Rakesh Gupta's patients have back pain. Their necks ache. Their vision is blurred. But above all else, their hands hurt.
"It's very obvious when they spend a long time sitting behind a desk, staring at a computer, chatting away, these problems are going to happen," he said.
Gupta told ABC News his patients are not socializing online and they're not playing computer games. They work 10 hours a day talking to Western customers thousands of miles away.
They are the foot soldiers of the outsourcing revolution, the 20-something Indians who try to sound American while talking to an AT&T customer in Maryland, the 30-somethings who wait patiently as a woman in Utah reboots her Dell computer.
Most of the 1.6 million Indians who answer calls from Western customers are doing quite well in a country where 60 percent of people live in villages and make less than $2 a day. The Indians who work in information technology are one of the driving forces that has propelled their country to become the second-fastest growing economy in the world.
But there is a much more painful side to their jobs — quite literally. The majority of them suffer from physical ailments known as repetitive stress injuries. Some suffer from nerve damage in their backs and necks. Some suffer psychological pain. And others are increasingly suffering from diabetes and obesity, the products of long days sitting in one place, staring at one screen, talking to one company's customers.
"The only thing I could type was my name and my password," Nithin Kaulavkar, who works for Hewlett Packard in Bangalore as a software architect, told ABC News.
After a few years of spending six days a week typing on a laptop, his pain became so bad, he was incapacitated.
"I used to get numbness in my hand. A lot of pain in my forearms. I also had some trouble towards my shoulder. This pain would remain throughout day and night. I would wake up with pain. And it's not something that painkillers would help."
He took three months off work, unable to even drive his car. "It's a numbing pain. You're constantly holding it, massaging it, all the time."
He was treated by Deepak Sharan, the medical director of the RECOUP Neuromusculoskeletal Rehabilitation Centre in Bangalore, India's equivalent to Silicon Valley.
Perhaps more than anyone, Sharan knows the toll that work in IT can take on a body. For the last eight years he has studied Indians who work in the industry, from software companies to call centers.
Of the 30,000 workers he's surveyed, 75 percent suffer from some physical ailment because of their work. In the West, that number is closer to 60 percent.
"We don't have any national guidelines like they have in the U.S. or the U.K.," he said. "The companies in India are not bound by any legal reasons to have any particular workstation safety, or that all the employees get trained in the correct health and safety practices."
From Sleep Disorders to Diabetes
From Bangalore in the south to Gurgaon in the north, an army of 20- and 30-something Indians work 24 hours a day to answer the needs of American and British customers.
They often work in the middle of the night and sleep during the day, if they can. Many eat poorly, get little exercise and suffer from the sedentary lifestyle their jobs force upon them. They have sleep disorders, heart disease, diabetes and depression, just to name a few.
"The number of young people coming to us with problems is increasingly steadily," said Gupta, the senior consultant for internal medicine at New Delhi's Indraprastha Apollo Hospital. His patients from the IT sector are all in their 20s. "If they work for a year or two in the field, these problems will crop up."
Sharan describes that there are three stages of pain that his IT patients feel: symptoms that disappear after work; symptoms that disappear after a good night's sleep; and symptoms that don't go away.
It is that last group of people, experiencing stage 3 pain, that he sees most often.
"Many people have to give up working or give up using their hands. This kind of injury leads to a lot of burning, swelling and stiffness, and people find it very difficult to carry out their normal day to day tasks," he said.
Sometimes, the pain does not stop at the physical.
Karuna Baskar, a psychologist and the director of 1to1help.net, a counseling service for IT companies and employees, told ABC News that she talks to parents whose children are crying because mom is never home.
She talks to couples who both work in IT and never see each other because they have opposite shifts. She talks to 23-year-olds who live away from their parents and do nothing but work at night and fail to sleep during the day.
"They are very often away from home and their normal environment and their lifestyles are very different. They have to take on a different identity — try to be more Western or American, and conflict comes with that," she said.
For these people, the physical pain becomes mental. Nearly 100 people a day call 1to1.net complaining about psychological distress, sometimes even depression.
"They have so little free time, so they get cut off from the people they would otherwise be close to," Baskar said. "They're working when everybody else is asleep. There is a high percentage of greater emotions, and that in turn affects their relationships … and they become increasingly irritable."
In a country where most young people live at home until they're married, many young IT professionals have to move out, often away from their friends and family for the first time.
"Because of the kind of lifestyles they're leading, with much less supervision than typical Indian families, they're not used to that kind of freedom," Baskar said.
Some suffer from such bad nutrition and such insecurity, they want to quit. "But many can't quit," she said. "They're the highest-earning members of their families."
When it began in 2001, 1to1help.net was a pioneering service. Today, there are stories of companies that are aware of the problem and are truly trying to help.
"There are good companies and there are bad companies" when it comes to IT, says Sharan.
Hewlett Packard and Texas Instruments, for example, allow Sharan's doctors to make regular visits to the office, checking desks to make sure employees are sitting correctly and leading talks about what symptoms to look out for.
The good companies, he says, will bring fitness trainers or yoga instructors into offices and force employees to take breaks every 30 or 45 minutes, just to relieve the strain on their eyes and bodies.
But the bad companies "take shortcuts," Sharan says. "They get any available doctor, unqualified, who doesn't know anything about ergonomics and try to get a certificate that he was there. And if an employee complains about pain the company will just produce the certificate and say, 'There must be something wrong with you, not us.'"
One employee who worked for Dell says his company doesn't have any system for helping its employees.
"They do help people but there's no program as such for computer-related injuries. Their awareness is low," said a former Dell employee, who requested to remain anonymous.
For the IT professionals who end up in Sharan's office, relief from their pain sometimes comes in days, but sometimes doesn't arrive for more than a year.
For every patient there is a three step process: Muscle tightness and spasms can be treated with deep tissue massages, trigger point release, stretching and other methods.
After that, doctors will help make patients' joints more flexible with stretching, yoga or a stretching and breathing system known as the Alexander technique.
Lastly, strength training and a high-tech system involving electrodes can permanently help patients learn to relax their muscles while at their desks. Long-term treatment can involve tai chi and more aggressive strength training.
To cure sleeping problems, Baskar insists that the people she speaks to be more assertive. "It's not part of our culture to say, 'don't call me at a certain time.' That is very rude in Indian culture … but it's perfectly fine to tell people not to call me at this time because I'll be sleeping."
But the best treatment, doctors and patients say, is prevention — avoiding repetition, avoiding sleepless days and avoiding fatty foods.
"These injuries can hit you anytime," Kaulavkar said. "What is unfortunate is that you will realize it one fine day, because many people don't realize there are symptoms before that."