement. Calls were made proactively to key contacts and to more than 50 clients who have operations and employees in Iraq.

News reports indicated 20 people had died and more than 100 were injured. Establishing links with the U.S. military, the United Nations, and the World Bank, we coordinated help and assistance to 15 members--mainly injured NGO staff--after they had been airlifted out of Baghdad to hospitals in Kuwait, Oman, and Germany.

We helped identify NGO staff taken to the receiving centers, monitored their condition, and provided ongoing assistance to the patients. Employers, families, and colleagues were contacted and reassured, and arrangements were made for them to visit their loved ones.

When patients were deemed fit to fly, we repatriated them and organized their ongoing medical treatment at receiving hospitals in their home countries. The first patient repatriated from Germany to Switzerland was one of the World Health Organization's own medical directors.

In a very different setting, a modern and busy medical clinic operates on behalf of a Canadian company at a gold mine in the northwestern area of Tanzania. This clinic is one of more than 160 remote site projects managed around the world, with clinic services from staffing and management to design and medical supply. These clinics are usually in locations where transportation, climate, and communications are a constant challenge.

At the Tanzania gold mine clinic, three doctors and one paramedic are on duty 24 hours a day, supported by nine nurses, a radiographer, and a laboratory technician from the mine.

One of the on-site contractor's employees developed a slight headache, body aches, and runny nose. Initially he shrugged it off as a bout of influenza and continued to work. When the symptoms became worse after a week, he visited the clinic and a malaria test turned out positive. He was prescribed medication and returned to work, but his condition again began to deteriorate. Back at the clinic, a battery of tests confirmed the employee was suffering from liver failure as a result of the original malaria attack. Immediately evacuated him to Nairobi, Kenya, he received dialysis after developing kidney failure.

His wife was flown in from South Africa so she could be close to him. Finally, he started to improve steadily and manage without dialysis. Fourteen days after first becoming ill, he was fit enough to be discharged. His story had a happy ending--an ending that would have been much different if he had not been located in an area where first-rate medical assistance was immediately available.

Identify the Risk
Safety and health issues abound for OSH managers charged with caring for overseas employees. The planning considerations that arise from the need to deal with these issues generally are based on the need to accurately identify risks and take appropriate measures to mitigate those risks and respond to emergencies.

The principles around mitigating risk and facilitating response are, at their most basic level, fairly straightforward; for example, the following recommendations are currently promulgated by ASIS International and listed on its Web site (

  • Maintain situational awareness of world events and ongoing threats.
  • Ensure all levels of personnel are notified via briefings, e-mail, voice mail, and signage of any changes in threat conditions and protective measures.
  • Encourage personnel to be alert and immediately report any situation that may constitute a threat or suspicious activity.
  • Post emergency telephone numbers for police, fire, and rescue. Encourage personnel to memorize important numbers.
  • Know the location of the closest police stations, hospitals, schools, etc.
  • Encourage personnel to keep their family members and supervisors apprised of their whereabouts.
  • Coordinate and establish partnerships with local authorities to develop intelligence and information sharing relationships.

The challenge lies in acquiring the capability to implement the above recommendations. Where can credible and timely information be found on international threats? How can employees reliably and efficiently be informed of the current conditions in the areas they're operating? When overseas, where do employees call for round-the-clock assistance for medical or security issues, and to whom do they turn for qualified local assistance? How does a company establish close working relationships with the governments and law enforcement authorities of perhaps dozens of countries and regions in which its employees work?

Preparation and mitigation are only the first half of the equation; the ability to respond when an event occurs is equally critical. How do you find your travelers and expatriates in a crisis? How do you communicate with them and vice versa? How do you secure them in the wake of an incident? How do you evacuate safely and securely when normal transportation modes may be affected? What tools and resources do you need to meet your duty of care responsibility?

For American businesses and other organizations with overseas interests, an incident or major medical disaster anywhere in a given country or region may require responses ranging from warning or reassuring employees to treating and evacuating personnel. If not handled properly, response to such an incident can adversely affect an organization in multiple ways. For planning purposes, corporations should consider:

Impact on employees. The impact of a serious incident on employees, contractors, and family members can cause annoyance, inconvenience, stress and reduced productivity during a trip to the preoccupation of senior management, illness or accident resulting in significant missed work, even serious harm or death. The morale, motivation, and retention of employees also can be affected adversely if a perception is created that the company does not support and protect employees in need.

Duty of care. The tragic events of 9/11 caused a fundamental reassessment of duty of care expectations and standards for corporations. Organizations that do not exercise due diligence and care for their employees risk litigation for negligence, as well as potentially severe damage to brand and reputation. This has led to requirements for accurate, detailed, timely, and tailored information and intelligence, plus an increased need for emergency response planning.

Expectations of shareholders, governments, and the public. A major incident that takes a corporation unaware, causes significant harm to employees or others, or interrupts vital business functions can affect the very viability of the enterprise. Companies unprepared for crisis risk damaging themselves and their reputations, potentially leading to media and public criticism, loss of confidence among investors and lenders, and government investigation or sanction. Any of these outcomes can reduce the valuation of the business and even threaten the ability of a company to continue profitable operations. While the well-being of employees and families remains the paramount concern, major companies are also expected to safeguard the continuity of their business and protect fiduciary obligations.

The attractiveness of the global marketplace will continue to grow in the years ahead. But the risks imposed by doing business in developing markets will not go away. For corporations who choose to pursue business in this marketplace, and for the occupational health and safety professionals they employ, the challenge will be to effectively anticipate and manage risks so that they can protect their most valuable asset--their employees--in a manner wholly consistent with their obligations.

This article originally appeared in the July 2004 issue of Occupational Health & Safety.

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