The Fişek Model is a resultant of dreams and a way of life. The entire model, the information and accumulated experience of the Fişek Institute is composed of both the dreamsand hard work of many deeply committed volunteers.
This conglomeration of knowledge, experience and dreams focuses onthese issues:
1. Improvement of working and living conditions of workers
2. Protection of the children who particularly start working at very early ages.
3. Intervention of women’s social problems early on in their development and workinglives.
Research demonstrates, it is possible to prevent occupational healthhazards for workers (including child and young workers). To attain this goal; the Fişek Institute establishes health units in Workers’Schools (i.e. Apprenticeship Education Centers) that are the frequented places for manychildren and young workers, and gives free health examinations at the jobsites with itsmobile clinic (a health caravan). The Institute’s education programs about’occupational health and safety’ for the jobsites and Workers’ Schools have beenpreventing many diseases and accidents while raising consciousness for the future. Suchactivities of the Institute are supported by the fees from employers in return for theservices given to adult workers, money from occupational safety education for the tradeunions, income from subscriptions to our bi-monthly periodical (Çalışma Ortamı – Working Environment), sale of postcards,handmade crafts and other items at fairs or bazaars, grants and donations to the’Science & Action Foundation for Child Labor’ (a branch of Fişek Institute).
The living conditions of children and adult workers have many things incommon. Currently, a level of income sufficient to make a living in human standards and asocial security system that should protect them against risks are nonexistent for bothchild workers and adults. In addition, there lacks widespread and sufficient professionaleducation programs with job security and youth centers for leisure time activities. As forthe working conditions, things are similar for all workers as well. Pre-employment medicalexams and periodical health checks are offered on a limited basis for adults while almostnone are given to children. When exams are given, they are formed without taking intoconsideration the specific occupation of the workers. As for the environmentalmeasurements, they are not done regularly. In order to improve health and safety servicesat work, consultation services must be benefited from, necessary records must beregistered, statistical data must be collected and unfortunately, these practices arerelatively nonexistent. On the other hand, effectiveness of the labor (occupational healthand safety) inspectors who oversee the laws is quite limited. Personal protectiveequipment is manufactured for adult workers, however, the supply of these protectives isinsufficient and there are generally none for working children. If we take intoconsideration all of the above, it follows logically that improving children’s livingand working conditions would improve adult workers’ lives as well. For example, safetymeasures at the jobsite would benefit both child and adult workers. Periodical healthchecks for child workers motivates future employees and employers to be more consciousabout the subject. At jobsites where child workers receive health services, adult workerssoon become aware of the necessity of health measures and request similar benefits.Realizing all these facts, Fişek Institute has beendeveloping a model aimed at not only working children, but adult workers as well.
The Fişek Institute bases itsactions on international human rights documents. These documents include the belief thatthe entrance of a child to the labor market at an early age is contrary to human rights.For children have the right to live out their childhood and a child’s right to aneducation is also guaranteed by many international documents. However, children that startto work at early ages have to perform the role of adults and when they are very young;they have no opportunity to be normal children. They are unable to be mischievous ornaughty, to be spoilt, to play games and to become friends with school children of thesame age. Long hours of work exhaust them and doesn’t allow them a place to think or toparticipate in age-appropriate developmental activities. In addition, discontinuingtraditional education at very early ages promotes skill-education rather thanprofession-education.
Jobsites employing children are generally in relatively worseconditions than the ones not employing children. These conditions increase the risk ofoccupational accidents and diseases for children. Often, families of these children areindifferent to or unable to intervene due to lack of knowledge concerning the problemsrelated to working conditions (for example, these children may be exposed to bad treatmentor harassment of the elders as well as heavy and hazardous work) We should bear in mindthat factors forcing children to work at early ages in our country are often related tosurvival as the social security system is very insufficient. Therefore, it is impossibleto eliminate child labor without instigating a successful fight against poverty.
In spite of all this, child labor is a social fact. It is obvious thatit will take time for a fight against poverty program to succeed. For this reason, shortterm programs in which social measures are given priority must be implemented. Toimplement such programs is a ‘loyalty debt’ of society, for, children entering theworkforce at early ages contribute to the national income while other children at the sameage benefit from public funds during their education.
Therefore, it is obvious that the problems of working children shouldbe lightened and a close protection should be developed for them in addition to the longterm social policy measures. The Fişek Institute’sproposal is to spread the ‘Fişek Model’ that hasbeen experienced since 1982 and gained the support of International Labor Organizationafter 1992. The Fişek Institute is offering a modelin line with the principles of community medicine with its 16 year experience (taking intoconsideration its preparation period) in the subject.
One characteristic of the FişekModel is to take a ‘common health unit among small enterprises’ as a starting point inTurkey; it is a requirement for the jobsites employing 50 or more workers to employ anoccupational physician and occupational nurse although such a ‘must’ does not existfor smaller firms. However, those employing child workers are generally small enterprises.Nevertheless, these enterprises still have a legal obligation to make periodical healthchecks for workers employed. The Fişek Institute hasrealized common health units for small jobsites using that obligation as a motivatingfactor. The participation of jobsites in these units occurs not as a result of a’must’ but rather by choice.
Small jobsites are dispersed in the industrial region and this causestransportation difficulties to the common units (thus, to work losses). Therefore, Fişek Institute implements a dual practice: on the one hand,a center – named Industrial Health Center – where first aid, and necessary healthexaminations and communication etc. are carried out; on the other hand, Mobile Clinic(mobile unit) that visits workplaces. In addition to these two units where we are able toreach working children, a health center in a Workers’ School in an industrial region hasbeen established. School health practices have also been developed there. As well as this,sports education-medicine activities have also been started due to the Project for WorkingChildren to Regain his/her Identity.
Our field studies have demonstrated that ‘Workers’ Schools’ havesocial places in school-health practices. Working children as a category fall under thescope of three branches: school medicine, occupational medicine, sportseducation-medicine.
The Fişek Model has introducedsome ‘firsts’ for Turkey in addition to some original contributions for the world. Forexample, inclusive research on working children was done by our Institute (1984-1986). Infact, one of the first initiatives of Fişek’s wasin gathering small jobsites around one focus for the purpose of health service (1982).Today, Fişek Institute serves 400 small scalejobsites in Ankara (city)-Ostim (industrial region), 40 inAnkara-Sincan, 140 in İstanbul and 45 in Denizli. The Institute’s practicecenters serve without any delay, with a regular service chain. They are continuouslydeveloping. However, all of these centers implicate different qualities. For exampleAnkara-Ostim is the first practice center and carries out intensive jobsite relations and services. Since 1994, İstanbul-Yenibosna hasstarted to implement SSK service (Social Security Association’s health service forworkers) and has increased its health unit services in the industry at a substantial rate-while in Denizli, practices oriented to working girls are more intense. All of theseservices are given by visiting the jobsites one by one and constituting relationships withthe individuals involved.
The Fişek Institute is anon-governmental organization that has a social mission with a high participation ofvolunteers in its actions and a wholehearted adoption and support of the services by thetargeted population.
The Fişek Model contributes muchto the experience of non-governmental organizations and has led to new experiences.Increased awareness of human rights by concrete practices and adoption of the achievementsnaturally by the workers constitute a new perspective.
Beyond anything else, the FişekInstitute’s practice centers in three cities developed by the support of InternationalLabor Organization/International Programme on the Elimination of Child Labor (ILO/IPEC)proved that a ‘dream’ may become reality. That this occurred in cities under verydifferent conditions demonstrates a longing for ‘useful and good practices’. Ones whoshare this evaluation are not only those benefiting from services. Our practical studieswere displayed as one of the ‘Best Practice’ for the United Nations by the TurkishRepublic Prime Ministry Planned Community Administration Presidency HABITAT IICoordination Unit. There were only eight examples from Turkey in this exhibition.
The differing characteristics of the FişekModel in comparison to others are stated below:
- Emphasis on children and youth: Until recently, there was no special emphasis on children and youth in occupational medicine studies and in occupational health and safety services. However, children and youth constitutes a social risk group that should be studied seriously. They are a sensitive group and their future roles in our society will be important. The most concrete example of special emphasis for children and youth is the activities carried out in the Workers’ Schools and the mobile clinic services for small scale jobsites. The Fişek Institute gives free health service to those under fifteen.
- Emphasis on woman identity: The most important problem of working girls is the conditioning of removal from the laborforce following marriage that they receive since birth. This hinders them from having an occupational education and developing a professional career. Generally, due to the economic condition, she has to reenter the laborforce after her marriage and having children, although as cheap and unqualified labor. In our Denizli practice center, our projects are attempting to develop the working girls’ own self-identity and continue their professional development.
- Emphasis on occupational health and safety: Health is an indispensable part of production. Occupational health and safety activities that constitute the fundamental part of our model should be considered in a multi-science axis. It is impossible to examine the subject by separating the medicine, engineering and social dimensions from each other. Studies in occupational health and safety afford the possibility of finding out possible hazards in the jobsite and early diagnosis for the workers exposed to those hazards. However, this is still the beginning of the process. What is to be done afterwards is to determine the measures to be taken at the jobsite and to observe them insistently. The most important assisting factor in this in the Fişek Model is the practice of the Exhibitionhouse. The environment, where measures for occupational health and safety (measures against fire, machine protectives, mobile working planes, first aid studies etc.) and personal protective equipment is displayed, at the same time serves as a place for educating employees and employers.
- Emphasis on social dimension: In our approach, health is not regarded as being only physically and mentally fit and the working environment is not considered with regards to being only physically healthy. Lots of issues are emphasized from working hours to yearly paid vacations; from shelter conditions to leisure time activities; from examination of working girls’ social problems to evaluation of their social status and identity formation… The Fişek Institute is not contented with only improving the working environment; it tries to evaluate and develop the workers within their living conditions.
- Continuous action and social participation: One of the most important characteristics of the experiences of the model is being in a continuous action (dynamism). This action oriented by social requirements gives the possibility of renewal of the model (vertical development). Three means are benefited to watch closely the social requirements and to adopt itself.
5.1. Social participation: Continuing communication with children,workers, employers of the jobsites where the model is implemented and sensitivity to theirproposals increase the society’s interest and contribution to the studies of the model.However, tests of ways to increase this participation are still continuing. On the otherhand, the most powerful weapon against possible non-communication and insensitivity ofimplementers (i.e. personnel of the Institute) is the possibility of employers and tradeunions ceasing from buying the services.
5.2. Initiative to the Institute personnel: The Fişek Model aims to make good use of the experiences of theInstitute’s personnel. Their past and current information and experience accumulation isbeing translated into practice quickly; restrictions are being avoided. At the same time,newnesses and contributions are being encouraged. It is also seen as a positive experiencewhere the personnel may develop their professional identities and strengthen their tieswith their professional organization.
5.3. Organization of volunteer and expert participation: Volunteerparticipation in the Readers’ Seminars once every two months organized by theInstitute’s bi-monthly periodical Working Environment (ÇalışmaOrtamı) plays an important role in its structurebased on collective work and discussion. These seminars are an action of communitymedicine and have widespread participation throughout the country. They have been gainingmany of the characteristics of a school over time.
- Employers’ Participation in Overcoming Financial Difficulties: The most important obstacle of a model study is the probability of its not lasting long enough. This is common for many studies maintained through outside financial support. If funds are withheld, it is a large source of injustice and hopelessness for the ones served. Because of that, the impression of non-sustainability of good practices in our country is held. However, there is also disappointment for the implementers who originally felt enthusiastic. Moreover, temporary practices generally contend with unstable personnel. However in the Fişek Model, financial means are created by the employers who maintain the responsibility to have a safe jobsite. Today, the Fişek Model is in a position to stand on its own without any other financial support.
- Widespread practice and organization of the Fişek Model with one focus: Becoming more widespread throughout the country (horizontal development) requires the practice centers to increase, to organize around one focus and to be in solidarity. In that focus; new information and experiences should be acquired and documented. Projects should be both supported and produced and the Institute personnel should have continuous education. This structure should have the identity of science (and action) gradually. Being so widespread is also useful as it causes the equipment (health equipment etc.) and risks to be shared. From this point, the central focus serves as a supporting service unit, as well.
It would be better to view the Model as a modular structure that isdeveloped so as to find a group solution by the FişekInstitute to the occupational health and safety problems of small scale jobsites. As forthe modules to be repeated in different environments and under different conditions, theevidence would be seen in its general validity. Every module (service supply to thegrouped jobsites) is a part of a whole. A focus constituted by the integration of modulesand structuring at the country level may be discussed.
The Fişek Institute’s aim is atorganizing the modular structures only up to a focus level as it is a non-governmentalorganization. With its 16 years of experience, it has proved that various socialpossibilities with employer contributions as the primary sustenance might be mobilized forsuch an aim. The system has supplied its sustainability and renewed itself continuously.However, its scale is limited. The Fişek Institutebelieves it would be only possible with a social state’s interest and encouragement tomake a central organization of focuses similar to a honeycomb.
Nevertheless, the focus required by the modular study is a structurethat Fişek Institute keenly insists on. It describesthis focus as a ‘science and action center’ and attributes various functions such asstandardizing the module study, making it more effective, giving financial support whennecessary, supervising at the principal level etc.
Dreams and efforts are combined to develop the ‘module’s and the’focus’ of mutual influence.
Expectations from the focus:
- To remove the communication and coordination insufficiencies
- To watch closely the units with regard to service quality and technical human force
- To implement projects that would develop the practices of units and to find institutions to sponsor these projects if possible
- To develop activities that present the Institute and its actions in the best possible way
- Constituting a library, preparing reference books, making research and implementing long-term education programs
Expectations from the Modules:
- To ensure the modules’ self-sufficiency and self-functioning in order to have enough power to transfer resources so as for the focus to successfully function
- To detect new attitudes and characteristics of the served employees. These differences may vary throughout the sectors of workforce and with regard to gender or cultural differences that the service is given to.
- To establish good relations with the employers and employees and to gain respect from both camps. So that the modules would become essential structures and society would continue services and seek out suggestions and advice. Yet, the module would remain separate and independent of employers and employees both.
- To collect and document data about the facts either social or regarding health.
We may summarize the originalities of the Fişek Model as stated below:
- It adopts the community medicine approach; it gives emphasize to preventive medicine and it recognizes the individual within his/her social environment (See the table at the end of this section so as to compare the community medicine approach and the Fişek Institute’s approach)
- Its basic target is working children and youth. It gives a special importance to the working girls.
- It focuses on occupational health and safety.
- Its main financial resource is the payments of small industry employers in return for services given.
- It has a modular structure organized around one focus.
- It has proved its sustainability.
- It connects development (renewability) to participation.
- Means used in supplying services are such:
- Mobile Clinic
- School Health Unit in the Workers’ Schools
- Health Center in Industry
- Exhibitionhouse
- The services stated above are given by an organization independent from the government and other special interest groups.
- It has an academic , ethical and artistic care.
- It has been implementing what is original and challenging.
Steps followed by FİŞEK MODELpractice:
- Health Center in Industry
- Service to the small jobsites by ‘Mobile Clinic’
- School health service in Workers’ School
- Enrichment of service with regard to equipment
- Environmental measurement and service of evaluation of jobsite environment
- Enrichment of the team of professionals
- ‘Health Friend’ service (improvement of service in regard to curing patients and health consultation)
- ‘Occupational Health and Safety Exhibitionhouse’ work
- Improvement of ‘Occupational Safety Service’
- Campaigns:
- DO NOT START SMOKING
- CHILD IDENTITY
- WOMAN IDENTITY AND DEVELOPING WOMAN ENTERPRISE
- ‘Information Documentation Center’ i.e. ‘Science Center for Child Labor’ and Researches About Working Children:
- Health and Social Problems of Children
- Hazardous Jobs and Conditions for Children
- Effects of Chemicals on Child Development
- Child Labor and Population Policies
- Institutional Relations and Common Studies
SIMILARITIES AND DIFFERENCES BETWEEN COMMUNITY MEDICINE APPROACH AND FİŞEK MODEL
| Aspects | Community Medicine Approach | MODEL |
| Served | Health service during times of both health and illness | SAME |
| Contents of service | Prevention, curement and rehabilitation | SAME |
| Evaluation of the served | A person constitutes a whole with his/her physical, biological and social environment. He/she cannot be isolated from them | SAME |
| Reasons of diseases | Biological and social reasons | SAME |
| Exploration and curement service | Using specially trained health personnel except from physicians in widespread and deathly diseases if necessary | SAME |
| Supplying service | Providing health service for all | SAME (Providing health service to the person by the Mobile Clinic and School Health Units) |
| Prevention from diseases | Given priority | GIVEN PRIORITY (Effort for prevention of occupational accidents and diseases by improving working environment and developing living conditions) |
| Priority in financement | Prevention and curement of diseases being most widespread, killing or disabling many people are primarily fed by the limited resources | Working children and women being under a bigger risk are primarily fed by the limited resources |
| Social concept and planning | Objectively observing the community’s health problems and development of the services in the framework of a plan that is a part of the socio-economic development by relying on the observations | SAME |
| Organization | A teamwork at the national level supported and completed by small teams composed of various professionals in coordination | SAME |