Friday, December 4, 2009

Mining and its devastating Impacts on Health in Goa

By Zina Shanahan

There is little doubt that mining has an adverse affect on the health and well being of people living and working in mining regions. Health is impacted by factors including air pollution, noise pollution, water contamination and migrant labour. In some cases the effects are noticeable immediately, but for many mining related illnesses, symptoms take some time to manifest. These long term effects are particularly serious as they are preventable, but may not be identified until it is too late.

Air contamination by dust particles is one of the biggest causes of illness in mining related communities, and has serious impacts in both the short and long term. In 2006 The Energy and Research Institute (TERI) produced a report on health and human well-being in mining affected Goa. This report confirmed that individual exposure to air pollution in mining areas in Goa is high, and that the populations of these areas are at serious risk of developing respiratory illness. Specifically, the report confirmed that in the mining affected areas of Bicholim and Sanguem, respiratory illness increased significantly between 2001 and 2004. Dr Prabhudessai, a private practitioner in the remote village of Colomba, is certain that the high incidence of respiratory illness in his area is intrinsically connected with mining. “Respiratory ailments are common,” he says. “Respiratory ailments have increased because of the dust. This is more in the area where there are more mining trucks.” A local health officer serving a large community in the north of Goa stated that upper respiratory ailments are one of the most chronic health issues impacting children under the age of five, and that air pollution in mining areas is a significant problem for people of all ages. TERI found that people living in areas frequented by mining trucks (road corridors) reported higher incidence of lower respiratory symptoms than in any other area. These symptoms are likely to be caused by long term exposure to air pollution from dust and fumes. TERI’s screening of local individuals found that respiratory morbidity was higher in mining areas than in the control (non-mining) area. The report also found that the risk of developing obstructive/restrictive lung function was nine times higher than the control in the road corridor (Curchorem), and 2-5 times higher in mining areas. But you do not really need to read a report to recognise that people in mining areas are suffering from respiratory ailments. Just sit on a bus, visit a doctor’s waiting room or walk around the streets of these towns and villages. Through the noise of roaring trucks you will surely hear the sound of people coughing.

Pneumoconiosis is an occupational lung disease caused by long-term exposure to dust. In the context of coal mining it is popularly known as the black lung disease. In asbestos mining it is known as asbestosis. If the dust is of iron origin, such as in Goa, then it will cause siderosis. Symptoms of this disease include cardiac failure, diabetes and liver cirrhosis. If not detected early enough, the disease can be fatal. It is not only mine workers who are at risk of developing siderosis, as villagers are also forcibly exposed to this harmful dust on a daily basis. TERI reported that in the mining areas studied, individual exposure to respirable suspended particular matter (that is, dust particles that are less than 10 microns in size and can be easily absorbed into the lungs) was substantially above India’s national ambient air quality standards for industrial zones, and 50% higher than the standard for residential areas. In light of this, it is no wonder that respiratory ailments are high.

Another serious illness associated with various mining industries - including iron - is silicosis. This disease is caused by the inhalation of crystalline silica dust - which is odorless and non-irritable, thus easily confused with regular dust. Several months of exposure to this contaminant can lead to complete loss of lung function as well as increased susceptibility to tuberculosis, bronchitis and lung cancer.

Tuberculosis (TB) is a widespread preventable illness in India. In South Africa, TB is considered to be one of the most common illnesses effecting mine workers, intensified by the concurrent prevalence of poor ventilation, dust and HIV. In India too, mining aggravates the already serious TB epidemic. The presence of dust and respiratory illnesses associate with dust make a person more susceptible to TB. As Dr Prabhudessai explains, the spread of the illness is also intensified by malnutrition and the over-consumption of alcohol, both serious problems facing mining affected communities in Goa. Within small communities, and particularly within the confines of small houses, TB is quickly and easily passed between adults and children alike.

Equally as serious as dust pollution, but less visible to the naked eye, is the threat of water contamination. Like dust pollution, water contamination has immediate effects as well as others that may take several years, or even decades to manifest. People in Goa are well aware of many of the harmful effects of water contamination. For many years they have suffered from skin disease, typhoid, cholera, dysentery and gastroenteritis. Doctors are routinely treating people for vomiting and diarrhea. Dr Prabhudessai’s primary concern however, is with the long term effects of water contamination, particularly in relation to iron and manganese mine rejects. Not only are rivers and local water supplies threatened; but mining leases have recently been approved in very close proximity to Salaulim damn: a major reservoir supplying water to Goa.

Existing data on the effects of ingesting excess amounts of manganese are scarce; however symptoms that have been associated with ingestion include poor memory, lethargy, tremors and mental disturbances. More comprehensive studies which have examined the long-term effects of manganese dust inhalation observe weakness, anorexia, muscle pain, apathy, slow speech, monotonous tone of voice, emotionless facial expression, and slow clumsy movement. In general, these effects are irreversible.

Furthermore, there is the possibility of iron contamination. This is a threat both to water supplies and also in the potential presence of metals in crops grown on mining reject dumps. TERI’s report briefly addresses the latter threat, however the results are largely inconclusive – indicating that further research into this issue is crucial. What is apparent from this report is that an excess of metals in mining dumps can accumulate in plants which can affect humans both through direct consumption and through the food chain. There are serious risks involved in re-vegetating mining dumps for local consumption and export, risks which need to be explored with closer attention in Goa. TERI’s study found that cashew samples showed a positive relationship between metals in the soil system and in the plant system, indicating that iron uptake in cashew plantations may threaten local agriculture and local health.

According to the Iron Disorders Institute in the United States, iron overload can lead to chronic fatigue, joint pain, infertility, premature cessation of menstrual cycle, changes in skin colour, jaundice, abdominal pain, depression, high blood sugar, weight-loss, shortness of breath, chest pain, heart arrhythmia, depression, enlargement of spleen and elevated liver enzymes. Even mild cases of iron overload increase the risk for liver disease (cirrhosis, cancer), heart attack or heart failure, diabetes mellitus, osteoarthritis, osteoporosis, metabolic syndrome, hypothyroidism, hypogonadism, and in some cases premature death. Iron overload can also accelerate such neurodegenerative diseases as Alzheimer’s, early-onset Parkinson’s, Huntington’s, epilepsy and multiple sclerosis, while acute iron poisoning can lead to organ damage and death.

A third potential threat to the safety of water is arsenic poisoning. As per the 2008 report, ‘Rich Lands, Poor People’ by the Centre for Science and Environment, two of Goa’s rivers – the Zuari and Mandovi are threatened by arsenic. Arsenic is a natural chemical element, widely distributed throughout the earth's crust. It is introduced into water through the dissolution of minerals and ores. The symptoms and signs that arsenic causes appear to differ between individuals, populations and geographic areas, however immediate symptoms on an acute poisoning are known to include vomiting, oesophageal and abdominal pain, and bloody diarrhoea. Chronic arsenic poisoning, as occurs after long-term exposure through drinking- water, causes cancer of the skin, lungs, urinary bladder, and kidney, as well as other skin changes such as pigmentation changes and thickening (hyperkeratosis). Cancer caused by arsenic poisoning usually takes more than ten years to develop. Exposure to arsenic via drinking-water has been shown to cause a severe disease of blood vessels leading to gangrene in Taiwan, China, known as 'black foot disease'. Studies in several countries have demonstrated that arsenic causes other, less severe forms of peripheral vascular disease. According to some estimates, arsenic in drinking-water will cause 200,000 -- 270,000 deaths from cancer in Bangladesh alone.

The most important remedial action to prevent chronic arsenic poisoning is the provision of safe drinking-water. The cost and difficulty of reducing arsenic in drinking-water increases as the targeted concentration lowers, and the technology for measurement of arsenic in drinking-water at levels relevant to health, as well as the removal of arsenic from the water supply is costly and requires technical expertise.

In addition to air and water contamination, the mining industry threatens local health through the emergence of migrant labour. In July of this year, Dr Prabhudessai was visited by his first patient suffering from chikungunya. The young man was suffering from a high fever, and the doctor gave him symptomatic treatment, not immediately recognizing the disease as it was until then unknown in this area. On the third day the man returned, still suffering from fever. On examination it was revealed that the man was also suffering from joint pain and a rash. Soon after this, patients began coming more and more frequently, until the doctor’s average of 20 patients per day had increased to 80, all complaining of the same symptoms. In total, the Doctor attended to between seven and eight hundred chikungunya patients, believing that around seventy percent of the community was afflicted. With so many people coming down with this illness, the doctor explained that people were becoming anxious. “Suddenly a young fellow is not able to do anything. Suddenly he can’t move. He becomes so incapacitated and depends on his other fellows to help him. He is not able to walk.” In this case individuals suffered relapses for an average of 2-3 months. Dr Prabhudessai has no doubt that the chikungunya epidemic was related to the mining industry, specifically as a result of migrant labour. “It was brought by a person, he was suffering from chikungunya. He was bitten by a mosquito, which got infected, so the locals got infected.” Unfortunately there is little research done into chikungunya in India, as the doctor says, “We are too busy fighting the fire. We do not have time to do research.” However while the Goan Director of Health Services advised Dr Prabhudessai that death is rare, research in Kerala suggests an increasing rate of fatality for chikungunya.

In addition to the chikungunya epidemic, there are other diseases popping up in the community including HIV and Hepatitis B. These diseases were until recently unheard of, but with the increase in migrant labour, foreign diseases are beginning to infiltrate mining regions. Such communicable diseases are not only damaging in and of themselves, but they pose the additional threat of increased susceptibility to further illnesses prevalent in these communities.

Despite the increasing ill health of people in mining areas, medical services remain limited. The number of doctor’s posts sanctioned to serve the mining areas is low in comparison to government norms. Additionally, TERI’s research suggests that sanctioned positioned often remain unfilled. For example, in Sanguem Health Centre there were seven doctors in 2006, and now there are only five. Primary Health Centres, the main medical facilities serving mining affected communities, are not required to have specialists. The Bicholim and Saquelim health centres have x-ray facilities, but these are not always available and there are no on-site radiologists. The x-rays must be sent to Mapusa for analysis. At the Sanguem centre, there is no x-ray facility at all. There are no facilities for pulmonary function tests in any of the health centres contacted. In communities suffering from extremely high levels of respiratory illness, including tuberculosis, the basic facilities provided by the health centres are certainly inadequate. For further facilities patients must access the private health sector (which is usually more expensive and likely to be located in urban areas) or district centres (which are usually further away). What with the traffic congestion created by mining trucks paired with the demands of work and family life, it is difficult for many people to access distant medical facilities and receive proper treatment.

As per the Mines Safety Act of 1952, mining companies are expected to provide emergency facilities, regular health checkups for workers and free consultation facilities at mining dispensaries. TERI’s report suggest that only some companies are providing these services, and further research suggests that where these services are provided, they are inadequate. The report also states that the Mineral Foundation of Goa ‘provides some community health facilities from time to time.’ The details of these remain unspecified.

Locals in mining affected areas are generally dissatisfied with the available medical services. Complaints include long waiting times, ineffective treatment, difficulty in accessing services, not enough centres, unavailability of medicines, lack of equipment and doctors, and lack of ambulance services.

When I asked Dr Prabhudessai about the services provided by the mining companies in his area, it became clear that without his private practice, the community would not be adequately served. One doctor is sanctioned by the mining company to provide services in the community, however he is appointed to five or six places. His schedule is not dependable, and he may attend the community for only an hour or two, for a few days each week. He is not available at many times, and does not stay in the community overnight. And as the Doctor put it, “If you create a disease and then you say, ‘I am giving you somebody to cure the disease’, it is not the right philosophy.” For this reason, many community members will refuse to see the company doctor, preferring to visit Dr Prabhudessai’s private practice – a place where the doctor will not only treat them, but stand beside them and fight against a major source of their ailments: the mining companies.

The illnesses and diseases discussed here are only the tip of the dry and dusty iceberg of health concerns that these communities are facing. Further health impacts to consider include the effects of air pollutants on the eyes and skin, stresses on the body of mine workers, such as hearing impairment, lower back and sciatic pain and lumbar inter-vertebral disorders. Cancers of the lung, bronchus, and trachea have also been associated with iron mining elsewhere.

Additionally, the psychological impact of mining on local communities must be devastating. In Colomba, Dr Prabhudessai, his wife and many other community members were arrested for protesting against a mine situated on community land. The matter of ownership of this land has been in court for two years, and while it remains undecided, mining is allowed to continue. In order to gain control of land for mining, companies are well known to employ the tried and tested technique of divide and conquer and in some cases have successfully destroyed community relations based on differences of religious belief, caste or other distinctions. The pressure to succumb to the demands of the companies is heavy. People in Dr Prabhudessai’s community are suffering high levels of anxiety, and the use of anti-anxiety medication is on the rise. He has found that sleeping troubles, mental agitation and high blood pressure are also prevalent; symptoms that you would not usually expect in such a small, remote community.

Alcoholism is also a serious problem, and not only because it increases the individuals susceptibility to various diseases. Alcoholism is well documented as a common problem in mines across the globe. Dr Phabhudessai described how there are now many young women in local villages, widowed because of alcoholism. “If you sit with me in my consulting room, you will find widows coming, young widows. These mines are creating alcoholism, thereby creating more widows.” Liver failures, peptic ulcers and traffic accidents are just some of the ways that alcohol is killing young men who should be in their physical prime.

The economic impact of poor health in mining regions is also substantial. According to TERI's report, the economic cost of ill-health due to exposure to air pollution alone in Goa's mining regions is an annual total of Rs.71,236,788. As this report was published three years ago, we can assume that with the increase in mining activity that the economic impact of mining related ill-health will also have risen.

Mining is considered by many to be the backbone of Goa’s economy. But mining as it is performed here is not sustainable. At the rate that these companies are going, it does not take long for a mine to be exhausted and for the company to pick up and move to the next place. So what will happen when the mines are closed? Goa’s “backbone” will be broken, and then how will it stand? What will happen to the people who are left behind, with wounds afflicted by mining in both their bodies and their land? The services provided by the mining companies do not even begin to come close to adequately addressing the problems they create. And the government, hand in glove with the mining companies, also provides less than the bare minimum. So what will happen, we must ask, when the long term effects of mining begin to show? The companies may well have left, and by then they will have washed their hands of their legal and moral responsibility to the people of these Goan communities.

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