Sandur, which is amongst one of the mineral-rich towns in Bellary, Karnataka, has become a death trap. With a lack of awareness, ignorant mining companies, no maintenance of database regarding diseases, the treatment of Silicosis and silico-tuberculosis is hard to find.
April 11, 2020
Hariswami, a resident of Chornur village, has been struggling to make ends meet after he was diagnosed with silico-tuberculosis in January this year. He was the sole bread earner of the family, working at Sandur Manganese and Iron Ore (SMIORE) Mines for almost 10 years before getting diagnosed with silico-tuberculosis. Coming out of his small one-bedroom house where he stays with his wife and two children, he looks pale and haggard. With sunken eyes and an ailing body, he coughs a few times before speaking.
“I was having severe cough and constant chest pain for almost six months, but I ignored it thinking that it was nothing but a case of normal flu.” Hariswami pauses, and coughs a few more times, clearly indicating his difficulty to speak. “As I could not bear the difficulty while coughing, I decided to approach the local Primary Health Centre on January 26 and after three days I was diagnosed with Silico-Tuberculosis on January 29.” Since then Hariswami is undergoing treatment for silico-tuberculosis.
“Now, I have stopped going to work.” Hariswami said, “Instead, my son, works in some shop in the village and that is how we manage the house.”
Hariswami’s son is 14 years old and often skips school in order to sustain the family.
Ignorance is not always a bliss
Just like Hariswami, many people in Chornur village suffer from breathing difficulty, chest pain and constant cough, which is often ignored and non-diagnosed. Since many people in the Chornur village depend on mining as a means of providing for the family, they often ignore the health hazards associated with mining.
Kumaraswamy, another resident of Chornur village is now worried for his daily living, as he continues to battle with tuberculosis. A farmer by profession, his farm is near the mining area in Chornur village. He said, “Two years back I was diagnosed with Tuberculosis, and have been undergoing treatment regarding the same, in the government hospital Bellary. But with my ailing body, I can not go to work on the field.”
As Kumaraswamy is undergoing treatment for tuberculosis, his sister and wife have taken charge to work on the field. Rukmini, Kumaraswamy’s wife, said, “It becomes difficult to manage the house and the field, with Kumaraswamy’s treatment going on. But we are somehow managing to make the ends meet. The mining in this area has proved detrimental to our lives when we are not even associated with mining. “
Mrs Swati, a Junior Health Assistant at the Primary Health Centre (PHC) of Chornur Village told the reporter that many people are ignorant about constant cough and chest pain. If their cough exceeds a period of one month, they should either visit the local PHC or the government hospital. “We have cases of silicosis and silico-tuberculosis in this village. As soon as we attend to a patient complaining about cough and chest pain over a period of a month, the very first thing we do is to have a sputum test done of that patient to confirm the type of disease the patient is suffering from.”
She added, “If it’s not confirmed by the sputum test, we advice the patient to get a Chest X-ray done from the government hospital.”
No data of Silicosis and other diseases
The health hazards in Sandur Taluk are at its peak due to mining with many people being subjected to deadly health conditions on a daily basis. Despite this, the government does not have data of either Silicosis or the other diseases associated with it.
Dr Gopal Rao, the Taluk Health Officer confirmed that silicosis is rampant in Sandur Taluk. He said, ” Even though we have seen cases of silicosis in the area, we do not have a record that can tell the number of Silicosis cases, diagnosed so far. “
Echoing the thoughts of Dr Rao, Dr Kiran, a physician in the government Hospital of Sandur pointed out the check-up of silicosis, silico-tuberculosis and COPD by different doctors to be amongst the main reason for the non-availability of data.
“Most often patients complaining of chest problems are often treated by different doctors. That’s why the data concerning with silicosis and silico-tuberculosis is not maintained,” Dr Kiran explained. “Also the fact that most of the patients visit the hospital when the symptoms of silicosis start becoming complicated, then the patient is treated as a case of either silico-tuberculosis or COPD depending upon his condition. That’s why it becomes difficult for the hospital to maintain data for silicosis.”
Dr. Harish Kumar, a doctor at the Tarnagar PHC observed the refusal of villagers to get a chest x-ray done or sputum test done as a reason for the failure of earlier diagnosis of silicosis.“We have 12 villages under this PHC. The most common disease that we have noticed amongst the people of these villages is Asthma, which is mainly due to the mining dust. But many times the villagers refuse to get a chest x-ray done or sputum test done. This creates a hurdle for us to have a proper reporting of silicosis in the Taluk.”
However, the guidelines by the WHO states maintenance of patient’s treatment and demographic data is necessary for providing universal health coverage. It can also lead to medication errors, transfusion errors, testing errors and wrong person procedures.
Dr Mahima Sadanshiv Sonwani, a graduate in General Medicine from Christian Medicine College, Vellore told the reporter that not having maintained data regarding the number of patients for the treatment of a particular disease, has an impact on the line of treatment of any disease.
“Tuberculosis is an active disease and thus should be treated differently from Silicosis. In the case of both silico-tuberculosis and tuberculosis, it becomes necessary to have data in order to check, whether the particular patient is undergoing treatment or not. Since both the diseases are communicable, the chances of others getting affected is huge.” said Dr, Sonwani.
“ If in either disease, the primary infection is not treated properly, then there are chances that it can become Multi-Drug Resistance (MDR) tuberculosis, which is already on the rise. It can later become Extensive Drug Resistance Tuberculosis(XDR TB), whose treatment is not available right now.” She added.
Talking about silicosis she informed that silicosis is an occupational disease, which is due to the inhalation of silica dust and thus the treatment usually relies on bronchodilators. Unlike Tuberculosis, there is no specific treatment of Silicosis and thus the treatment only relies on the prevention of inhalation of silica dust.
“Silicosis is an inactive disease and thus non-communicable,” Dr Sonwani said. “It takes almost 10-15 years for the diagnosis of silicosis before any type of treatment is started. Also, it is a lifelong disease and patients have to undergo treatment for a lifetime. But since it is non-communicable, it can be controlled.” Dr Sonwani said.
She further added. “Also, the maintenance of proper records of the patient is essential for the diagnosis of any disease. It helps in understanding the grievances of the disease as well as helps to decide the type of treatment that should be given.”
Silicosis- a dreadful past, present and future
Silicosis is a lung disease which is usually caused when a person inhales silica dust. It happens to those who work in the mining area. Its initial symptoms are a nagging cough, phlegm and breathing difficulty, with later symptoms of weight loss, chest pain, fever and headache. Its adverse effects are tuberculosis, Chronic Obstructive Pulmonary Disease (COPD), lung cancer and chronic bronchitis.
In acute silicosis, the symptoms can occur after a few weeks up to two years, after constant exposure to the silica dust. In chronic silicosis, the symptoms usually occur ten years after the exposure to mild to moderate amount of silica and are the most common type of silicosis. In accelerated silicosis, the symptoms occur after heavy exposure of silica dust.
Complications of Silicosis
Dr Kiran explained the protocol done by the hospital for the detection of the lung disease. He said, “The standard way to detect whether a patient has silicosis, tuberculosis or Asthma, is through chest X-ray. In Asthma, there will be hyperinflation of the lungs. However, in silicosis, the chest X-ray will show a patchy appearance within the lungs. The similar x-ray finding is also for tuberculosis. However, a patient’s silicosis becomes tuberculosis with weight loss, loss of appetite and paleness of the person.”
Dr Sonwani, raised concern, over the testing methods for the diagnosis of any disease. She informed the reporter that Chest X-ray is not always a reliable method for the diagnosis in most of the diseases.
“A chest X-ray can be reliable for the diagnosis of tuberculosis. However, a Bronchoscopy test or High-Resolution CT Scan (HRCT) is necessary, for the diagnosis of any chest disease, since many times the disease can get undiagnosed even after Chest X-ray.” Dr Sonwani said.
Tuberculosis is a disease of the lungs that is caused by Mycobacterium Tuberculosis. It can spread from one part of the body to another. The classical sign of tuberculosis is cough, chest pain, coughing up of bloo lost of appetite and weight-loss. A tuberculosis patient is given the treatment through Directly Observed Therapy (DOTS), short course. In this anti-tubercular drugs, are given to the patients for six to eight months as recommended by the WHO, until the disease becomes non-infectious.
As per the research done by St. James Hospital, Dublin, there are two types of treatment- Opened and Closed. Open TB is considered to be infectious and occurs when the TB bacteria in the lungs breaks through the air passages, from where it can be expelled into the air when coughing, sneezing or singing. Closed TB is not considered infectious as it cannot be expelled directly into the air unless disturbed.
Dr Sonwani told the reporter, that in either case of Opened or Closed tuberculosis, the treatment of DOTS, must be provided.
Regarding the treatment of tuberculosis, Dr Harish informed that a DOTS centre is situated in Bellary. He said, “Apart from the DOTS treatment, we are carrying out door to the door screening programme for tuberculosis. “
Dr Sonwani informed the Softcopy that the complications of Silicosis are not limited to silico-tuberculosis. She said, “Since it takes almost 10-15 years for the diagnosis of silicosis, in severe cases, it gets converted into COPD, Asthma and Bronchitis. “
Raju, a resident from Devagiri- Kumturu village, informed that he developed bronchitis last year, due to working in the mines and underwent treatment in Bangalore regarding the same.
Dr Kiran informed the Softcopy that on an average basis, four to five patients visit the hospital for the treatment of COPD, and eight to nine patients for asthma while one to two cases of tuberculosis cases can be seen on a weekly basis. He said, “These are the number of patients we are assuming visit the hospital every day for treatment. However, we can not provide a definite number of patients who visit on a monthly basis. “
The data from the government hospital Sandur shows 132 cases of tuberculosis last year, with Chornur village having the highest number of 36 cases, followed by Taranagar, Matrini, and Vitalpur.
Dr Harish Kumar, a doctor at the Tarnagar PHC said that on an average basis, almost 10-12 patients come for the treatment of the chest related disease. “We have 12 villages under this PHC. The most common disease that we have noticed amongst the people of these villages is Asthma, which is mainly due to the mining dust. Most of the times, patients refuse to get a chest x-ray done or sputum test done.
The History of Health-Hazards
The history of silicosis and silico-tuberculosis dates back to the early ’70s in Sandur Taluk. Walking down the narrow lanes of village Sushilnagar where the noise of mining trucks can be heard from afar, the seventy-six-year-old, Devala Naik, reminisced about the difficulties he faced while suffering from Tuberculosis 35 years ago. He used to work in Jindal Steel Works, another mining company in Sandur. In 1976 after he was diagnosed with Tuberculosis and he underwent the treatment for almost two years, and then gave up working in the mines.
“I have now switched to farming. After tuberculosis, I was too worried to work in the mining industry. I was too worried for the future of my family,” said Naik.
Sushilnagar is the closest village to the main mining area of Jindal Steel Works (JSW) mines. With most of the houses covered with a layer of red dust, it is another village where the residents have stopped working in the mines. Just like Devala Naik, over the years, many people have switched from mining to either agriculture or another occupation. Devala Naik told that everyone has their own story of sufferance due to mining.
“In the past 20 years, most of the people who earlier used to work in mines switched to different occupations. While some chose to do farming, other migrated from the village to cities to earn their living,” told Naik. “The people who are now working in JSW mines are migrants coming from different states.”
In Sushilnagar, the older generation has seen enough due to mining to be concerned for the younger ones. Dressed in a purple lambani outfit, with wrinkles covering her face, Devibai, another resident of Sushilnagar, seemed unhappy with the mining areas around. “This mining activity has robbed us of our health. It’s not only affecting us, the elders, but also our children. Even though most of the people have stopped working in mines from this village, the dust that is present in the air is affecting us.”
Dr Harish told that even though the doctors are concerned for the health of miners, their lack of awareness regarding health effects due to mining is a reason for the rampant health hazard in the Taluk.
The Not-so responsible mining companies
Many mining companies say to provide quality healthcare to the miners and the families. However, this is not the same case scenario.
In Sandur three mining companies namely- Sandur Manganese and Iron Ore (SMIORE), NMDC and Jindal Steel Works have been dominant in the business since early ‘60s.
Talking about the provision of free health care facilities for the miners, Mr. Saleem, Vice president and unit head of the Sandur Manganese and Iron ore said that the company provides free health facilities to the employees. “The company has taken responsibility for providing all type of health care facilities to the employers. The SMIORE Company has a hospital known as SMIORE Arogya in Sandur, which provides free health care facilities to the miners and their families.” Mr Saleem informed. “We also have a dispensary in Devagiri and Swamihalli, where the doctors, as well as resident doctors, are stationed. The miners are provided with a health card to get access to free medicines. Since we are providing all these facilities, we are not providing any insurance.”
However, Hariswamy who was earlier employed with SMIORE, disagreed with the statements made by SMIORE. “The only reason I am going for my treatment to a government hospital in Sandur, is because I do not possess a health card that is usually provided by the company.”
Devagiri- Kumturu village which is situated at the north of Sandur Taluk, where mining activity is most prominent. Set up in a hilly area, it is the main location for mining for Sandur Manganese and Iron Ore Limited. On an average around 300-500 trucks travels through the muddy and unpaved road that connects Devagiri- Kumturu village with Sandur. With most of the population of these two villages being heavily dependent on mining, the health care facilities in these two villages are limited.
Arun Kumar, the Panchayat Development officer of Devagiri-Kumturu village told the reporter that even though the company provides health care facilities to the miners, and practise eco-friendly mining, that is not enough to prevent health hazards. “The residents of the Kumturu village suffer the maximum due to mining. Devagiri village has people who are in higher positions in mines and thus can access the benefits. However, the Kumturu village has been negligent by both the mining companies and the government.”Kumar said.
“There have been many people who work in mines but are not able to reap the benefits provided by the mining companies. The only ANM centre in Kumturu village is closed for a year. I have written to the district authority several times, about this concerning matter and the only reply that I get is that the government does not have required funds,” he added.
Devagiri- Kumturu village is not the only village where people complaints about the negligence by the mining companies. In Taranagar village which is situated 10 kms of Sandur in its east, the problem is familiar.
Sattar Sav, resident of Taranagar village was upset about the negligence showed by the mining companies. “The people in our village are suffering with various breathing difficulty. However, the mining companies are negligent. You can see the hazardous dust as soon as you enter this village and get sick.” Sav informed. He looked tensed and angry telling the plight of people due to mining. “We can’t even complain about this, because we know that everybody is involved, even the top officials.”
Dr Sonwani emphasised that provision of masks and safety gears are the only way through which the health hazards due to mining can be prevented. She also told that silicosis is an occupational disease, self-prevention is the only way through which the disease can be kept under control.
That’s why an awareness programme by the government, local authorities and the mining companies is necessary for curbing down health-related hazards in Sandur.
The regular survey by the government to check the air quality index in the Taluk would also be beneficial for avoiding health hazards. The government must also make it mandatory for the mining companies to follow the norms that come under the National Mineral Policy.