|Year : 2019 | Volume
| Issue : 4 | Page : 347-351
Rehabilitation of silicosis victims of district Karauli, Rajasthan, India
Department of Health Education and Health Promotion, Faculty of Public Health and Health Informatics, Umm Al Qura University, Makkah, Saudi Arabia
|Date of Submission||28-Jan-2019|
|Date of Acceptance||26-Aug-2019|
|Date of Web Publication||12-Nov-2019|
Dr. Shamim Mohammad
Department of Health Education and Health Promotion, Faculty of Public Health and Health Informatics, Umm Al-Qura University, Makkah Al Mukarrmah 24242
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: This study was carried out to assess the reach of medico-social and economic programs to the silicosis victims in Karauli. The district is infamous for large-scale unregulated sandstone mining, a pulmonary hazard, causing silicosis, a debilitating occupational disease compensable under Indian laws. Methodology: A sample of 250 silicosis cases from 38 villages were randomly recruited and interviewed from four different sites. Results: The study reports that 99% of sandstone miners came from marginalized poor communities, had large families, and lived in mud houses. Victims' linkage to their entitlements and welfare programs was poor (51%). Victims (43%) continue to work as casual laborers including in mining sector due to economic compulsions. Greater than 68% of the laborers were wrongly treated for tuberculosis (TB) prior to their diagnosis, >50% go out of the state or cities for better treatment, and 60% of cases had not received their compensation from the government. Among those who received compensation, only 4% spent money for productive purposes and 44% victims were not in a position to work due to health difficulties. Conclusions: Silicosis has affected the poorest of the poor; victims are wrongly diagnosed and treated for TB. The district is not equipped to deal with the health problems of the victims, forcing them to seek treatment in other states and cities. In conclusion, the impact of rehabilitation programs in the district is ineffective and inadequate and has limited reach. Findings of the study will have far-reaching implications for informed policymaking on the rehabilitation of silicosis victims in the state.
Keywords: Mine workers, mining, rehabilitation, sandstone, silicosis, tuberculosis
|How to cite this article:|
Mohammad S. Rehabilitation of silicosis victims of district Karauli, Rajasthan, India. Indian J Community Med 2019;44:347-51
| Introduction|| |
In Rajasthan, mining contributes >4% of the state's gross domestic product; sandstone is quarried in 13 districts including Karauli district. Rajasthan alone contributes >90% of the total production of the stone in the country; its quality meets international standards. In the absence of irrigation facilities and alternate livelihood options, a large chunk of the rural population in the state is forced to mining sector., The state has >1.65 million poor mine workers, highest in the country, who are at high risks of contracting silicosis. Silicosis is a silent killer; >3 million workers are at risk of silicosis in the country; men in young age are dying at an alarming rate in Rajasthan. Factories Act (1948), Employees Compensation Act (1923), and Mines Act (1952) recognize silicosis as a compensable occupational disease; miners are also vulnerable to tuberculosis (TB), and this makes diagnosis even more difficult and often misdiagnosed as TB.,
On an intervention of the State Human Rights Commission in 2012, the state government pays 2 lakhs (earlier 1 lakh) to those certified by the Pneumoconiosis Board and 3 lakhs to the kith and kin of those who die due to silicosis. Compensation settlement process is very slow; out of 33,765 suspect cases registered with the state government, only 24% have been certified for the disease, out of which, 5.80% have received their compensation and around 50% of cases are still pending for diagnosis and certification. These certificates are known as “death certificate” or “death warrant.” During 2015–2017, around 7959 cases were diagnosed with silicosis, out of which 449 people died in the state. This compensation scheme, as any other scheme, is riddled with corruption; each death certificate costs INR 40,000. In the same period, there were 2548 silicosis-inducing mines; however, this number is much larger because illegal mining happens on a large scale in the state. There is no or little scope for workers to claim compensation in case of injury, accidents, or occupational disease as a result of mining sandstone. The risk of excessive and long-term exposure to airborne silica poses serious health hazards; silica is a known carcinogen. Silicosis is an asymptomatic disease largely until it advances to the progressive massive fibrosis stage. Silicosis burden is substantial globally with 30,000 annual deaths. Rajasthan is the highest hit in the country, and Karauli is the worst-hit district from silicosis; a study reported that >74% of sandstone workers in Karauli are suffering from silicosis. In a cross-sectional study, it was found that 4% of men are suffering from silicosis and 8% are suspected to have silicosis in district Karauli.Ex gratia amount to 700 victims of silicosis is pending in Karauli district since 2016–2017.
Mining sector is infamous for the violations of human rights of mine workers and degradation of the environment. Unregulated mining in large scale exposes mine workers to various hazardous materials, injuries, and occupational diseases including silicosis. Most of the workers die in debts, and contractors get their sons forcefully to work for them to settle their fathers' dues. Sandstone workers are not provided identity proof or labor records; they are cheated and paid less than the market rates. Hence, this study was carried out to assess the efficacy and adequacy of socio-medical and economic rehabilitation of silicosis victims in Karauli.
Karauli is the 22nd most backward district of the state of Rajasthan and is famous for pink-colored sandstone, which is chemically composed of 96%–98% of SiO2. Agriculture and sandstone mining are the driving engines of the district's economy; sandstone is in abundance and occurs in layers, locally called Patti, below a few feet of the earth. It is mined using rudimentary tools such as hammer and chisels [Figure 1].
| Methodology|| |
A total of 250 confirmed silicosis cases were randomly recruited for interviews from four different sites frequented by these cases [Figure 2].
|Figure 2: Recruitment sites of cases with silicosis for interviews (original)|
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The study tool was a questionnaire containing series of close- and open-ended questions, which was developed and field tested for data collection.
| Results|| |
The study sample (n = 250) belonged to 38 villages spread all over the district. The results reveal that the silicosis cases earned on an average of INR 3500/month; no female was found with silicosis; 68% of victims belonged to the scheduled caste (SC) community, followed by 16% to scheduled tribe (ST) and 15% to other backward caste (OBC) [Table 1]. The majority of the victims (86%) lived in kutcha (mud) houses, and 72% of the participants were illiterate. On an average, victims had large families (>6 members per family). In addition, on an average, each silicosis victim had five members to support.
The results show that around 19% of victims were receiving old-age pensions. Around 8% of cases were covered under below poverty line category. Overall, linkage of the victims to the developmental programs and welfare schemes such as rural employment guarantee scheme (6.8%), subsidized loans (2.4%), scholarships to children (3.6%), disability benefits (3.2%), and housing schemes (4.8%) was very low [Table 2]. It emerged that 24% of the silicosis victims were engaged in the loading and unloading of the mined sandstone, while 28% were involved in hammering, 25% in breaking, and 9% in drilling of the sandstone. Around 7% of the silicosis victims were predominantly engaged with the removal of the mined stone from the mines.
|Table 2: Distribution of silicosis victims availing social benefits (n=250)|
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Further, majority of the cases (53%) were first diagnosed at a TB hospital, Karauli, followed by 16% at a TB hospital, Jaipur, 10% of cases by the National Institute of Miners' Health, Nagpur, and another 21% were diagnosed by other health facilities outside Karauli. Silicosis victims were visiting several cities inside and outside the state for the treatment.
The results demonstrate that 43% of silicosis victims completed TB course, whereas 9% received intermittent TB treatment and 8% stopped the treatment in between. Data further revealed that on an average, a patient received TB treatment for 24 months; 67.6% of silicosis victims were being treated or had received treatment in government hospitals, whereas 9% were being treated in private hospitals [Table 3]. Moreover, 23% of the victims were receiving treatment in both government and private hospitals. On an average, a case visits a doctor 1–3 times a month and spends an amount of INR >1700 on medicines monthly.
The results reveal that only 40% of silicosis victims had received compensation from the government; 96% of the victims spent their compensation money for unproductive purposes such as in treatment and medicines, repayment of loans, domestic expenditures, and their daughters' marriages. However, an insignificant number of silicosis victims (4%) used their compensation money for productive purposes such as buying buffaloes, cows, and goats; running small businesses such as grocery shops; purchase of tempos; and some made bank deposits [Table 4]. Further analysis revealed that 44.4% of victims were not in a position to work due to their poor health [Figure 3].
|Table 4: Utilization of the compensation money by the silicosis victims (n=250)|
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| Discussion|| |
The study findings reported that 99% of silicosis victims were from poor and marginalized (SC, ST, and OBC) communities. Findings from similar studies report that in mining industries, 95% of people are Dalits and tribals and come from lower economic strata of the society. No female cases of silicosis were found in all these villages. This is because mining sector is a masculine industry with minuscule percentages of female workforce. Findings suggest that victims' income was INR 3500/month; on an average, they were living in kutcha (mud) houses and were illiterate. Similar findings were reported in a study that most of the workers are illiterate and have no ideas about their entitlements and rights.
The study reported that mine workers had large families. Linkage of the silicosis victims to developmental programs and welfare schemes run by the government was poor, and around half of the victims still engage in mining activities due to economic compulsions. In a similar study, it was reported that poverty brings people to the mines, and women and children work in these mines to pay off debts passed on to them by their husbands or fathers.
Almost half of the victims are being diagnosed at a TB hospital, Karauli, and the same number of cases is visiting other cities in the state and outside the state for diagnoses and treatment. Around 70% of victims were treated for TB. It is reported that resistance to diagnosing silicosis is due to a couple of reasons. First, the law requires doctors to notify the disease to appropriate authorities and doctors do not want to take this added responsibility. The other reason is lack of training to identify occupational diseases.
The findings reveal that on an average, a silicosis patient visits the doctor 1–3 times a month, spends an amount of INR >1500/month on medicines monthly, and pays INR 100–200 as consultation fee/visit. It is reported that when the miners develop respiratory difficulties, government doctors treat them for TB; if they visit private doctors, they charge INR 100–150/visit. Doctors also make them to purchase prescribed medicines and undergo diagnostic tests from the recommended pharmacies and laboratories. On an observation, the state's human rights body reported that district health authorities showed TB camps as silicosis camps. Most of the time, these Medical Mobile Units are found parked in the district headquarter and face challenges related to competency of the staff and adequacy of the equipment.
Less than half of the victims of silicosis received compensation and spent their money on unproductive purposes such as treatment and medicines, domestic expenditures, daughters' marriages, and repayment of loans. However, a minuscule number of victims used money for productive purposes such as buying livestock and tempos, running grocery shops, and making bank deposits. A study found that contractors (called the kedars locally) lend money to these ailing workers. Most of them, at the end, die in debts. The contractors get their sons forcefully to work for them to get their dues settled.
| Conclusions|| |
Silicosis has affected the male members of the marginalized communities the most. silicosis victims' linkages with the social welfare schemes and with other legal entitlements were inadequate. Majority of the silicosis victims continue to work as casual laborers including in the mining sector due to economic compulsions. A large part of these silicosis victims were wrongly treated or being treated for TB. Majority of the silicosis victims are yet to receive the compensation. Those who received the compensation money spent it on unproductive purposes. Government hospitals continue to treat the majority of the patients. However, many patients continue to visit other cities in and outside the state in search of better diagnoses and treatment facilities. Almost half of the victims were incapacitated to various degrees of disability and unable to work owing to silicosis.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]