development
Breathing space 
By Adithya Pradyumna
                    
“Let me ask you a question”, said Dr Radheshyam Chaturvedi at GRAVIS (Gramin Vikas Vigyan Samiti) hospital in Tinwari near Jodhpur, “why are these people falling sick?” It is a question that is not often asked when discussing health. This question became more pertinent as it was asked in relation to the thousands of workers suffering from silicosis in Rajasthan. A disease associated with the dust generated from stone-mining activity, it has allegedly affected around 800,000 workers in Rajasthan according to a 2005 study by PRIA (Participatory Research in Asia) and may have consequently caused several premature deaths. The dust particles are inhaled by the workers, causing the lungs to react and eventually damage themselves over periods of exposure ranging from few months to over a decade. Dr Chaturvedi mentioned that most diagnoses have been based on non-response to 2 years of tuberculosis medication, which delays any potential intervention that can be made to limit the illness.

So, why have these workers continued to suffer from silicosis? With all this talk about dust, the obvious solution that comes to mind would be the control of dust levels at the mines, and provision of safety equipment and periodical health checkups. Ram Chander, a mine worker for the past 15 years at Sur Sagar, smiled at being asked about these measures “no sir, we have not been provided with these facilities”. Chandana Ram, an unlikely 65 year old retired mine worker from Gagadi would agree with that. A victim of lung disease, he now watches his three sons leave to work at the mines during most months of the year. Spending 30% of their daily wages of Rs 200 on the commute to work is an additional cost they are willing to pay.

A few of us from the group leaned over the barricade to see the mining operations, specifically to see the worker use the recently introduced advanced drill apparatus. Newer technological alternatives, you would think, reduce human misery. Ironically, these newer drills generate a lot more dust, and the cloud which emanates can easily find its way to the drill-worker’s face. The afternoon spent at a couple of mining sites indicated the poor occupational environment, which was in stark contrast to the high spirit of the workers. `An epidemiologist would always be careful while collecting information from workers at work sites, due to what has been termed as healthy worker effect. The sick ones often stay behind at home, giving the impression of a healthy workforce. We did not have adequate time however, on this journey, to visit homes of affected workers.

A female worker who passed by Ram Chander and myself, commented about him with a smile, “He drinks a lot of alcohol”. Rajendra Singh, Programme Coordinator at GRAVIS, mentioned that not just alcohol, but also opium is a very common addiction among workers “they spend Rs 500 for a pack, which lasts between 2 days to a week”. The economics of this is quite baffling, considering the meagre earning capacity of between Rs 100 to 300 per day. With rampant alcohol and opium consumption, nutritious food takes the backseat, making the already vulnerable population more susceptible to tuberculosis. But alcohol, according to Ram Chander, gives them the ability to work at the mines. The women and children, constituting around 40% of the workforce at the mines, are paid lesser, and remained inconspicuous during our interactions with workers there, reflecting their even more marginalised position. 

And the diagnosis is..
There are no cases of silicosis in the area based on official records. Government doctors are expected to present themselves at court to provide evidence when a case of silicosis is diagnosed by them, in order for the compensation to be awarded. So far, no such cases have been reported. Tuberculosis having similar symptomatology provides them with an excuse to misdiagnose silicosis. A study by National Institute of Occupational Health suggests otherwise, reporting 21% of mine workers as probable cases of silicosis. Occupational injuries including fractures, a common occurrence, are an even more unrecognised entity, Ram Chander commenting “we apply bandages at the mine site itself”.

Local organisations have made and are making attempts to better the conditions at the mines and for the mine workers. Rajendra Kumar related his organisation’s experience with this campaign “no doubt there has been a change in the situation over the past decade”. While he stated that the progress has not primarily been in terms of greatly improved health of workers, or with improved dust control measures, there has been increased awareness among the workers and mine owners about the health impacts of mining practices, and about simple personal and environmental safety measures to improve situation of dust at mines. Medical camps conducted for mine workers by NGO-driven campaigns have been few and far between due to constrained resources. GRAVIS Hospital attempts to use the Robin Hood method by cross subsidising the poorer patients, including mine workers. Such initiatives provide a much needed support, but an end-of-pipe one.

Could the need for such for health care services ever be fully met by NGOs? Should they be the ones looking at meeting these needs? What about the bigger picture of prevention?

Stone-willed
People work to find a means to survive. The monsoon rains affording just flying visits to Rajasthan like consultants at a hospital, the locals without access to irrigation facilities are compelled to find non-agricultural work elsewhere for 8 to 9 months every year. In the midst of this quite barren landscape, the pink stone provides a great opportunity, and how. Over 2 million people work in these mines in Rajasthan alone. It takes away much though, many years of the workers lives, with the average mine worker living between 45 to 55 years of age. While the workers continue to show their will and right to exist and thrive, there is a role of the healthcare and human right sector to strengthen the case for a better workspace and life. There are efforts in progress to document the health status of the mine workers, empower them and make authorities more accountable. The opium and the alcohol may help the workers deal with the hardships for the moment, but the long term emancipation of this population would depend on more than that.