Silicosis: losing lives to keep up with construction

Silicosis has the potential to destroy communities due to its very localised effects based on the surrounding industry. The Madarangajodi village in Keonjhar district is a prime example of this. The most common occupation in the village is mining. This has led to a disproportionate number of deaths due to silicosis and resulted in the village being known locally as the “village of widows”.

India’s construction industry is booming. This is, in no small part, due to the need to keep up with the nation’s rapidly expanding population and a growing trend of urbanisation. However, beneath the surface, many are losing their lives to this process.

The human cost of keeping up with the demand for construction materials is being observed in the multiplying deaths of those employed in the industry. Ever increasing numbers of stone quarries are being created in mineral-rich states like Madhya Pradesh. It is the poor that are often forced to work in the mines and quarries despite the dangerous nature of these professions, simply out of necessity. There are immediate risks such as cave-ins and accidents that may injure, maim, or outright kill workers. However, there are also long-term illnesses that effectively create a situation where workers are trading years of their lives for a steady income.

Silicosis is one of the most prominent of these illnesses. There is currently no known cure. Among workers employed at quarries and mines across the country, 230,000 people are estimated to be at risk of contracting silicosis, according to the Directorate General of Mines Safety.

The cause of the disease

Silicosis is caused by exposure to respirable crystalline silica (RCS), found within stone and rocks and distributed into the air by processing or mining of the materials. Consistent exposure to RCS can cause fibrosis, this is developed when small particles are ingested into the lungs, causing scarring and hardening of lung tissue.

This scarring is irreversible, as more and more lung tissue is damaged, lung function can become severely impaired. The condition can lead to an inability to perform simple functions due to breathlessness, and even lead to premature death through heart failure. Exposure to RCS is also considered a risk factor for developing chronic obstructive pulmonary disease (COPD) – one of India’s deadliest noncommunicable diseases (NCDs).

Rapid exposure to large volumes of RCS can cause acute silicosis. This condition is rare, as it involves the inhalation of a significant amount of silica. Nonetheless, it can be life threatening. Those working in quarries and mines are far more at risk of acute silicosis due to the constant potential for high levels of inhalation. Long-term exposure to silica has also been suggested to be a risk factor for developing lung cancer.

Misdiagnosis of silicosis is a common issue. The disease is often mistaken for tuberculosis. Dr Habibullah Saiyed, former director of the National Institute of Occupational Health, said most doctors do not take into account the occupational history of a patient. This is a vital aspect of identifying silicosis.

Is enough being done to protect workers?

Media outlets such as Newsclick go as far as to suggest state governments are shirking their responsibilities to the workers of mines and quarries by overlooking the potential for the development of silicosis and allowing its misdiagnosis as TB.

“You can claim compensation from your employer if you are diagnosed with silicosis. But there is a legal process to fulfill, and in such cases the doctors could be called into court to give evidence,” says Environics Trust’s occupational health expert Mohit Gupta. “So it’s far more convenient for the doctor to put the patient on a tuberculosis course and the patient won’t return for another six months.”

Gupta said there is no trained and experienced doctor at the Panna district hospital (an area where the Environics Trust identified high numbers of silicosis patients) who can read X-ray plates and connect them to other symptoms to make a correct diagnosis. “It’s very difficult for a doctor to pick up on silicosis by looking at the X-ray result of a patient as it looks very similar to that of a tuberculosis patient.”

An unresolved situation

Last year the Mine Labourers Protection Campaign partnered with a number of Indian medical institutions, including the All India Institute of Medical Sciences (AIIMS), to arrange a conference to address the situation. It would appear little has been done since this conference.

Regulations are necessary to ensure that workers are provided with the correct safety gear such as breathing apparatus to reduce the exposure to the dusts that cause silicosis. Measures must also be put in place to allow for the use of occupational history in medical diagnosis to allow doctors a means to more easily diagnose silicosis and differentiate it from potential cases of TB.