PHNOM PENH, Cambodia — Last month, Thon Sophana was working on the factory line in Quint Major International factory (QMI) when she was suddenly gripped by an overwhelming sense of dread.

“I felt my hands and my legs become cold, and then I had difficulty breathing,” said the 35-year-old worker. “And then I collapsed.”

Sophana was one of 38 workers who lost consciousness at QMI on July 2, the third day in a week that the manufacturer had seen these mass faintings. But the QMI incident was not an isolated case; in that same week, a total of nearly 400 workers collapsed in four factories across Cambodia.

Mass faintings are a curious phenomenon that regularly plagues Cambodia’s $6 billion garment industry. Last year, the Ministry of Labor recorded that more than 1,800 workers collapsed in 24 factories. Labor activists believe the problem to be far greater, saying that while large numbers typically garner media — and government — attention, the frequency of afflicted workers collapsing in smaller groups is higher, but more difficult to quantify given the secrecy in many factories across the country.

At its height in 2011, the ministry recorded almost 2,000 worker faintings. While this number makes up a small percentage of the 350,000 workers employed by the industry at that time, the incidents garnered international attention, perhaps due to the perplexing circumstances.

Experts from the International Labor Organization concluded that the faintings were caused by a combination of reasons: namely poor nutrition, low ventilation and air circulation in factories, and mass psychogenic illness — more commonly referred to as mass hysteria — experienced by workers. In an effort to combat this, the ILO’s Better Factories Cambodia program, which monitors the country’s exporting factories for labor compliance, launched the “One Change Campaign” in 2012, encouraging factories to make changes, such as providing subsidized meals for workers, or organizing paid five-minute breaks. Major clothing brands, like H&M, Gap, and Levis, threw their support behind the campaign.

For the Garment Manufacturers Association in Cambodia’s part, deputy secretary-general Kaing Monika said that since the problem emerged in the 2011, they have been working with the Ministry of Labor’s National Social Security Fund.

“We have been going on a mass education campaign to educate workers on how to take care of their hygiene, and we also educate factories on how to improve the work environment, how to handle the chemical substances,” Monika said. “It’s about education to workers; it’s about stringently enforcing labor compliance.”

Union leaders and labor activists have long argued that raising the minimum wage would better solve this issue. In 2011, the minimum wage sat at $61 a month. If wages were higher, they argued, workers would be able to afford better quality food, and not feel pressured to work excessive overtime hours to increase their take-home salary, activists say.

With the wage recently raised to $128 at the end of 2014, Joel Preston, a consultant with Community Legal Education Center (CLEC) — a Cambodia-based organization that advocates for workers rights — said that the situation has only slightly improved.

He added that while the mass faintings attract media attention, CLEC is worried about individual workers losing consciousness in factories. During the first six months of this year, CLEC calculated that more than 900 workers — either individually or in a group — have fainted.

“That sort of goes to show that mass hysteria can’t really be blamed because you have people fainting just in one singular instance, and not everybody in the factory falling over,” Preston said.

But Sotheara Chhim, executive director of Transcultural Psychosocial Organization (TPO), which provides mental health care to locals, said that mass hysteria is a piece in the puzzle that should not be ignored. Eschewing the word “hysteria,” Chhim instead referred to it as a “conversion.”

“It refers to the escalation of anxiety that transforms into psychological or neurological symptoms and that could affect what we call voluntary, mobile and sensitive systems. So people can be affected by numbness and loss of sensations or it can be paralysis,” he said. “Usually this condition follows after events, after conflicts, or after a serious difficulty or hardship or problems in interpersonal relationships.”

For Sophana, the 35-year-old worker who fainted in QMI factory last month, she had been feeling an ever-increasing amount of stress at work recently. Three months ago, the factory started raising the target amount of clothing that workers had to produce, she said.

“I’ve been feeling a bit of pressure because they forced me to meet a new target. In one day, we need to do 400 pieces of clothing, which means that in one hour, we need to finish 40 articles,” she said, explaining that the target used to be 200 pieces a day.

High stress, low wages, and poor factory conditions are issues raised by unions in many garment-producing countries, yet the mass faintings seem specific to Cambodia. Chhim believes that this is due to how Cambodians interpret their surroundings, believing that spirits reside upon building structures or in natural elements. For workers who have traveled long distances to Phnom Penh, there is the belief that new environments are inhabited by different spirits, which means that protection is not guaranteed without offerings of some kind.

“People feel more secure when they are close to home….And then they come to Phnom Penh, where they live in different places, and there are different spirits,” Chhim said. “And people believe that they might be doing something…that upsets the spirit, and that could cause faintings or possessions.”

The most recent example of this occurred at around 3 p.m. on July 24 in Yu Fa factory, on the outskirts of Phnom Penh. Eighteen workers collapsed in unison at their workstations, but there was one woman who set it off, said Kim Khouch, a worker representative in the factory.

“One worker said that the spirit possessed her. She woke up and she said it needed food; it was hungry,” Khouch said. “And then she lost consciousness. Other workers saw that and they fainted as well.”

The workers were sent to a local clinic, and then home. But three days later, it happened again — 17 workers fainted this time. With workers terrified of spirits, factory management immediately arranged for a ceremony to provide offerings. Phoeng Kakada, a 27-year-old worker who was among those who passed out, blamed the faintings on the management.

“There is a new manager in the factory. The old managers always prayed to the spirits of the factory but this new manager never respected the spirits of the factory,” Kakada said. “He only offered fruit, but did not pray, and maybe that’s why it caused the anger in the spirits.”

This is not the first appearance of a spirit possession in the factory. Local media reported in 2012 that dozens of workers of Anful factory fainted after witnessing one of their coworkers falling into a trance, and then screaming for food and wine to appease the spirit within her. The faintings continued for days after, until the factory owner finally paid for a Buddhist ceremony.

While TPO’s Chhim agreed that some Cambodians are more inclined to subscribe to a cultural explanation instead of a scientific one, the solution to stopping these mass faintings would lie in actual changes within factories to de-escalate stressful situations, to provide workers with clean water, rest areas and to have more ventilation within the premises.

Cheav Bunrith, policy director of the ministry’s National Social Security Fund, reverted back to the argument that workers should take better care of themselves. He explained that because Cambodians often send home the bulk of their salary to their families in the provinces, they are skimping on the quality of their daily meals — eating the cheapest option available instead of the healthiest.

“What is the most important is that workers need to be concerned about their own health and take better care of it,” Bunrith said. “We need to base our investigations on the science of it, but we also need to take into account of our culture and what the workers feel.”

For Yu Fa factory worker Kakada, she recovered only after management held a ceremony offering two chickens and barbecued pork to the factory’s spirits. The next day, the factory owner invited five monks to bless workers.

“I got blessed with holy water by the monks on Wednesday, and I am fine now,” Kakada said. “I feel happier now and at peace, and I am glad to return to work.”

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