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Occupational diseases and safety measures: Perceptions of saw mill workers – A qualitative study in Pondicherry, South India
indian journal of medical specialities 7 (2016) 19–22
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/injms
Original Article
Occupational diseases and safety measures: Perceptions of saw mill workers – A qualitative study in Pondicherry, South India R. Vishnu Prasad *, K. Kanimozhy, Rajesh Kumar Konduru, Zile Singh Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
article info
abstract
Article history:
Background: Rapid industrialization has been known to cause major health problems. Saw
Received 1 October 2015
mill workers are not an exception from being victims of various occupational diseases. Often
Accepted 5 November 2015
personal protective equipment (PPE) are not provided to the workers in India.
Available online 29 November 2015
Aim: To explore the perceptions of saw mill workers with regard to their health problems as a result of exposure to saw dust and felt needs and issues toward use of protective wears.
Keywords:
Methods: A qualitative study was carried out among saw mill workers. Three focused group
Saw mill worker
discussions were conducted among 27 workers. Thematic analysis was done to identify
Occupational hazards
themes that emerged from the group discussions.
Perception
Results: Majority of the study participants were involved in saw mill work for at least 6–8 h in
Felt needs
day and voiced their concerns with regard to health problems that may be attributed to their work type. The majority of the emphasis was placed upon inhalation of wood dust particles and respiratory diseases. Most of the study participants were aware about PPE; however, there were concerns over the regular and persistent usage. Conclusions: The present study revealed that saw mill workers believe respiratory diseases were the common health problems among them. User friendly PPE were not available to the workers. # 2015 Indian Journal of Medical Specialities Trust. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All rights reserved.
1.
Introduction
Rapid urbanization and industrialization has been known to cause major health problems among the population, especially when it is unplanned. With more than 1.2 billion population and rapid industrialization, India, as a developing nation,
needs much more attention toward occupational health. Some of the problems identified toward occupational safety and health in India include legislation that covers only a minority of the population, poor surveillance, and fragile academic base.1 Saw mill workers are not an exception from being victims of various occupational diseases; in fact they are certainly at a higher risk of developing lung diseases when
* Corresponding author at: Department of Community Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry 605 014, India. Tel.: +91 9994473926. E-mail address: [email protected] (R. Vishnu Prasad). http://dx.doi.org/10.1016/j.injms.2015.11.002 0976-2884/# 2015 Indian Journal of Medical Specialities Trust. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All rights reserved.
20
indian journal of medical specialities 7 (2016) 19–22
compared to others. Wood dust is considered carcinogenic according to the reports of International Agency for Research on Cancer.2 Exposure to wood dust can cause irritation to oral cavity and throat, chest tightness, dermatitis, and deterioration of pulmonary functions.3–5 Apart from respiratory diseases due to exposure to wood dust, saw mill workers are also affected by excess noise and stress at work place.6 Noise levels generated by saws in operation have been reported to vary from 80 dB up to 120 dB.7 Often in a middle income country like India, protective masks, goggles, and other equipments are not provided to the workers as a pragmatic strategy to limit the cost spent by the employer. Compliance of the workers with the safety and protective wears is also questionable. Hence, saw mill workers in developing countries like India are at a higher risk of health hazards due to exposure to high level of wood dust at workplace. It is important to know the workers knowledge and perceptions regarding various health problems that are commonly seen among them and their peers, as well as to know the issues with compliance of safety and personal protective wears use at work place. The present study aimed at exploring the perceptions of saw mill workers with regard to their health problem as a result of exposure to saw dust and felt needs and issues toward use of protective wears.
2.
Subjects and methods
The study was carried out in Pondicherry, a Union Territory in South India. Qualitative study design was selected to know in detail about the saw mill workers' perceptions about their health problems and issues regarding the usage of protective equipment during working hours. The study was conducted during December 2014 to May 2015. The workers were selected from three saw mills, one from rural area and two from urban area to represent different types of working environment and population. The saw mills and the workers for focus group discussions were selected by convenient sampling. Three focus group discussions were conducted at different saw mills and sessions involved 27 participants in total (7 + 11 + 9). Individuals aged 18 or above and working in saw mills for a minimum period of two years were only included in the study to maintain the validity of information being provided by the participants. All the focus group discussions were moderated by the author RVP and audio was recorded either by RKK or KK. The audio recordings were then transcribed, coded, and grouped into data driven emergent themes by the authors RVP and KK. Focused group discussion began with introduction and general discussions about socio-demographic details of the participants. The rest of the focus group discussion was conducted using a set of pre-determined open-ended questions with a topic guide. The same procedure was applied for all the three focused group discussions. On an average, each of the focused group discussion lasted for one hour. Thematic analysis was done to identify various salient topics or themes that emerged from the focus group discussions. The purpose, benefits, and implications of the study were explained to the participants in the local vernacular language and written informed consent was obtained from all the participants before starting the focused group discussion.
3.
Results
All the study participants were males, and no females were working in the saw mills visited by the research authors. Mean age of the study participants was 33.63 years. Majority of our study participants (70%) were from urban region and belonged to class 3 socio-economic status (74%). Majority of the study participants (81%) were involved in saw mill work for at least 6–8 h in day (Table 1). Most of the study participants actively participated in the focus group discussion and expressed their views, beliefs, thoughts, and expectations with regard to health problems due to working in saw mills and various measures to prevent these health problems. Based on information obtained from the focus group discussion, two major themes that emerged during the discussions were health problems and personal protective measures.
3.1.
Health problems
Individual participants of the focused group discussions did voice their concerns with regard to health problems that may be attributed to their work type. The majority of the emphasis was placed upon inhalation of wood dust particles and respiratory diseases. Some participants (5/27) also shared the experiences of their peers or relatives who were also involved in similar work. For example a 37-year-old individual expressed during the discussion that ‘‘I don't have any problems but my friend who is working in another saw mill says he is suffering from breathing difficulty quite frequently. Even after so much money being spent in hospital every time, he still has the problem.’’ A 25-year-old individual working in saw mills for the past three years stated ‘‘My father also was working in a saw mill, he has breathing difficulty and asthma now. Doctors say it is because of working in saw mill. But this job is our only source of income’’. Majority of the participants (25/27) also believed that respiratory problems are the most common to occur among the saw mill workers; a 57-year-old male working in an urban saw mill responded during the discussion ‘‘Because of this dust entering into the body people can develop breathing difficulty and heart attack’’. Apart from respiratory diseases, allergies and injuries were the other health problems being encountered and reported by
Table 1 – General information of the study participants (n = 27). Characteristic
Frequency
Place of residence 19 Urban 8 Rural Socioeconomic Status (BG Prasad Scale – 2014) 20 Class 3 7 Class 4 Duration of work in saw mills 2–5 years 15 12 >5 years Duration of work hours on a typical day 22 6–8 h >8 h 5
Percent 70.37 29.63 74.07 25.93 55.56 44.44 81.48 18.52
indian journal of medical specialities 7 (2016) 19–22
the study participants. Five of the participants in total reported having some kind of allergy currently, which they attributed to working in saw mills. A 26-year-old participant working in saw mill from a rural region for more than three years reported that ‘‘I have dust allergy. I have recurrent sneezing and running nose when at work but when I go home and take a good bath, my problems will go off. I believe this problem is due to working here (in saw mill)’’and another participant from a saw mill in urban region expressed that ‘‘I am very fine at work time, but in the evening I have severe itching in my forearms and it subsides only after taking a hot water bath. Because of this problem I go to hospital atleast once in a month and Doctors say I have allergy.’’ Workplace injuries were also not uncommon among the saw mill workers, where majority of the participants (20/27) reported experiencing minor injuries at workplace. A 43-yearold male from urban region and who was working in saw mills for more than 15 years and lost his distal half of middle finger said ‘‘Very often we injure our fingers and hand while working with the saws, two years back my middle finger got injured and half of the finger was lost.’’ Apart from cutting and carving the wood, saw mill workers were also engaged in lifting and moving the heavy logs quite frequently. Few of the participants (4/27) reported having mechanical or musculoskeletal problems causing numerous body aches and pains. ‘‘I get severe pain at the back, it is because my job here is mainly to lift or shift the log towards the electrical saw’’, a 30-year-old saw mill worker from urban region expressed during the focused group discussion. One of the participants felt that exposure to saw dust at work place can cause so many health-related problems that might eventually reduce his life span, he expressed ‘‘Since three generations, our family is involved in this type of work only, we do not know any other job. If you (Moderator and Research assistants) are living until 80 years of age we (Saw mill workers) will live only till 50 or 60 years of age’’. No periodic screening or health check-up for occupational diseases is being done for any of the study participants. So they had minimal awareness on occupational diseases. During the discussion, some of the participants were eager to know more about the consequences of exposure to wood dust at work place and various possible preventive measures. One of the participants even wondered to know what happens to the dust particles that are being inhaled by them. ‘‘Where does the dust that we inhale go into our body and what were the actual health problems that we may get because of inhaling more dust?’’
3.2.
Personal protective measures
Most of the study participants (25/27) were aware about the various personal protective measures available for the saw mill workers. However, there were certain concerns over the regular and persistent usage of personal protective measures. None of the study participants reported that they ever used a goggle during their work. Majority of them (18/27) were using masks at the time of working hours, though infrequently. Some participants preferred cloths to masks stating that they were more comfortable with using cloths. A 47-year-old worker from rural region mentioned during the discussion that ‘‘Usually we used to tie cloths covering our nose and mouth while at work, even then dust enters the nose while breathing.’’
21
Only masks were available among the personal protective measures in all the three saw mills in which focus group discussions were held. Masks were provided free of cost to all the workers in the saw mills that were involved. However the compliance with the usage of masks varied greatly among individual participants. Some of the study participants raised concerns over inefficiency or ineffectiveness of the masks being provided by the employer; a 26-year-old worker from urban region reported that ‘‘I use masks regularly in working time. But still, after I go home in the evening and I clean my nose, I find so much dust inside my nostrils’’; similar concern was also raised by another worker in a different saw mill from urban region by responding ‘‘We have masks with us (provided by the employer) but we feel more dust is going into the nostrils while using mask when compared to using cloths. We need to change the mask every half an hour.’’ Other issue that was mentioned in a focused group discussion by a participant from rural region was the personal protective measures that are available were not user friendly. A 35-year-old participant mentioned that ‘‘Dust gets clogged in the mask and it is difficult to clean it very frequently while at work’’. Similarly another participant reported being uncomfortable while using masks, and he stated that ‘‘For so many years I was working without using any masks, I feel uncomfortable with it when I wear it while working’’.
3.3.
Felt needs of the workers
When asked about their felt need toward personal protective equipment (PPE), a 25-year-old study participant responded ‘‘If there are some protective devices that covers the whole face like a helmet it will be useful. Because it works as a goggle and also as a mask’’. Another participant said ‘‘It will be difficult to wear such a device continuously for 8 h and at times it may be suffocating’’. They also expressed their opinion that if they had regular check-up by a Doctor who visits the mill regularly, they can know about their health status.
4.
Discussion
Various perceptions and knowledge with respect to the health problems, usage of personal protective measures, and felt needs of the saw mill workers were explored in the present study. The present study results showed that majority of the study participants and their peers reported that respiratory symptoms were attributed to working in saw mill industries. Breathlessness was the most common symptom reported among the saw mill workers. Musculoskeletal pain was also reported by few workers. Very few studies in India have established morbidities among saw mill workers. Kacha et al.8 in their study observed that lung function indices of the saw mill workers reduced with their long duration of service. Inhalation of wood/saw dust is associated with a reduction in pulmonary function and also greater decline in pulmonary function was noted with greater duration of exposure. Similar results were seen in other observational studies conducted at various regions of the world. Schlünssen et al.4 in their study among Danish wood workers also reported a similar result demonstrating reduced lung function. Also, in a study done at New Zealand among saw mill workers it was observed that
22
indian journal of medical specialities 7 (2016) 19–22
Self-reported tuberculosis, Pneumonia, Neuropsychological symptoms, frequent mood changes without cause, low libido, and palpitations were significantly associated with duration of exposure to saw mill industry.9 Irritation of nose, throat, and eyes were the most commonly reported symptoms of the saw mill workers according to a study done by Yusuf et al.10 Wood dust was also reported to cause chronic bronchial irritation which is responsible for the restrictive type and restrictive plus obstructive mix type of pulmonary function impairment.8 Results of the above discussed studies were consistent with the symptoms perceived and reported by the present study participants. With regard to usage of PPE or wears, it was observed in a study by Yusuf et al. that only 26.25% of the saw mill workers were found to be using protective wears at the time of work.10 In our study, none of the study participants were using standard recommended protective wears, although they were following other local protective measures like covering the face with cloths. However, the effectiveness of these local measures in preventing diseases is questionable. Chandra et al.11 in their study reported that handling heavy load, sustained work activity, strenuous job, and uncomfortable posture might be the causative factors for the development of musculoskeletal disorders among saw mill workers. It was found in a study done by Dhere et al.12 in Solapur district that 28% of the saw mill workers were having noise-induced hearing loss. In a study conducted in Nigeria,13 conjunctival disorders due to irritation of saw dust was reported whereas in the present study, none of the participants stated about conjunctivitis among saw mill workers. Respiratory infections and Chronic obstructive pulmonary diseases are found to be some of the long-term effects of workers who are exposed to timber dust.14 Some of the strengths include that the present study explored the health effects of saw mill workers as perceived by themselves and also ergonomic problems faced by the workers. Limitation of the present study could be that it was conducted only among male population since we did not encounter any females working in the study saw mills. Although there are significant proportion of workers involved in saw mill industry, no considerable recognition was given for the preventive and promotive actions for the better health of the workers in India. User friendly and economical PPE may be needed to prevent occupational health hazards of these workers.
5.
Conclusion
The present study revealed that saw mill workers believe respiratory diseases, allergies, and injuries were the common health problems among them. The personal protective measures were not adequately made available to the workers and when available, these were not user friendly.
Conflicts of interest The authors have none to declare.
references
1. Joshi TK, Smith KR. Occupational health in India. Occup Med. 2001;17:371–389. iii-iv. 2. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. Wood Dust and Formaldehyde. Geneva/Lyon, France: International Agency For Re-search On Cancer/WHO; 1995. Available at: http://monographs.iarc.fr/ENG/Monographs/ vol62/mono62.pdf. 3. Priha E, Pennanen S, Rantio T, Uitti J, Liesivuori J. Exposure to and acute effects of medium-density fiber board dust. J Occup Environ Hyg. 2004;1:738–744. 4. Schlünssen V, Schaumburg I, Taudorf E, Mikkelsen AB, Sigsgaard T. Respiratory symptoms and lung function among Danish woodworkers. J Occup Environ Med. 2002;44:82–98. 5. Osman E, Pala K. Occupational exposure to wood dust and health effects on the respiratory system in a minor industrial estate in Bursa/Turkey. Int J Occup Med Environ Health. 2009;22:43–50. 6. Sbihi H, Davies HW, Demers PA. Hypertension in noiseexposed sawmill workers: a cohort study. Occup Environ Med. 2008;65:643–646. 7. Ali A, Qutubuddin S, Hebbal S, Kumar A. An Ergonomic Study of Work Related Musculoskeletal Disorders Among the Workers Working in Typical Indian Saw Mills. vol. 3. 2012;38–45. 8. Yogesh Kacha YN, Vegad A, Varu M, Mehta H, Shah CJ. Effects of wood dust on respiratory functions in saw mill workers. IJBAP. 2014;3:7. 9. McLean D, Eng A, Dryson E, et al. Morbidity in former sawmill workers exposed to pentachlorophenol (PCP): a cross-sectional study in New Zealand. Am J Ind Med. 2009;52:271–281. 10. Yusuff A, Adegbite R, Awotedu O, Akinosho H. An empirical verification of occupational health hazards on sawmill workers. Acad J Interdiscip Stud. 2014;3:511. 11. Chandra AM, Ghosh S, Asahara S, Barman S, Dev S, Gangopadhyay S. An ergonomic study on musculoskeletal health hazards among sawmill workers of West Bengal, India. J Hum Ergol (Tokyo). 2011;40:1–78. 12. Dhere A, Pawar C, Patil D, Pawar J. Noise induced hearing loss (NIHL) in saw mill and printing press workers in Akluj Town of Solapur district. J Environ Sci Eng. 2009;51:187–190. 13. Njinaka I, Uhumwangho OM, Edema OT, Dawodu OA, Omoti AE. A comparison study of conjunctiva disorders in technical and administrative sawmill workers in Nigeria. Malays J Med Sci: MJMS. 2011;18:43. 14. Leesi C, Nobana K. Timber workers' safety measures towards curbing machine-induced health problems in rivers east senatorial district of rivers state Nigeria. Ozean J Appl Sci. 2013;6:93–101.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/injms
Original Article
Occupational diseases and safety measures: Perceptions of saw mill workers – A qualitative study in Pondicherry, South India R. Vishnu Prasad *, K. Kanimozhy, Rajesh Kumar Konduru, Zile Singh Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
article info
abstract
Article history:
Background: Rapid industrialization has been known to cause major health problems. Saw
Received 1 October 2015
mill workers are not an exception from being victims of various occupational diseases. Often
Accepted 5 November 2015
personal protective equipment (PPE) are not provided to the workers in India.
Available online 29 November 2015
Aim: To explore the perceptions of saw mill workers with regard to their health problems as a result of exposure to saw dust and felt needs and issues toward use of protective wears.
Keywords:
Methods: A qualitative study was carried out among saw mill workers. Three focused group
Saw mill worker
discussions were conducted among 27 workers. Thematic analysis was done to identify
Occupational hazards
themes that emerged from the group discussions.
Perception
Results: Majority of the study participants were involved in saw mill work for at least 6–8 h in
Felt needs
day and voiced their concerns with regard to health problems that may be attributed to their work type. The majority of the emphasis was placed upon inhalation of wood dust particles and respiratory diseases. Most of the study participants were aware about PPE; however, there were concerns over the regular and persistent usage. Conclusions: The present study revealed that saw mill workers believe respiratory diseases were the common health problems among them. User friendly PPE were not available to the workers. # 2015 Indian Journal of Medical Specialities Trust. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All rights reserved.
1.
Introduction
Rapid urbanization and industrialization has been known to cause major health problems among the population, especially when it is unplanned. With more than 1.2 billion population and rapid industrialization, India, as a developing nation,
needs much more attention toward occupational health. Some of the problems identified toward occupational safety and health in India include legislation that covers only a minority of the population, poor surveillance, and fragile academic base.1 Saw mill workers are not an exception from being victims of various occupational diseases; in fact they are certainly at a higher risk of developing lung diseases when
* Corresponding author at: Department of Community Medicine, Pondicherry Institute of Medical Sciences, Kalapet, Puducherry 605 014, India. Tel.: +91 9994473926. E-mail address: [email protected] (R. Vishnu Prasad). http://dx.doi.org/10.1016/j.injms.2015.11.002 0976-2884/# 2015 Indian Journal of Medical Specialities Trust. Published by Elsevier, a division of Reed Elsevier India, Pvt. Ltd. All rights reserved.
20
indian journal of medical specialities 7 (2016) 19–22
compared to others. Wood dust is considered carcinogenic according to the reports of International Agency for Research on Cancer.2 Exposure to wood dust can cause irritation to oral cavity and throat, chest tightness, dermatitis, and deterioration of pulmonary functions.3–5 Apart from respiratory diseases due to exposure to wood dust, saw mill workers are also affected by excess noise and stress at work place.6 Noise levels generated by saws in operation have been reported to vary from 80 dB up to 120 dB.7 Often in a middle income country like India, protective masks, goggles, and other equipments are not provided to the workers as a pragmatic strategy to limit the cost spent by the employer. Compliance of the workers with the safety and protective wears is also questionable. Hence, saw mill workers in developing countries like India are at a higher risk of health hazards due to exposure to high level of wood dust at workplace. It is important to know the workers knowledge and perceptions regarding various health problems that are commonly seen among them and their peers, as well as to know the issues with compliance of safety and personal protective wears use at work place. The present study aimed at exploring the perceptions of saw mill workers with regard to their health problem as a result of exposure to saw dust and felt needs and issues toward use of protective wears.
2.
Subjects and methods
The study was carried out in Pondicherry, a Union Territory in South India. Qualitative study design was selected to know in detail about the saw mill workers' perceptions about their health problems and issues regarding the usage of protective equipment during working hours. The study was conducted during December 2014 to May 2015. The workers were selected from three saw mills, one from rural area and two from urban area to represent different types of working environment and population. The saw mills and the workers for focus group discussions were selected by convenient sampling. Three focus group discussions were conducted at different saw mills and sessions involved 27 participants in total (7 + 11 + 9). Individuals aged 18 or above and working in saw mills for a minimum period of two years were only included in the study to maintain the validity of information being provided by the participants. All the focus group discussions were moderated by the author RVP and audio was recorded either by RKK or KK. The audio recordings were then transcribed, coded, and grouped into data driven emergent themes by the authors RVP and KK. Focused group discussion began with introduction and general discussions about socio-demographic details of the participants. The rest of the focus group discussion was conducted using a set of pre-determined open-ended questions with a topic guide. The same procedure was applied for all the three focused group discussions. On an average, each of the focused group discussion lasted for one hour. Thematic analysis was done to identify various salient topics or themes that emerged from the focus group discussions. The purpose, benefits, and implications of the study were explained to the participants in the local vernacular language and written informed consent was obtained from all the participants before starting the focused group discussion.
3.
Results
All the study participants were males, and no females were working in the saw mills visited by the research authors. Mean age of the study participants was 33.63 years. Majority of our study participants (70%) were from urban region and belonged to class 3 socio-economic status (74%). Majority of the study participants (81%) were involved in saw mill work for at least 6–8 h in day (Table 1). Most of the study participants actively participated in the focus group discussion and expressed their views, beliefs, thoughts, and expectations with regard to health problems due to working in saw mills and various measures to prevent these health problems. Based on information obtained from the focus group discussion, two major themes that emerged during the discussions were health problems and personal protective measures.
3.1.
Health problems
Individual participants of the focused group discussions did voice their concerns with regard to health problems that may be attributed to their work type. The majority of the emphasis was placed upon inhalation of wood dust particles and respiratory diseases. Some participants (5/27) also shared the experiences of their peers or relatives who were also involved in similar work. For example a 37-year-old individual expressed during the discussion that ‘‘I don't have any problems but my friend who is working in another saw mill says he is suffering from breathing difficulty quite frequently. Even after so much money being spent in hospital every time, he still has the problem.’’ A 25-year-old individual working in saw mills for the past three years stated ‘‘My father also was working in a saw mill, he has breathing difficulty and asthma now. Doctors say it is because of working in saw mill. But this job is our only source of income’’. Majority of the participants (25/27) also believed that respiratory problems are the most common to occur among the saw mill workers; a 57-year-old male working in an urban saw mill responded during the discussion ‘‘Because of this dust entering into the body people can develop breathing difficulty and heart attack’’. Apart from respiratory diseases, allergies and injuries were the other health problems being encountered and reported by
Table 1 – General information of the study participants (n = 27). Characteristic
Frequency
Place of residence 19 Urban 8 Rural Socioeconomic Status (BG Prasad Scale – 2014) 20 Class 3 7 Class 4 Duration of work in saw mills 2–5 years 15 12 >5 years Duration of work hours on a typical day 22 6–8 h >8 h 5
Percent 70.37 29.63 74.07 25.93 55.56 44.44 81.48 18.52
indian journal of medical specialities 7 (2016) 19–22
the study participants. Five of the participants in total reported having some kind of allergy currently, which they attributed to working in saw mills. A 26-year-old participant working in saw mill from a rural region for more than three years reported that ‘‘I have dust allergy. I have recurrent sneezing and running nose when at work but when I go home and take a good bath, my problems will go off. I believe this problem is due to working here (in saw mill)’’and another participant from a saw mill in urban region expressed that ‘‘I am very fine at work time, but in the evening I have severe itching in my forearms and it subsides only after taking a hot water bath. Because of this problem I go to hospital atleast once in a month and Doctors say I have allergy.’’ Workplace injuries were also not uncommon among the saw mill workers, where majority of the participants (20/27) reported experiencing minor injuries at workplace. A 43-yearold male from urban region and who was working in saw mills for more than 15 years and lost his distal half of middle finger said ‘‘Very often we injure our fingers and hand while working with the saws, two years back my middle finger got injured and half of the finger was lost.’’ Apart from cutting and carving the wood, saw mill workers were also engaged in lifting and moving the heavy logs quite frequently. Few of the participants (4/27) reported having mechanical or musculoskeletal problems causing numerous body aches and pains. ‘‘I get severe pain at the back, it is because my job here is mainly to lift or shift the log towards the electrical saw’’, a 30-year-old saw mill worker from urban region expressed during the focused group discussion. One of the participants felt that exposure to saw dust at work place can cause so many health-related problems that might eventually reduce his life span, he expressed ‘‘Since three generations, our family is involved in this type of work only, we do not know any other job. If you (Moderator and Research assistants) are living until 80 years of age we (Saw mill workers) will live only till 50 or 60 years of age’’. No periodic screening or health check-up for occupational diseases is being done for any of the study participants. So they had minimal awareness on occupational diseases. During the discussion, some of the participants were eager to know more about the consequences of exposure to wood dust at work place and various possible preventive measures. One of the participants even wondered to know what happens to the dust particles that are being inhaled by them. ‘‘Where does the dust that we inhale go into our body and what were the actual health problems that we may get because of inhaling more dust?’’
3.2.
Personal protective measures
Most of the study participants (25/27) were aware about the various personal protective measures available for the saw mill workers. However, there were certain concerns over the regular and persistent usage of personal protective measures. None of the study participants reported that they ever used a goggle during their work. Majority of them (18/27) were using masks at the time of working hours, though infrequently. Some participants preferred cloths to masks stating that they were more comfortable with using cloths. A 47-year-old worker from rural region mentioned during the discussion that ‘‘Usually we used to tie cloths covering our nose and mouth while at work, even then dust enters the nose while breathing.’’
21
Only masks were available among the personal protective measures in all the three saw mills in which focus group discussions were held. Masks were provided free of cost to all the workers in the saw mills that were involved. However the compliance with the usage of masks varied greatly among individual participants. Some of the study participants raised concerns over inefficiency or ineffectiveness of the masks being provided by the employer; a 26-year-old worker from urban region reported that ‘‘I use masks regularly in working time. But still, after I go home in the evening and I clean my nose, I find so much dust inside my nostrils’’; similar concern was also raised by another worker in a different saw mill from urban region by responding ‘‘We have masks with us (provided by the employer) but we feel more dust is going into the nostrils while using mask when compared to using cloths. We need to change the mask every half an hour.’’ Other issue that was mentioned in a focused group discussion by a participant from rural region was the personal protective measures that are available were not user friendly. A 35-year-old participant mentioned that ‘‘Dust gets clogged in the mask and it is difficult to clean it very frequently while at work’’. Similarly another participant reported being uncomfortable while using masks, and he stated that ‘‘For so many years I was working without using any masks, I feel uncomfortable with it when I wear it while working’’.
3.3.
Felt needs of the workers
When asked about their felt need toward personal protective equipment (PPE), a 25-year-old study participant responded ‘‘If there are some protective devices that covers the whole face like a helmet it will be useful. Because it works as a goggle and also as a mask’’. Another participant said ‘‘It will be difficult to wear such a device continuously for 8 h and at times it may be suffocating’’. They also expressed their opinion that if they had regular check-up by a Doctor who visits the mill regularly, they can know about their health status.
4.
Discussion
Various perceptions and knowledge with respect to the health problems, usage of personal protective measures, and felt needs of the saw mill workers were explored in the present study. The present study results showed that majority of the study participants and their peers reported that respiratory symptoms were attributed to working in saw mill industries. Breathlessness was the most common symptom reported among the saw mill workers. Musculoskeletal pain was also reported by few workers. Very few studies in India have established morbidities among saw mill workers. Kacha et al.8 in their study observed that lung function indices of the saw mill workers reduced with their long duration of service. Inhalation of wood/saw dust is associated with a reduction in pulmonary function and also greater decline in pulmonary function was noted with greater duration of exposure. Similar results were seen in other observational studies conducted at various regions of the world. Schlünssen et al.4 in their study among Danish wood workers also reported a similar result demonstrating reduced lung function. Also, in a study done at New Zealand among saw mill workers it was observed that
22
indian journal of medical specialities 7 (2016) 19–22
Self-reported tuberculosis, Pneumonia, Neuropsychological symptoms, frequent mood changes without cause, low libido, and palpitations were significantly associated with duration of exposure to saw mill industry.9 Irritation of nose, throat, and eyes were the most commonly reported symptoms of the saw mill workers according to a study done by Yusuf et al.10 Wood dust was also reported to cause chronic bronchial irritation which is responsible for the restrictive type and restrictive plus obstructive mix type of pulmonary function impairment.8 Results of the above discussed studies were consistent with the symptoms perceived and reported by the present study participants. With regard to usage of PPE or wears, it was observed in a study by Yusuf et al. that only 26.25% of the saw mill workers were found to be using protective wears at the time of work.10 In our study, none of the study participants were using standard recommended protective wears, although they were following other local protective measures like covering the face with cloths. However, the effectiveness of these local measures in preventing diseases is questionable. Chandra et al.11 in their study reported that handling heavy load, sustained work activity, strenuous job, and uncomfortable posture might be the causative factors for the development of musculoskeletal disorders among saw mill workers. It was found in a study done by Dhere et al.12 in Solapur district that 28% of the saw mill workers were having noise-induced hearing loss. In a study conducted in Nigeria,13 conjunctival disorders due to irritation of saw dust was reported whereas in the present study, none of the participants stated about conjunctivitis among saw mill workers. Respiratory infections and Chronic obstructive pulmonary diseases are found to be some of the long-term effects of workers who are exposed to timber dust.14 Some of the strengths include that the present study explored the health effects of saw mill workers as perceived by themselves and also ergonomic problems faced by the workers. Limitation of the present study could be that it was conducted only among male population since we did not encounter any females working in the study saw mills. Although there are significant proportion of workers involved in saw mill industry, no considerable recognition was given for the preventive and promotive actions for the better health of the workers in India. User friendly and economical PPE may be needed to prevent occupational health hazards of these workers.
5.
Conclusion
The present study revealed that saw mill workers believe respiratory diseases, allergies, and injuries were the common health problems among them. The personal protective measures were not adequately made available to the workers and when available, these were not user friendly.
Conflicts of interest The authors have none to declare.
references
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