Image credit: Fair Trade for surgical instruments, Mahmood F Bhutta

As the Fair Trade movement moves into the consciousness of society, so too does the exploitations that occur when fair trade criteria are not met. The past year has highlighted an unlikely, but important, sect of production in Pakistan. Pakistan is one of the world's leading producers of surgical instruments, approximately 20%, though the producers see little, if any, of this $US650 million dollar industry. Sweatshops, employing adults and children as young as seven, are producing our scalpels, scissors and other items at a high social cost for their low prices. "Some 50,000 people are involved in making stainless-steel surgical tools in Sialkot; around 7,700 of them are children." Health problems abound in these dangerous working conditions as workers suffer from various ailments, back and neck injuries to eye and lung problems from the grinding, milling and corrosive chemicals used.

These problems in Pakistan and elsewhere were exacerbated in 1994 by the US when legislation passed which set international quality standards for all surgical goods. While maintaining standards is certainly beneficial and important to consumers, it had an adverse effect on the workers, as production of identical products leaves only price as a competitor, and that's been lowered at the expense of the laborers.

In 2000 a program was launched by U.N. International Labor Organization and the Surgical Instrument Manufacturers Association of Pakistan to work towards ending the child labor in this industry. A similar program producing sport equipment such as soccer balls found success and international acclaim. The negative impact, however, was not so well publicized. Many children under the age of 14 found themselves out of work. With no money to eat, and sometimes supporting other members of their family, these children were forced to find work elsewhere, such as in surgical instrument production. The only permanent solution to end child labor is to pay the adults a fair wage, and ensure they are not killed or maimed due to dangerous work environments so that their children may attend school.

Public awareness of these atrocities is limited, as surgical instruments go through many wholesalers, sometimes "even stamped 'Made in Germany' at the request of middlemen worried about Pakistan's image." Societal outcry is further muffled due to lack of knowledge, as few patients are aware of where their doctors and hospitals source their vast amount of equipment and supplies. The burden then falls upon medical professionals, who are aware where the products come from and have the power to instigate change, and they have begun to do so.

Doctors in the UK recently called upon the National Health Service (NHS) "to establish fair trade agreements with companies making high-quality surgical equipment in Pakistan." This would help establish more direct trade with the producers, who are currently receiving approximately $2 for instruments which sell to hospitals at $80. Cutting out the middle man will put more profit in the producers hands, as well as create direct and transparent trade to ensure Fair Trade criteria are met. Dr Peter Tiplady, of the BMA’s public health medicine and community health division said, "Our gut reaction would be to boycott this production but this is not the answer because the poor will get poorer and the rich will get richer. Fair trade is the answer. It already exists for products like sugar and tea, so why not medical instruments."

The next time you visit your doctor or hospital, ask where they purchase their instruments and if they are aware of the current push to ethically source these products. Encourage them to use their power as consumers to ensure they were made in a safe environment by adults being paid a fair wage.