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May 2013 19 mental and physical, because call centre people are at their seats for long peri- ods of time, sometimes three hours at a stretch, without being able to move around," she says. Employees must constantly be watching the clock. Under "dynamic scheduling," McDougall says, the schedule of breaks and lunches changes day to day. Workers are judged on their "adherence" — that is, how closely they stick to the schedule. In addition to the constant schedule change, they o en have to remain on a call when a sched- uled break comes up and so deemed "out of adherence." ese internal workplace pressures, she adds, as well as frequent verbal abuse from callers, contribute to stress and workers' low morale. In addition, the ability to socialize — a main benefi t of being in the workforce — is almost non-existent due to the nature of the work and time constraints. "You feel as if all you do is come in, you plug in. It's almost like being a robot. Call centres are being likened to modern-day sweatshops," she says. "We have more people going out with all kinds of mental stress issues and on long-term disability." Physical hazards Call centre workers are also exposed to physical problems. A 2012 study from the United Kingdom, for example, found one in four call agents suff er voice problems, including voice loss, sore throat, hoarseness and breath- lessness. It recommended call centres provide basic training in voice control and protection. Lynn Woodman, director of Voice Power, a Toronto company that pro- vides voice, speech and presentation training, says the main problem for workers required to speak for long peri- ods of time is vocal fatigue. To work eff ectively and stay healthy, she explains, the vocal cords need to be fl exible, hydrated and supported by a steady stream of air, obtained by deep, abdominal breathing. "When we don't have enough breath support, we push the sound through the vocal cords, and it becomes strained and thin. Over time, this has a drying eff ect on the vocal cords, and they don't have the fl exibility they need," she says. When breathing is shallow, Wood- man adds, a person uses a narrow portion of the voice's full range and tone, depriving it of its resonance, which helps the voice carry easily. Call handlers compensate by speaking louder, which requires more energy and eff ort. In time, she says, incorrect speaking behaviour can lead to vocal nodes, which require a period of rest or, in some cases, surgery. To keep vocal cords hydrated, Wood- man recommends call agents sip water throughout the day and avoid spicy foods and caff einated drinks. Good pos- ture is essential, too, to reduce strain in the neck and promote relaxed airfl ow, she says. Staying in the same position for a long time causes tension, so call handlers should try to move around. "If they can get up, stretch and yawn and get a glass of water at least every 90 minutes, that is defi nitely going to serve them," she says. Spending hours on the phone every day also poses risks to hearing. Even a er only a year or two, many call agents show signs of hearing loss, says Sean Lennox, an audiologist with Advanced Hearing Group in Ottawa. A major cause of damage is headsets, he says. Sets covering both ears shut out more background noise and make hear- ing easier. But many workers wear sets covering only one ear and so tend to turn up the headset's volume. " ey usually have more sensory hearing loss in one ear versus the other ear," he says. "We recommend people have both ears covered, so they don't turn the volume up as loud." A common problem among call centre workers, Lennox says, is acous- tic shock disorder (ASD), a syndrome caused by a sudden, loud sound. O en misdiagnosed, ASD may produce some hearing loss, but its main symptoms are an intense fear of loud sounds, depres- sion, anxiety and tinnitus, a phantom sound ranging from a hum to a high- pitched squeal. For call handlers, whose headset volume may already be turned up, the danger comes when a person on the other end of the call raises their voice. " e noise is already at an unsafe level, and then they have someone yelling at them on the phone. And a lot of these phones don't have the capability to limit output, so they'll hear someone yelling in their ear at over 110 decibels," he says. Call centres should conduct regular ambient noise surveys, Lennox says. If the average noise level is above 60 or 70 decibels, they should consider acoustic modi- fi cations, such as additional carpeting. Workers should have their hearing tested regularly to detect loss early on. Call centre workers also face a number of musculoskeletal issues, says Dhananjai Borwankar, technical specialist with the Canadian Centre for Occupational Health and Safety in Hamilton, Ont. Sitting for long periods of time, for example, restricts blood cir- culation. In a prolonged fi xed position, the muscles of the neck, shoulders and trunk become tense, preventing blood from reaching these areas. "Your body has a decreased ability to transfer oxygen and nutrients to where it needs it most," he says. Workers may spend hours leaning to the right or le , Borwankar adds, alternating between hands to hold the phone. Moreover, if the workstation is poorly organized, they may have to stretch to get documents placed beyond their reach. Repeatedly stretching the body to its extreme range of motion, or holding an awkward position for a long time, increases the risk of injury to that part of the body, he says. e dimensions of the workstation, especially in relation to the worker's height, are key ergonomic consider- ations. Working at a table that is too high or low can injure the shoulders and wrists. Borwankar advises compa- nies bring in an ergonomic specialist to review workstations and match them to the workers. "[ ey need] someone who will look at the workstation — not just at new chairs but also at the type of work that's being done and how it's organized — and look at putting all those elements together to try to minimize ergonomic concerns," he says. As the Morneau Shepell study emphasizes, it's important for call centres to promote good physical and mental health, in both workers and supervisors. 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