The pain would come, she knew. As sure as the turkeys coming down the line, about 30 each minute, ready to be gutted and clipped and de-boned and sliced.
Karina Zorita knew this, almost four years ago, as she considered a job at House of Raeford Farms, the poultry plant along the highway near her home in rural Eastern North Carolina.
It's dangerous, her friends warned. Too painful. Tus Manos.
She knew this. But she didn't know.
She couldn't know that in poultry plants across America, workers are imperiling their hands and wrists simply by coming to work each day. She couldn't know that injuries often come from doing the job as instructed, that doctors say the thousands of pulling and cutting and digging motions required daily at poultry plants can cause irreversible damage.
Like black lung in the coal industry and brown lung in textiles, the hands of the poultry industry suffer a long-neglected threat. Two decades ago, musculoskeletal disorders at poultry and meatpacking plants prompted a public outcry. Legislators and government officials vowed change.
Now, an Observer investigation shows, the hands of poultry workers are more threatened than ever.
America's growing demand for specialty cuts presents an ergonomic nightmare for workers. At the plants, regulatory inspections have decreased. On the line, the work force has become predominantly Latino, often illegal, more exploitable.
Observer reporters spoke to more than 130 workers who say they were injured on the job at 13 plants in the Carolinas and Georgia. About three-fourths complained of hand and wrist injuries.
"An epidemic," says Lance Compa, a Cornell instructor and Human Rights Watch author who in 2004 interviewed dozens of employees at U.S. poultry plants and remembers none who didn't suffer a work-related affliction. Most, he says, were in the hands and wrists.
"Inhumane," says Steve Striffler, a University of Arkansas anthropologist and author who spent two three-month stretches working in Tyson chicken plants this decade and remembers: "Anyone that I saw that worked anywhere on the line for six months definitely had a hand or wrist injury." Most of his co-workers, he says, were Latino.
"Once I shake their hands, I know what they do," says Pablo Forestier, a doctor at the Latin American Family Medical Clinic in Monroe, where he often sees workers from the nearby Tyson plant. Most, he says, begin to suffer after only two months of grabbing and cutting and squeezing. Few, however, complain about it at work, for fear they will lose their job.
Tyson spokesperson Gary Mickelson said the company requires all employees to report every work-related injury or illness, no matter how small, allowing the company to "dramatically reduce any potential severity." Industry officials say that poultry work is now a safer occupation, with more ergonomically designed workstations and tools -- and more machines replacing humans for tasks such as gutting birds.
"Workplace safety is a key objective and core value for all poultry processing companies..." said National Chicken Council spokesperson Richard Lobb, pointing to U.S. Labor Department surveys that show a steady decline since 2000 in reported poultry work injuries.
Critics say those numbers are misleading, that companies often ignore and underreport the injuries workers do complain about.
Karina Zorita knew none of these statistics. She was an illegal immigrant, 28 years old and single, a mother whose two young sons remained in Chilpancingo, Mexico.
She took the House of Raeford job, working as "Epenisa," the name on the fake ID card she purchased after she came to Raeford.
She said she made about $6.50 an hour, weighing turkey breasts.
More than a year later, she was moved to a different part of the line, where she pulled bones from cooked turkey with her fingers.
The pain came. She knew it would.
She just didn't know how devastating it would be.
A revolutionary product
America's best-selling meat comes in dozens of cuts and hundreds of further-processed forms, such as turkey hot dogs and chicken patties. It's a variety born of necessity, as historically thin profit margins have forced poultry producers to develop new products in their search for revenues.That strategy was accelerated a quarter century ago with the debut of chicken's most revolutionary product.
In 1983, McDonald's introduced nationwide the bite-sized chicken pieces that were kid friendly, car friendly and presumably a healthy alternative to burgers (consumers didn't know they were fried in beef fat). Within two years, McDonald's was the second-largest chicken seller in the country, behind Kentucky Fried Chicken.
The launch ignited consumer demand for a diversity of poultry products, a trend that continues today.
It has not been good news for poultry workers' hands.
Forty miles west of Columbia, in the off-the-interstate town of Newberry, a plain brick building houses the Emmanuel Family Clinic, where a sign above the front desk flashes: "Dios Le Ama!" God Loves You!
Inside, two doctors are asked how many poultry workers they've seen.
About 1,000 in the past seven years, says Dr. Jorge Garcia. About 100 in 18 months, says Dr. Franco Godoy. That works out to more than a dozen a month coming through the clinic, with shoulder injuries and burns and fractures and, all of them, with one ailment in common.
"I don't know a single worker who doesn't have some sort of pain in their hand," Garcia says.
The patients, most of whom are from Mexico and Guatemala, come to Emmanuel from the Louis Rich and Amick Farms plants nearby, but also all the way from House of Raeford in West Columbia. Why drive 40 miles to see a doctor? "Because we speak Spanish," Godoy says.
Officials at House of Raeford and Kraft Foods, parent of Louis Rich, said their poultry plants' injury rates are among the lowest in the industry. Amick Farm officials did not respond to questions from the Observer.
Says Garcia of his patients: "I get people who say, `Please don't tell them I went to my private doctor. If they find out, they will fire me.' "
It is this contradiction -- workers fretting about losing a harmful job -- that troubles the doctors on the fringe of the poultry business. For workers, the issue is often a simple equation: how much they can make versus how much they can bear.
That decision, doctors say, is usually made without important knowledge about a basic piece of equipment -- the hand.
Resilient and delicate
Given the workload it endures each day, the hand is among the most resilient parts of the body. It also is among the most intricate. "It's like a little Swiss watch," says Dr. James Boatright, an orthopedic specialist and surgeon in Charlotte. "It doesn't take much for it to break down."
That watch is powered primarily by nine muscles -- the extrinsics -- which at the wrist become nine slender but strong cords called tendons. These cords run along the palm area and through sheaths of tissue along the fingers, creating a pulley system that allows fingers to smoothly curl and straighten.
The largest of those sheaths is in the wrist, where all nine tendons are gathered around a nerve the size of a No. 2 pencil. The whole package, snug inside that sheath, is the carpal tunnel.
"The carpal tunnel is like a biscuit can," says Boatright. "If anything kinks it, or anything increases in volume, it puts pressure on the nerve. That's where the pain comes."
That pain can come from several sources, doctors say.
Arthritis. Family history. Poor work posture.
It also can come, they say, from frequent and repetitive motions, from squeezing shears or making multiple slices for each of the hundreds of birds that move down a poultry line every hour.
It can come from picking bones out of warm turkey breasts and thighs, in a cold room. That was the job Karina Zorita says she was assigned in mid-2006 at House of Raeford. She says her hands soon began to hurt, so she went to see the nurse, who sent her back to the line. There, she says, a supervisor told her that the door was open for her to leave.
House of Raeford officials said Zorita's account of events is "inaccurate" but declined to comment on Zorita's and many workers' specific allegations, saying that, without signed releases, it was unable to discuss the details of their health and employment histories.
By late 2006, Zorita says, she'd had enough. "There were times I cried on the line because my fingers were burning," she says. She went to a nearby clinic, where a doctor recommended rest and lighter duty. She remembers a supervisor saying no to her request for lighter duty.
Zorita took about three weeks off, two of them paid, she says.
She was making about $9 an hour.
She was sending $150 a week to her mother, for her children.
"I was worried they'd fire me," she says.
In early 2007, after returning to work, the pain took Zorita back to the clinic, she says. There, a doctor recommended that she see a specialist. When she called in to work, she says, she was fired for missing too much time.
She was 31. With no money, she was forced to live with friends, who looked at her shaking hands and said: "She needs real help." In March, the pain still intense, she went to another clinic in Maxton, closer to her friends' mobile home. She was diagnosed with "bilateral hand pain," doctor referral sheets show, and again told to see a specialist.
With no health insurance, she says, she couldn't afford to go.
Does she have carpal tunnel syndrome? She doesn't know, and Boat- right declined to speculate without examining her. But such symptoms might be easily explained, doctors say.
The large lump at the bottom of her palm? Consistent with tendinitis, in which the tendons become irritated, often with a new, repetitive activity.
The inability to straighten out her gnarled fingers? Consistent with "trigger finger," a condition in which a sheath at the base of the finger becomes too thick and constricting, inhibiting the tendon from sliding through, prompting a cycle of swelling until fingers become locked.
The inability to grab a spoon, a broom, a glass of water? Consistent with the later stages of carpal tunnel syndrome, in which the nerve deadens with the loss of blood flow.
Doctors say the key to treating the problem is detecting it before damage is done. "You'd like to treat people who need urgent care sooner," says Garcia.
Says Boatright on carpal tunnel syndrome: "If early on, you allow the blood to flow back to the nerve, it will recover. But the continuing pressure will deteriorate the nerve to a state of non-function."
Says Zorita: "Nothing hurt when I started working there."
And: "My children are still small. They still need me."
And: "My hands don't work anymore."
More speed, more injuries
By the end of the 1980s, reported injuries spiked at poultry plants.With the increase in chicken products and production had come a rise in poultry plant line speeds. Add in the varied cuts required for a growing number of specialty chicken products, and some workers were being called to do more than 20,000 repetitive hand movements per shift. In one 1990 study, the National Institute for Occupational Safety and Health found almost 40 percent of female workers at two N.C. Perdue plants suffered from symptoms of musculoskeletal disorders (MSDs).
In 2002, researchers from Duke University began visiting the same two plants, in Lewiston and Robersonville. As before, the researchers interviewed female workers, who made up most of the work force. The study, conducted over several years and released in 2007, showed that of the almost 300 workers interviewed, 43 percent reported symptoms of MSDs.
"We saw a prevalence of disease that looks exactly the way it looked 15 years ago," says Duke epidemiologist Hester Lipscomb.
Perdue officials dispute the study. "It flies in the face of everything I know to be true," says Roger Merrill, Perdue's chief medical officer. Merrill says Perdue hires workers with no histories of back or wrist problems for physically demanding jobs, then acclimates workers slowly and rotates them into different jobs to relieve stress. The result, the company says: The entire company had just 28 lost-time injuries in 2006.
Lipscomb and others suspect poultry employers, including Perdue, are underreporting injuries. Also, she says, workers told Duke researchers they were afraid to complain.
Industry critics say the lack of progress with hand injuries begins with the Occupational Safety and Health Administration, which struggled throughout the 1990s to issue tougher ergonomic standards in the face of political and business opposition. When those rules finally took effect in January 2001, they were erased two months later by President Bush and the Republican-led Congress.
Now, OSHA largely relies on voluntary adherence to ergonomics rules.
"It's basically an industry (OSHA has) chosen to ignore," Lipscomb says. "It frustrates the hell out of me."
`I can't do anything'
In spring 2007, with no job or health insurance, Karina Zorita took a bus from North Carolina toward the Mexican border. In three days she was home in Chilpancingo, with its small homes and dirt roads.
She lives with her mother and sons, now 9 and 8. The chickens in the yard supply their eggs and meat. She relies on her mother to kill the birds.
Her hands, she says, are the same -- always trembling, always hurting. She struggles to lift herself out of bed, to wash herself.
"I can't do anything," she says over the phone.
She is unhappy to be home, where she cannot work or support her family. She would like to return to the United States, but she knows she could not work there, either.
She says she wishes she never worked at the poultry plant.
She says her friends warned her.
What would she say if a friend came to her? Would she recommend that job?
Yes, she says.
"People need work," she says. "It's the only job there is."
THE CRUELEST CUTS The Human Cost of Bringing Poultry to Your Table