BREATH OF DEATH

Silicosis continues to be a major killer in certain areas of Delhi and its neighbourhood where workers of stone-crushing and quarrying units are exploited by their employers and neglected by governments.

in New Delhi

ON the surface, the national capital is aglow with well-being and prosperity. But underneath the ostentation, lie buried stories of people who may have built the city but are now condemned to a life of disease, death and despair.

It is always quiet in Lal Kuan, a village tucked away in a dusty corner of the city. It was never so. Formerly an active mining and quarrying area, all that is left of it today are the former mine workers and stone crushers for whom even the very act of breathing is an effort. Many of them are suffering, in varying degrees, from silicosis.

"I am not even fit to beg," says Budh Ram, a resident of Lal Kuan, in the Badarpur area of South Delhi. Budh Ram's constitution was not like this a few years ago. His present condition is a result of the work he did in the stone-crushing units and quarries that once dotted Lal Kuan. Today, he says he does not feel hungry and finds it difficult even to lift a jug of water to wash himself in the morning. "I cannot walk for long. I feel breathless all the time," he says. Budh Ram has been taking medicines for tuberculosis (TB) for the past eight to nine years and finds no improvement in his condition.

Budh Ram has no choice but to while away his days, unable to do anything productive even at home. He has three children and his wife, who is the sole breadwinner in the family, works as a domestic help. S.A. Azad, a social activist and the director of the non-governmental organisation, the People's Rights and Social Research Centre or PRASAR, says that Budh Ram and several others in Lal Kuan have a condition caused by silicosis. "No one acknowledges this as it would imply paying compensation," says Azad who first noticed the extremely emaciated people in the Lal Kuan area.

Lal Kuan literally means "red well". The village bears hardly any signs of prosperity. It is like any other place inhabited by the working class in the capital, the only difference being that most of its people have lost the will to live.

Lal Kuan has been at the centre of mining and quarrying activity since Independence. Active mining came to a halt in 1985, but the stone-crushing units continued to operate until 1992, when the Supreme Court in M.C. Mehta vs Union of India ordered that the units be closed and the stone-crushers, quarry workers and miners be shifted to Pali in Haryana. While the move contributed to a decline in Delhi's pollution levels, some of the workers were rendered jobless while others were shifted to Pali and other places where mining continued.

Dhanna Ram worked in what he calls the Lal Kuan pahaad (hill). Lal Kuan is located on the Mehrauli-Badarpur road. Dhanna Ram, like several others, has been battling tuberculosis for several years but medicines have failed to improve his condition. He cannot even get up from his cot. Dhanna Ram looks older than his years; his wife Kamla's condition is marginally better but she looks sickly and frail. Dhanna Ram recalls: "While working, we always had a thick layer of dust on our bodies. When we spat, all that came out was dust and phlegm."

Residents of Lal Kuan say that in the years when mining and crushing activities were on, everything in the village used to be covered by a thick layer of dust and visibility used to be poor. "It was quite normal. We, our children, all got used to it," said a fruit seller, who also used to do stone-crushing work. Now he cannot do any hard work and runs a banana stall, which is highly inadequate to support his family. Gulab Devi, another Lal Kuan resident, says she spent her youth in stone-related work. "For 30 years, I and several others worked in mining and stone crushing. We have done it all - we crushed stones and rubble, we lifted stones and we worked at the crusher," she says. Many of them belonged originally to Rajasthan and migrated several years ago, in search of employment. Lal Kuan is full of such people. There are survivors like Narayani, Kamla, Mangal Singh, Nathu Ram and Gulab Devi and there are those who worked and are now gone like the six sons of Gulab Devi, Bhola Ram and Mohini Devi who were sent out of government hospitals.

The misery in Lal Kuan came to light after an inquiry by PRASAR in 2001 revealed that several persons from the village who were involved in mining, quarrying and crushing activities had died prematurely and that there was no accountability of any sort on the part of the government or the employing agency. According to PRASAR, an unprecedented occurrence of death and ill-health among the residents followed. A survey conducted on the basis of an inquiry into the occupational patterns of the victims and on the symptoms of silicosis revealed that the majority of Lal Kuan residents suffered from respiratory problems and silicosis, a direct outcome of the nature of their work. Of the 146 persons interviewed, 83 were suspected to be suffering from silicosis and other incidental diseases and 55 persons claimed that their relatives had died of the disease. Several of those surveyed were being treated for tuberculosis without any improvement in their situation. The survey also revealed that the percentage of persons above 55 years in Lal Kuan was abysmally low.

PRASAR submitted its preliminary survey to the Centre for Occupational and Environmental Health for further verification. The centre conducted a survey, did check-ups and interviewed people. Commending the summary report prepared by PRASAR, the experts from the centre recommended that the degree of certainty of the presence of silicosis in the residents of Lal Kuan be ascertained. The preliminary findings showed that people suffered from cough with sputum and shortness of breath and appeared weak and wasted. It was also revealed that women who had lost their husbands to silicosis were themselves suffering from the disease. The centre's study, which was done in December 2002, said: "If silicosis or silico-tuberculosis is present, then the residents and ex-workers are eligible for compensation; if not, they are not." The experts, T.K. Joshi, Project Director from the Centre for Occupational and Environmental Health, and Elihu Richter, a Professor from the Department of Occupational and Environmental Medicine, Hebrew University, Jerusalem, stated categorically that if silica was found, it was a case for action. "Right now, absence of evidence should not be equated with evidence of absence."

They observed that some 70,000 residents and workers are or were reportedly at risk, many had died of tuberculosis-like respiratory diseases at a young age, many were still employed at the new quarry, and there was a sizable minority which had never worked in a quarry. Few, they noted, had been examined under X-ray, none had been autopsied, there was no air sampling done and there were no preventive safeguards of any kind. The issue, according to them, was about establishing a preventive programme of dust suppression at the current quarry and carrying out some simple epidemiology studies to make a presumptive diagnosis of the nature of the ailment the residents are suffering from. They recommended that "diagnostic tests be conducted to confirm or reject the hypothesis that silicosis or silico TB was a major form or the major cause of respiratory disease and premature mortality in this population". According to them, a quick comparative study between those who worked in the quarry and those who never did such work should be done to determine the prevalence and age of onset of respiratory disease.

Silicosis is the oldest known occupational disease to affect sand-blasters, rock cutters and miners. It is because prolonged exposure to free crystalline silica dust (silicon dioxide) results in chronic fibrosis of the lungs. When crystalline silica (dust) is inhaled, the lung tissue reacts by developing fibrotic nodules. This condition is called silicosis. If the nodules become too large, breathing becomes difficult and may result in death. Usually diagnosed by X-ray, silicosis is an irreversible, disabling disease. It can be prevented by employing certain mechanisms to avoid the inhalation of the dust and by the use of technology that avoids the formation of silica-bearing dust. The inhalation of crystalline silica particles can lead to TB and bronchitis.

In March 2003, Mohini Devi, wife of Mangal Singh, died because of the lack of treatment and the unsympathetic attitude of government hospital staff. She, who had worked as a stone-crusher for more than 20 years, went to seek treatment at the Badarpur dispensary, after vomiting blood. She was denied treatment. She approached the Nehru Nagar chest hospital, another government-run institute, where the doctor in charge allegedly refused to attend to her. Finally, on April 1, 2003, she was admitted to the Safdarjang Hospital where she breathed her last. Mangal Singh wrote to the Health Minister of Delhi regarding the callousness of the government doctors and, predictably, got no response.

Meanwhile, between October 2003 and January 2004, at least five more workers, including Budh Ram and Mangal Ram, were diagnosed with silicosis by the government managed Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases. The institute's chest physician, Anand Jaiswal, said that respiratory diseases caused by silica dust were common among people living and working in the area.

Jaiswal, who has been associated with the institute for a long time, said that the symptoms of the patients he treated included an "incapacitating breathlessness". He said: "I have been here for 13 years and they have been coming regularly. We have three units here and all three have been reporting silicosis cases. It is not rare anymore. Even our junior doctors have become experts in diagnosing such cases."

Jaiswal said that even though the work had shifted out of Delhi, patients were coming from Haryana. He said that the disease was found among those who had been involved in stone crushing and quarrying operations for five to 10 years. "There is no cure. Once the dust settles in the lung, it evokes a response from the lung. This results in fibrosis - an irreversible disease. It paralyses the immune cells, which are involved in controlling the TB bacillii. Hence silicosis predisposes one to tuberculosis in some cases," Jaiswal said.

Although, unlike TB, silicosis is not accompanied by fever, blood in the sputum or the presence of TB bacilli in the lungs, normally such patients were given medicines used to treat TB, sometimes multiple doses that had the potential to expose them to certain undesirable side effects including hepatitis. "Here, we often give multiple counselling sessions to convince them that it is not TB that they are suffering from," Jaiswal said. But overall, the experience was that there was very little left to treat them with. "The dust causes irreversible damage. More often, they never get back to normal. We give them bronchial dilators for relief," he said.

According to him most of the workers were involved in stone masonry, quarrying, stone crushing and sand-blasting. "The main problem is that it is the unorganised sector. The contractors never provide any masks or exhausts to ensure that the air current carrying silica dust is deflected away from the worker," Jaiswal pointed out. Most of them did not know whom they were working for. In contrast, workers in the organised sector are protected under the Employees State Insurance Scheme, which provides for a Respiratory Board to look into issues of compensation arising from ill-health at the workplace.

In the unorganised sector, work is done mostly on a contract basis. Workers are not listed in the rolls of the employer and they are unaware of the identity of the main employer, procured as they are by a thekedaar or contractor. Obviously, they are not entitled to any benefits and have to pay for their medical expenses from their own resources.

After having exhausted all possibilities including writing to the Ministries concerned at both the State and Central levels, PRASAR has now resorted to Public Interest Litigation (PIL). Its petition before the Delhi High Court, which is being argued by the Human Rights Law Network, has sought directions from the court for the constitution of a committee for the detection of silicosis among the residents of Lal Kuan; the issuance of appropriate guidelines for the prevention and treatment of silicosis and other incidental diseases; the rehabilitation of persons and families affected by the disease; compensation to the families of workers who died after contracting the disease; and alternative employment to the family members of victims.

There are national-level proposals for the unorganised sector, but none is ratifiable. The National Labour Commission (NLC) has recommended a policy on safety, health and environment at the workplace. Under the Factories Act, the managements are supposed to inform labour inspectors about the possibility of any health risks that might be involved. An Occupational Health and Safety Bill proposed by the NLC is still hanging fire. As no concrete legislation exists to protect the interests of workers in the unorganised sector, the onus is on the State governments and their respective Labour Departments to ensure that at least the minimum standards of safety are complied with at the workplace.

The International Labour Organisation (ILO) and the World Health Organisation (WHO) have come up with a joint programme for the elimination of silicosis. The programme identifies silicosis as a preventable disease, the incidence of which can be brought down through cost-effective programmes. Moreover, Article 4 of the ILO Convention on Occupational Safety and Health states that all member-states are required to formulate, implement and review a coherent national policy on occupational safety, occupational health and working environment in consultation with employees and employer organisations.

The unorganised sector is supposed to be covered under a piece of protective "umbrella" legislation as per the recommendations of the Second National Commission on Labour. But the enforcement of any such legislation will be contingent on tightening existing labour laws rather than making them flexible for employers.