World at work: health hazards among foot massage workers in China.

R eflexology or foot massage has long been part of Chinese tradition and culture. It is believed that foot massage can not only maintain and promote health but also cure a variety of ailments. Foot massage is considered a form of relaxation and, to some extent, a luxury. With improved economy, foot massage has become widely popular in China, especially in coastal cities that have benefited from the recent expanded economy. For example, in Shanghai alone there are 1300–2000 foot massage facilities and the total number of foot massage workers in Shanghai is estimated to be close to 30 000. In Shenzhen, the booming city just north of Hong Kong, the number of foot massage facilities is estimated at 3000–4000, and the number of foot massage workers at more than 40 000. Approximately 90% of foot massage workers in large cities are young females (aged 18–25), and most came from poor inland rural areas, where jobs are scarce and wages are low. Foot massage workers are exposed to not only biological, chemical, and physical hazards, but also emotional and psychological stresses. The health problems associated with foot massage workers are not limited to China. Foot massage is also popular in other regions in Asia, such as Thailand, the Philippines, Hong Kong, Taiwan, Malaysia, and Singapore. In addition, foot massage facilities can also be found in Asian communities in large cities in America and Europe. TASKS OF THE JOB Foot massage facilities range in size from small storefront shops of no more than 40–50 squared metres to huge multi-floor buildings. The storefront of a typical small foot massage shop is shown in fig 1. Small foot massage facilities usually consist of a single open room that can accommodate four or five clients at one time. Ventilation, plumbing, and hygiene are usually inadequate at these small makeshift foot massage shops. Large foot massage facilities are made up of tens of small private and large open rooms. By comparison, large facilities are usually better ventilated and more hygienic. Foot massage consists of three steps: soaking, cleaning, and massaging the client’s feet; the entire process lasting approximately one hour. The client sits on a sofa or an armchair and, with pant legs rolled up, soaks his/her feet in a wooden bucket of warm water with Chinese herbal medicines and other chemicals for about 10–15 minutes (figs 2 and 3). The foot massage worker then cleans the client’s feet with her/his bare hands using soap or other cleaning solutions (fig 4). The client’s feet are then rinsed and dried with a towel (fig 5). The cleaning process takes about five minutes. The client then puts both feet on a low stool in front of the sofa. The foot massage worker sits directly in front of the stool and massages the client’s feet. The process consists of applying massage oil or lotion to the client’s feet and massaging the feet with bare hands (figs 6 and 7). The foot massage worker uses her/his knuckles to apply pressure to different areas of the sole (‘‘pressure or reflex points’’), simultaneously slowly rotating her/his knuckles back and forth. The pressure or reflex points are supposedly connected to different organs, nerves, and glands of the body. It is believed that manipulating these pressure or reflex points helps to promote the ‘‘wellbeing’’ of the respective organs, nerves, and glands. The massage itself takes about 40–45 minutes. The feet are then wiped clean with wet hot towels. In addition to foot massage, some facilities also offer a toenail cutting service. Traditional nail cutting knives are used (fig 8). Most foot massage facilities open every day from midday to midnight (some as late as 2 or 3 am in the morning). On average, a foot massage worker handles 3–5 clients a day, and spends the rest of the time waiting for clients. Some workers, however, may work 14–16 hours and handle as many as 8 or 10 clients a day. In Shanghai, an hour of foot massage costs from ¥20 to ¥100 (exchange rate: US$1=¥8.2), but the foot massage worker gets only 10–40% of what the shop charges. On average, a worker makes ¥10 for an hour of foot massage, but does not get paid if there is no client. A foot massage worker earns approximately ¥1000 to ¥2000 a month.