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The dust that kills

By Jagdish Patel

The longest word in the English language is the full form of silicosis. No one knows it, just as no one knows that 10 million workers in India are at risk of silicosis, a fatal disease often mistaken for tuberculosis. Some industries, like the slate pencil industry in Mandsaur, report a 59% prevalence of silicosis. One village in Andhra Pradesh is even known as Widow's Village because most of the men in the village were stonecrushers who died of silicosis

Dust may seem inconsequential, but it can -- and does -- kill. Dust is a serious occupational hazard and a major cause of occupational disease and work-induced mortality. Workplace dust often contains toxic elements. Respiratory illness among workers in the stone crushing industry is a significant problem all over the world. It's estimated that 1 million people worldwide die annually from respiratory illnesses; 1.7 million are affected in India alone. Billions of rupees are spent annually on their treatment (1).

At least 100,000 workers are reported to have died due to exposure to asbestos, according to the International Labour Organisation. Workers at the Sheffield factory in England, who were exposed to iron dust whilst sharpening knives and scissors, were known to die at a very young age, of siderosis, a lung disease caused by iron dust. Coal miners exposed to coal dust suffer coal miners' pneumoconiosis, while workers exposed to cotton, jute or hemp dust could get byssinosis.

Workers engaged in various different industrial operations are exposed to dust: size reduction, surface cleaning (grinding, buffing, fettling), materials cleaning (like cotton cleaning, using combing machines), cutting, mixing, spraying/sprinkling, packing, materials handling (charging, downloading/dumping), housekeeping (road cleaning, etc), repair and maintenance, drilling, etc.

Crystalline silica, asbestos, soft coal, metal dust and other materials have a fibrogenic effect on the lungs. They also irritate the eyes and respiratory tract, causing reddening, swelling, itching, watering, sneezing, coughing and throat irritation. Dust of vegetable or animal origin can cause bronchial asthma or alveolitis; they include flour, pollen, animal hair, feathers, mould, fungus and insects. Bakers, farmers, librarians, bird breeders, zoo workers and others are particularly at risk.

Prevalence of silicosis

One of the oldest known occupational diseases, silicosis is caused by the inhalation of silica dust. The full name of the illness is 45 letters long (the longest word in the English language) --pneumonoultramicroscopicsilicovolcanokoniosis (2).

Workers in stone crushing, construction, stone quarries, ceramics, glass (all sorts of glass, including electrical lamps, tubes used for TVs and computer screens, glass linings of vessels, etc), foundries, slate pencils, agate polishing, all mining, manufacture of silicates, abrasives and refractory bricks, specific types of cement, boiler cleaning, kaolin, soapstone, granite processing, talc, emery stone, etc, face the risk of silicosis, possibly the deadliest of the dust-induced occupational diseases.

Since silica is abundant in the earth's crust, many occupations pose the threat of silica dust inhalation. Exposure to silica dust could lead to different respiratory ailments including silicosis, lung cancer, chronic obstructive lung disease (COPD), bronchitis and emphysema. Pulmonary TB and airway diseases are also believed to be associated with silica exposure, as also auto-immune disorders and chronic renal disease (2).

Although silicosis is fatal and has no cure, it can be prevented if the inhalation of silica dust is minimised. Silica dust of two to five micron size, when inhaled, travels up to the alveoli of the lungs. Sizes larger than this are filtered through the nose or thrown out by cilia in the windpipe. Though highly toxic, silica dust has no smell and offers no warning to the worker. Dust levels can be reduced through engineering controls and good maintenance of the system. The Factories Act has a provision for maintenance of dust levels at work. But many workplaces are not covered by the Act.

In China, 500,000 cases of silicosis were reported between 1991 and 1995. In Korea and China, tatami (a carpet woven from tatami grass) workers are reported to have contracted silicosis. In Brazil, workers engaged in digging wells have reported a 26% prevalence of silicosis. It is estimated that in India 10 million workers are at risk of the disease (3).

Silicosis in India

In India, silicosis was first diagnosed among Kolar gold mine workers in Karnataka in 1948. Later it was reported in mica miners in Bihar.

Every state in India has reported cases of silicosis. Guntur, in Andhra Pradesh supports thousands of stone crushing units spread across the city. Workers from these units are frequently seen in the pulmonary section of hospitals; they reportedly occupy around 60% of beds here (1).

In Bahargaon village in Pakur district, West Bengal (the country's single largest producer and supplier of granite ballast to Bangladesh), every second labourer working in the stone crushing factories suffers from silicosis or tuberculosis. Bahargaon and adjoining areas host 500 such units that employ nearly 37,500 people.

The slate pencil industry in Mandsaur in Madhya Pradesh reports a huge 59% prevalence of silicosis. One village in Andhra Pradesh is even known as Mundaralla Thanda (Widows' Village) because most of the men in the village have died of silicosis contracted whilst working in stone crushing units.

Godhra is a small town in Gujarat that shot to prominence in 2002 when a railway coach caught fire, killing 59. The incident sparked communal violence all over the state. But few know that Godhra is also a death trap for many tribals as it supports as many as 15 stone crushing units. Alarmed at the amount of dust the units generate, the Gujarat Industrial Development Corporation asked the National Institute of Occupational Health (NIOH) to conduct a study.

The study revealed extremely high levels of silica dust in the workplace. It noted that dust levels were so high that just six months of exposure could cause silicosis. Indeed, hundreds of tribal workers from Gujarat, Rajasthan and Madhya Pradesh have died here in the last 20 years.

A 2006 survey carried out by Khedut Mazdoor Chetna Sangath, a local union of peasants and workers, with assistance from Shilpi Kendra, an Indore-based NGO that works with public health, found that 21 people had died in Malvai village (Shilpi Kendra 2007). By May this year, another 12 had died. Of the 23 families whose members worked in stone crushing units in Gujarat, only four adults survive (5).

And they are a sad sight. Ramla Thavaria, who looks like a stick figure in a Warli painting gone wrong, lies on a charpai outside his hut. He used to work in Jyoti Minerals, Balasinor, three years ago, with a team of 14 labourers recruited by Dursingh, a mukadam (leader) who was also a relative. Dursingh is now dead, another victim of silicosis. For Rs 50 a day, Ramla fed the crusher with quartz rocks and bagged the silica powder that was produced. The work was strenuous. In the course of their work, Ramla and his fellow workers inhaled huge quantities of the fine silica dust that swirled around them like a fog. After four months of work in the lean summer season, Ramla returned to his home in Malvai. Within a year he fell ill, coughing and wheezing and slowly losing strength in his limbs. Silica choked his lungs, scarring the tissue and impairing oxygen uptake. His muscles simply melted away. Now Ramla cannot work at all and is confined to his bed, confronting imminent death and worrying about how to feed his six children (5).

It is much the same story in Chitrodiya, in Gujarat's Dahod district. Shailesh Soka Damor died on April 22, 2007, at the young age of 19. His sister-in-law Sumitra also died young, in 2005, leaving behind a one-year-old child. Shailesh's brother (Sumitra's husband) Subhash is now sick. He cannot earn anymore and his old mother has to work in the fields to support them.

Suresh Jokha, from the same village, died on July 10, 2005. His father died on the 16th of the same month.

All of them are suspected to have died of silicosis. In fact, since 2005, at least 15 people from Chitrodiya have succumbed to silicosis.

Shakarpur is 200 km away from Dahod. In October 2007, Pratap Gohil, an agate polisher, died in a hospital in Khambhat (the nearest town). Even as his body was being brought back to the village, wails were heard from another house. They were told that Kantibhai, another agate polisher, had also succumbed.

A couple of weeks later, on October 15, two more agate workers died -- Bhikhaji Vankar and Raman Vaghela. In 2007, the death toll in this village was 19; in 2008, 20 polishers died. People in this small village have been acquainted with silicosis for the past 60 years.

In Ahmedabad, in 2001, I met a man at the ESIC (Employees State Insurance Corporation) special medical board. He was accompanying his widowed sister-in-law who was meeting with the medical board in connection with a compensation claim for her dead husband. He told me he knew six workers, all of them young, who had recently died. They all worked in a foundry in Junagadh as sand blasters.

Sand blasting has been banned under the Gujarat Factory Rules since 1974. When I visited Junagadh later, I came across six workers with silicosis working alongside their colleagues.

Stigma and discrimination

Stigma and discrimination associated with HIV/AIDS is well known. But silicosis carries its own stigma. Workers and members of the community, including doctors, label the disease TB since the symptoms are similar. It is in fact common for a silicosis patient to also contract TB. And since TB is infectious, the patient is often isolated from his own family.

Many young people in the agate industry do not find brides as their occupation is known to kill at a young age. In tribal areas of Gujarat, once a man dies of silicosis, his widow is thrown out of the house. Hundreds of widows have been forced to return to their parents. In the agate industry, if a man dies of silicosis, his wife has to continue working on the wheel, shaping the stones and doing the same work that killed her husband. Not only to fill her stomach but also to repay advances taken by her husband from the employer. In Dahod district, tribals have sold their ornaments, cattle and land to get treatment for silicosis. Hundreds of people are in deep debt.

Orphaned children and single parents are a common feature in the tribal district of Alirajpur in Madhya Pradesh, and Anand and Dahod in Gujarat. Young widows are exploited and sexually abused by male members of society. They are also socially boycotted and disowned by their in-laws; they cannot inherit family wealth like land or a house.

Compensation and the law

Silicosis is a compensable disease under the Employees State Insurance (ESI) Act and the Workmen's Compensation Act. Workers at Alembic Glass in Baroda used to regularly succumb to what was then assumed to be tuberculosis. They never knew the real cause of their illness, nor were they aware of their rights. Then, in 1980, silicosis was diagnosed and also their rights under the Employees State Insurance Act.

Although the NIOH conducted medical check-ups, few workers could claim compensation under the ESI Act. Workers who were diagnosed with silicosis but were categorised as having 0% disability challenged the decision of the ESIC medical board in the courts. The battle dragged on for over 17 years. Ultimately, the Gujarat High Court passed a judgment ordering the ESIC to pay compensation to all the workers, at the 100% disability rate.

Many affected workers still did not receive compensation. Either they did not possess identity cards or a job history, or were not diagnosed as suffering from silicosis. Many were not aware of the legal provisions or procedure. Or they had no access to legal services or the monetary support required to fight a legal battle.

International response

The ILO/WHO Global Programme for the Elimination of Silicosis (GPES) was established following recommendations in 1995. The joint ILO/WHO committee on occupational health identified the global elimination of silicosis as a priority area for action, obliging countries to place it high on their agendas. India has its own national programme for the elimination of silicosis.

GPES initially focused on secondary prevention, upgrading the skills of physicians and strengthening the system of health surveillance. A silica essential toolkit has been developed, applying the principles of control banding.

Control banding is a risk assessment and management tool used where there is no technical expert, or quantitative exposure data is unavailable. It comprises step-by-step administrative actions to be taken by the employer to eliminate or reduce hazards in the workplace. Employers can be guided on what measures to take to control dust, for instance.

Although a national programme for the elimination of silicosis in India may be in place, the effects are not being seen on the ground. Mortality and morbidity rates are not going down. And the government does not even have figures to compare any progress that could be taking place.

(Jagdish Patel, an occupational safety and health (OSH) activist, worked for 20 years in small and medium-scale chemical factories. He got involved in the trade union movement and as part of the movement helped establish VSS Mandal -- a pressure group on OSH -- and later Peoples' Training and Research Centre. He has been editing a Gujarati bi-monthly on OSH since 1988. He now works full-time for PTRC)

References

  1. G Venu Gopala Reddy et al. Bombay Hospital journal (website details not available; hard copy in author's collection)
  2. 'The ILO/WHO Global Programme for the Elimination of Silicosis (GPES)', Igor Fedotov et al. The Global OH Network, p 1, Issue No 12, 2007 (www.who.int/occupational_health)
  3. 'Elimination of Silicosis in the Americas', Ellen Galloway, The Global OH Network, p 10, Issue No 12, 2007 (www.who.int/occupational_health)
  4. 'Silica related diseases: It's not just silicosis', Faye Rice. The Global OH Network, p 6, Issue No 12, 2007 (www.who.int/occupational_health)
  5. 'Contract Killings: Silicosis among adivasi migrant workers', Amita Baviskar, EPW, Vol 43, Issue No 25, pp 8-10 (www.indiaenvironmentportal.org.in/files/3_14.pdf)

InfoChange News & Features, April 2009