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 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.