UNDERSTANDING PREVENTIVE HEALTH

As a child growing up in a fairly remote village, I followed my mum a couple of times to the local maternity centre at the delivery of my younger ones for routine child immunization. One thing I noticed which I clearly remember till date is mothers giving their babies Paracetamol syrup prior to their baby’s immunization. I watched with so much curiosity with many questions in my mind but I was too little and naive to voice say these things out yet I lived with them for years.

When I started my career in 1997 in the hospital, I saw it happen again and I asked a Matron colleague of mine who took time to explain to me. It was then I realised, mothers actually give this medication prior to immunization to prevent their babies from having high temperature. I was so amazed when I imagined the level of awareness and poor educational levels of those women I saw in the village. What these mothers were involved in can be relatively seen as a preventive health approach to health (proactively preventing increased body temperature in infants). It simply means taking proactive actions to prevent possible ill health, sickness or disease before it comes.

What those mothers understood even in that poorly informed level is that their babies can avoid the pain of suffering from high body temperature if they are given paracetamol prior to vaccination. My question is why couldn’t the mothers leave the babies to just take the vaccines without necessarily giving them those medications? Even the Mothers need peace of mind. When their children suffer from increased body temperature, the mothers also suffer discomfort.

This was just to build a foundation on what this column will be focused on within the time or period we have at our disposal. Preventive health is indeed the new frontier in healthcare delivery; it is the new world order in both saving healthcare cost and achieving improved healthcare outcomes. We grew up to meet our healthcare professionals enjoying the conventional curative clinical care, the business the health professionals had with patients was just to listen to patients’ complains, examine their physical clinical presentations and either recommend them for further laboratory investigation or outright drug prescription. 

  

In modern day healthcare services, the complexion of healthcare delivery has greatly changed even the treatment pattern. The focus now is overall wellness, wholeness of body, mind and soul. This is where interaction and patient engagement has placed patients at the centre of quality healthcare delivery team. The rule is, we do not want you to be sick before you come to your healthcare professionals, even when you have questions, go to them and seek medical clarifications.

There used to be a level of reserved disposition among practitioners towards patients, but this has long changed because we must talk with our patients, answer their questions and clarify bothering medical issues they may have in their mind.

The role of the healthcare professionals have transcended beyond just caregiving but to health education, health awareness and health promotion. The patient needs to get informed, the patient needs to know what to do to maintain good health, he needs to know the food type suitable to maintaining good health and possible ways to modify life style in the midst of available health risk exposure.

Preventive health has been recommended as the most cost effective form of healthcare delivery. Let’s look at Hepatitis B which is a viral disease that has a violent effect on the liver, you will agree with me that it is easier, safer and most cost effective for us to get an early screening and take the vaccination if we come out negative. The highest cost you may get this screening and the three course vaccination will be between N5, 000.00 – N7, 500.00, but the average cost of having a six-month treatment outside the pre-treatment test falls within the neighbourhood of N500, 000.00 - N750, 000.00. There is no guaranty that the virus will be totally out within this six months, you might need about a year, two years, 6 years or longer therapy to totally get rid of this viral infection.  What this tells us is that the cost of immunising yourself against Hepatitis B virus is just 1% of the cost of having a six-month therapy.

In any balances you may weigh this from; it makes a whole lot of economic sense to embrace Preventive health in our overall quest to maintaining an improved and quality life style. Curative Medicine is still very much in practice and in use but we need to free spaces in our healthcare facilities through Preventive Health approaches to allow those who really need those clinical environments access to curative care as recommended.

Organisations, families, governments and health insurers are financially bleeding in their health funds because of the sole reason of waiting till we get really sick before we seek medical help. This is wrong; we need to seek Medical help in form of Medical advice even when we are not sick. We need to have thorough engagement will our healthcare providers, if they are not talking to us or providing answers to our questions they cannot be the kind of healthcare providers we really need.  

The most important approach to healthcare delivery in 21^st century is “Caregiver-Patient Engagement”. This has another twist is preventing medical errors and ensuring patients safety.

We will be looking at most of these issues in details as time permits us subsequently. Stay glued to us here, we will surely be back.

I can be reached at ehi@ohsm.com.ng

PROLONGED USE OF HIGH HEELS SHOES COULD CAUSE RESTLESS LEGS SYNDROME (RLS)

There is an issue of recent growing concern to me, most especially in the area of Ergonomics and health risk which is my focus area.

I do not know if you have noticed the indiscriminate use of shoes with incredibly high heels amongst ladies of all ages of late, this has got me really worried on the possible health outcomes. Most alarming is the prolonged use of such high heels shoes in work places ranging from 5 - 8 hours continuous use. This is where the troubles lies.

How many of us have heard of the term RESTLESS LEGS SYNDROME (RLS)? According to a publication of the National Institute of Neurological Disorders and Stroke, "Restless legs syndrome (RLS) is a neurological disorder characterized by throbbing, pulling, creeping, or other unpleasant sensations in the legs and an uncontrollable, and sometimes overwhelming, urge to move them". It is classified as a movement disorder, as individuals are forced to move their legs in order to gain relief from symptoms.

Although there are other factors responsible for this disorder but one of the factors indicative of this disorder is the use of high heel shoes predominantly amongst women. Men are all not together left out, studies have also shown that men are also in the habit of wearing shoes with heels such as Sanchos Boots.

I am most worried the way we get our feet traumatised in our quest to be seemingly look fashionable, elegant and perceived glamorous yet in our most discomfort mode. Every part of the body has a scientific process of use and management and you cannot afford to violate these processes without suffering the naturally prescribed consequences which you cannot appeal.

You must have heard of the term Cumulative Trauma Disorder (CTD), this is very applicable to this high heel shoes habit. We either pay now, or we pay later because you have continuously traumatised your feet and this has great consequences which awaits you in future. You may not have an immediate consequence but because this habit persists over a period of time, the possibility of suffering from RLS will be very high. But remember, this has to do with frequency of exposure and duration of exposure to such risk. This talks about how often you get involved in the use of high heels shoes and when you use them, how long do you stay on them (do you use them 5 days in a week and you are on them for 8 hours stretch in each of these days). I would rather think RLS is avoidable if we wear relatively flat shoes or shoes with very low heels more often, especially during work hours or at work.

We have heard of a number of crashes as a result of such high heel shoes in workplaces, it is more frequent when climbing or walking down the stairs. When you look at it closely, it causes organisations downtime through man-hour loss and RLS induced absenteeism, extra health cost and psychological tension amongst colleagues. The person who wears these shoes is not also left out because he or she lives to suffer the immediate pain and the cumulative long term health effect and consequences.

This can also be linked to insomnia. During my online course on Behavioural Medicine at Karonlinska Institutet Sweden, i realised one of the most predominant causes of lose of sleep is pain and this is most times taken out of focus by some Physicians while we continuously overwork ourselves trying to figure out ways of dealing with the lack of sleep without recognising the root cause. When you stay on these high shoes for longer hours, you are bound to go through pain just like an employee who has spent a whole day working in a workplace that is ergonomically dysfunctional. This continuous body pain in affected locations may not allow you have a good night rest because of pain and discomfort, you wake up in the morning feeling more tired than you were before you went to bed. Most times, even feel too tired to go to work and even when you manage to go, the law of circadian rhythm sets in. Because you had sleep disruption, you are at work and yet battling with heavy eyes and urge to sleep. This in turn does not allow an employee to be optimally productive and again leads to presenteeism (you are present at work just to be seen but in the real sense, you are productively absent).

This has a huge adverse effect on both the employee and the employer alike. The employer is not earning the expected production contribution of the employee and the employee when appraised also will not like the outcome of the appraisal and could jeopardise the position of the employee's continuity in the organisation.  

In as much as we love the fashionable and elegant look you seem to portray from the use of these sets of high heel shoes, we are more concerned about your feelings and look in your old-age. That is what sustainability is all about, so long as the high heels shoes and the fashionable look it gives to you cannot be sustained till old-age, then it is unhealthy and unsafe and not worth continuing with. Your feet should be able to function well all through your days at least, without necessarily going through pressures which we are imposing on them today.

It does not matter how long this has gone on, when we make a deliberate and honest decision to discontinue in this act or habit, restoration sets it and you will begin to have your legs back. I think it is worth giving a shot.

This is just a concern expressed in my own honest understanding but i hope it helps all the same. No harm intended at all.

I can reached at ehi@ohsm.com.ng

QATAR 2022: AS THE WORLD PLAYS FOOTBALL IN MIGRANT WORKERS’ BLOOD STAINED STADIA

I am a member of International Commission on Occupational Health (ICOH); I was at the 31^st ICOH Congress 2015 held May 31 – June 5, 2015 in Seoul South Korea. I sat in ICOH General Assembly on 5^th June 2015 when a colleague raised a question on the increasing rate of migrant workers death in Qatar because of the quest to impress the world in 2022 FIFA World cup. I tried to listen to the response of ICOH and its position on this issue but I got worried the more I listened. In my mind, I concluded this as a case no one can look into while the death toll even increases in the days and years ahead. This prompted me to look for reports on this issue and the level of the work done so far in this direction. I became more worried the more lines I read.

Amongst all the reports, I asked myself where is ILO? Where is WHO? and where are the Human Right Lawyers? I felt a bit of Amnesty International’s presence and I was wondering why everyone is quiet over these sad occurrences, we watch healthy young men slaughtered at workplaces in an attempt to earn an honest and legitimate means of livelihood and the whole world is quiet? If the right to safe and healthy workplace is a human right as collectively agreed in one of the global declarations, then we have all failed these murdered migrant workers by such a collective global silence. No life should be lost because the world wants to watch football matches, the football pitches are all stained with innocent migrant workers blood, when we all sit down on those stadia upon completion what do we really see? You may see beautiful matches played but most of us will not see those matches but stains of blood because that is what the stadia in Qatar and the adjoining structures will remind us of.

I got sad when I read the report that after five years of securing the bid to host the World Cup, Qatar’s government is just issuing a statement that significant progress was being made to improve lives and labour conditions of guest workers in Qatar. Who is going to speak for these workers who have got no voice because they have been banned from union representation, who is going to speak for them when the home government in Nepal have issued a careless statement that the migrant workers suffer stroke because they are adjusting to air conditioning systems. The government of Nepal’s interest and concern is only the remittances repatriated home by these people, this forms almost 30% of Nepal’s GDP. Is this enough for any responsible government to maintain silence and watch her people die in foreign workplaces? “Your life becomes wrecked when those who would have spoken in your defense turn their back against you to share Champagne with your adversaries”. This is sad and this describes the helpless case of Nepalese.

Qatar was once one of the poorest Gulf States, now one of the richest countries in the region as a result of the exploration of large oil and gas fields since the 1940s. It has more than 15% of world’s proven gas reserve. It got its independence 1971, has the world’s richest country per capita and ruled since mid-19th century by the Al Thani’s family. Qatar has also been identified as a middle power due to the ways it has projected itself to the world and Qatar is also an influential player in the Arab world.

Qatar has a population of 1.8 million people according to 2013 report which also states Qatari citizens are only 280,000 of the population while expatriates are 1.5 million people. This makes Qatari nationals merely 13% of the country’s population. According to 2013 report, Qatar has 545,000 Indians, 341,000 Nepalese, 185,000 Filipinos, 137,000 Bangladeshis, 100,000 Sri Lankans, 90,000 Pakistanis and many other nationals. This is the biggest ratio of migrants-to-citizens in the world.

Qatar will be the first Arab country to host the FIFA World Cup having won the controversial bid to host the 2022 World Cup and this marks the beginning of man slaughter in workplaces in Qatar. Though there are talks that the small but wealthy Gulf state would be stripped of the competition, amid allegations of corruption at world football’s governing body FIFA. “Qatar 2022 is now being investigated; FBI and Swiss are counting the alleged cost of bribes while Nepal is counting the actual cost of lives”. But will this justify or make up for the blood of innocent and harmless migrant workers who are killed every other day (an average of one death per day) in Qatar workplaces and yet the world seems to pay deaf ears? We allow evil to prevail when the good ones who ought to speak keep a total silence and that is currently the case in Qatar. The government of Nepal leads the position of utmost silence that is interpreted to mean “you cannot bite the finger that feeds you”. Really sad because silence connotes endorsement.

Recently, a story of a Nepalese named Shiva Tamanga who was murdered in Qatar by a Bulldozer in construction site on 19^th April, 2015 as reported by John Irvine, a Senior Special Correspondence at ITV. Shiva only left Nepal to work in Qatar six months before his workplace death leaving behind his pregnant wife; he was brought back to Kathmandu international airport in a coffin after six months. As monks chanted at his cremation, his mother wailed and his widow passed out. This is the story of Shiva Tamanga, one man down but who is next as Qatar’s construction continues.

A number of hardships are suffered daily by migrant workers in Qatar. According to ITV correspondence, one of the Nepalese migrant workers he interviewed anonymously complained about poor treatment and rotten food leading to food poisoning resulting in deaths of three to four workers in his company in Doha each month. He also complained he was having his holiday for the first time in three years because his employer has always refused to release him. He was eventually allowed to go home on this holiday on the condition that he accompanies a body (dead worker) in this journey.

If the world indeed gathers in 2022 to either play or watch world cup matches played in Qatar that will be seen as a global approval and justification for the gruesome deaths of those migrant workers who fall victims to poor labour legislation that has fanned into flame uncontrollable unsafe workplaces scattered all over Qatar. The speed at which construction of roads, stadia, new hotels and other facilities are currently going on at the expense of the huge population of migrant workers currently working in Qatar, needs to be brought to global pedestal for objective balancing. This is wicked, shrewd, rude, inhuman, and unacceptable and must be collectively criticized in one voice. The voice of the blood of innocent workers killed in Qatar cries so loud yet everyone pretends not to hear.

 

According to a recent graphics from Washington Post which suggested that as many as 1,200 migrant workers have died in Qatar since 2010, compared to handfuls of deaths before other recent global sporting events. A number of media outlets worldwide – including Channel 4 News repeated that figure of 1,200 deaths while the Qatar government has responded disclaiming those figures and tag them as untrue. These 1,200 deaths are claimed to be nationals of India and Nepal alone according to figures released by local embassies of both countries.

If indeed these figures are untrue, it is the responsibility of the government of Qatar to tell us the truth supported with evidence.

You will agree with me that most of these deaths are not reported and even deaths that are occupational risk induced could also be wrongly classified. The reason is not far from the poor Labour Legislation in Qatar. In any event, the source of the “1,200 death” figure  which originates in the 2013 report by the International Trade Union Congress (ITUC) is simply the total deaths among the Indian and Nepalese migrant population, not deaths from accident alone or just deaths among construction workers.

So how many people have died while working specifically on World Cup 2022 projects? We do not know but this government of Qatar says it is ZERO! The question is how true is this claim by the government?

There are many numbers of quotes out there like the one in this report from German newspaper Die Welt: “some time ago, Hamid said a worker fell to his death from the roof of a building on an adjacent construction site. In November, 2014 a man had been burnt to death in a fire incidence”.

But this is hearsay, the kind of evidence that would not stand up in a British court, and it is not clear whether the “adjacent construction site” had anything to do with the World Cup. But Amnesty International says it has “no reason to doubt” the claims that no lives have been lost on World Cup construction sites, although it argues that we need a broader definition of World Cup-related building work, saying: “Most major construction projects in Qatar are related to the World Cup”.

The law firm DLA Piper which was contracted by the government of Qatar to carry out an independent review of Qatar’s labour laws, found evidence of at least 22 worker-related deaths among Indian, Nepalese and Bangladeshi migrants in 2013 alone. That is out of the 600 total deaths among migrant workers from these three countries in that year.  

Now we begin to wonder where the claims came from by the government of Qatar that no worker has died working in Qatar on the World Cup project, we are all worried and hold the opinion that Qatar government has a lot to hide in this regard. The earlier they tell the world the truth on this matter, the faster help comes their way.

How dangerous is working in Qatar?

The Qatar government’s press release gives the impression that there are no health risks at all attached to being a foreign worker in Qatar but quite the opposite is the fact. There are more than 1 million migrant workers in Qatar, the Global Burden of Disease published in “The Lancet” in 2012 states that more than 400 deaths might be expected annually from cardiovascular disease alone among Qatar’s migrant population.

Figure sourced separately by the Guardian from Nepalese authorities suggests the total deaths during that period could be as high as 188. In 2013, the figure from January to mid-November was 168.

“We Know that people who work long hours in high temperature are highly vulnerable to fatal heat stroke, so obviously these figures continue to cause alarm”, said Nicholas McGeehan, the Middle East researcher at Human Rights Watch.

It is Qatar’s responsibility to determine if deaths are related to living and working conditions, but Qatar flatly rejected a DLA Piper recommendation to launch an immediate investigation into these deaths last year. It has been quoted in some quarters that the spate of the current heart attacks among migrant workers in Qatar is as a result of dehydration suffered by workers because they are not provided enough water to drink in their workplaces.

The Embassy of Nepal said 191 Nepalese workers died in 2013, adding that “most deaths were a result of cardiac arrest”, according to DLA Piper. A former Nepali Ambassador to Doha has put a more precise figure on the proportion of migrant worker death attributable to “sudden heart attack at 55%”.

Data on causes of death in Qatar is weak, the report adds, as autopsies and post mortem on people who die sudden and unexpected deaths are forbidden by Qatari law unless a crime is suspected. As things stand, there are few reliable statistics on workplace accidents and deaths in Qatar.

Qatar’s current health strategy document states: “Qatar’s vast population of male labourers, primarily in the construction industry, has limited access to healthcare services and also operates in hazardous environments”.

Workplace injuries are the third highest causes of accidental deaths in Qatar. And yet, Qatar does not have national occupational health standards or guidelines and there is limited data on workplace-related fatalities.

It becomes really difficult when even media professionals are not allowed to report on what’s going on in this country. Qatar gets a red rating from Reporters Without Borders, indicating a “difficult situation” for press freedom. Last month a BBC team was arrested and interrogated while trying to talk to migrant workers on fatalities and work conditions in the country.

I strongly believe this is an unhealthy practice that must be collectively condemned in strong words. You cannot expose workers to harsh and unsafe work conditions and want to shield this in secrecy. No, it does not work that way.

ITV News managed to film Nepalese workers in the country, as well as the families of dead migrant been flown back to Nepal in coffins. Nepal’s Minister for labour, Tek Bahadur Gurung, blamed the heart attacks on a problem of “orientation”, saying workers were dying after suddenly turning on the air conditioning in their living quarters.

The suggestion was that the Nepalese government would be reluctant to criticize foreign “partners” like Qatar given the amount of money sent back by Nepalese working abroad. These remittances made up 29 per cent of Nepal’s entire GDP in 2013/14. What a shame and human sacrifice by a country just to earn GDP at the expense of slayed citizens working abroad. It is not normal!

Sadly, we have seen that Nepalese migrant workers are faced with absolute betrayal from even the government of their home country. When truth is slaughtered on the altar of gains, this is always the result. The question is, “who now fights for the right of these helpless sets of people when those who are supposed to negotiate their rights have turned their faces against their collective hurts”. When a government issues a statement as this, it is taken as an approval of injustice and a continuation in status quo.

No matter the amount of remittances contributed to the GDP of Nepal, no amount of money is worth the slaughtering of healthy men who went to work in Qatar in quest of legitimate means of survival. The statement credited to Nepal’s Labour Minister should be used to make a case against him for aiding and abetting the increasing death of Nepalese migrant workers in Qatar. This is such a sorry state which I think Amnesty International should look into.

There are a number of other claims ranging from:

·   Migrant workers reduced to the status of slaves by the “Kafala” sponsorship system which means employers can confiscate passports of migrant workers and withdraw exit visas, effectively restricting them in Qatar.

·       Workers are denied trade union representation

·       Workers are often not paid in full or on time

·       Workers are exploited by recruiters who charge heavy fees from the migrant workers

·       They are forced to live in cramped accommodation of about 18 persons per room

This may only be a partial list, a number of issues possibly exist which are not accessible to the media because of the system that operates in Qatar.

The major report commissioned by Qatar into its treatment of migrant workers produced more than 60 suggested reforms and a confirmation that hundreds of migrants have died and many of them from unexplained sudden illnesses over the past two years, at a rate of more than one death a day. The report by international law firm DLA Piper calls for changes in the much criticized “kafala” system that ties workers to their employers.

Though the artists’ impressions of Qatar’s 2022 World Cup venues, like the Qatar Foundation Stadium, are impressive - but criticism over treatment of migrant workers has dogged the development.

It has been published in a number of papers that there has never been such high worker mortality recorded in the history of nations’ preparations to host the World Cup or any international sports tournament, from Beijing Olympics to Brazil World Cup. A number of people have though argued from different quarters that the deaths in Qatar has nothing to do with the World Cup because construction has been on-going in Qatar even without the World Cup host plan. But the Director of campaign of the International Trade Union Congress (ITUC), Tim Noonan says “although the World Cup stadium was only started last year, subways, hotels, and even an entire city are currently being built, not to mention an airport, numerous roads, a new sewage system in central Doha and 20 skyscrapers. “It needs to be remembered that the infrastructure program in Qatar is entirely built around the delivery date of the World Cup in Qatar”. Tim also said about 900 foreign workers will die per year in Qatar in the years leading to the tournament.

I took time to do this report using information that have been published on the ills in Qatar hoping it will create clarity on these health and safety concerns centered around the migrant workers in that country. We cannot all pretend to keep quiet over these issues while every day that passes, a migrant worker dies. They must not be our relatives before we show honest concerns, we must first see ourselves as “We” (fellow global citizens) before we see ourselves as “I”. “We are all we have”, when we close our eyes to the death of innocent migrant workers, we reduce our collective strength. “The weak needs the strong to stand for him and the strong needs the weak to show the might of his strength”, we all may not have voice that can be far heard but he who has lost his voice needs a brother to speak for him.

The whole world and global political powers may pretend not to know about the goings-on in Qatar, but we all need to remember that we are accountable to our own conscience. As popularly put by the Nigerian Guardian newspapers “Conscience is an open wound, only truth can heal it”.  I will rather be caught speaking or fighting for a cause than take the non-partisan position for fear of being tagged. What is wrong is wrong, no matter the balances where they are weighed and it is our responsibility to speak against them in clear terms.

It will make a global sense, if we all rise and speak against this ill in Qatar and migrant workers get saved than getting excited watching matches in Qatar stadia stained by the blood innocent migrant workers.

I am only an Occupational Health and Safety practitioner in Nigeria and these are my concerns.

I can be reached at: ehi@ohsm.com.ng

References

www.wsj.com: Rory Jones

www.itv.com : John Irvine

www.bbc.com

www.theguardian.com
www.blogs.channel14.com
www.rt.com/news