Extract of discussions put together by:
OSHAfrica, in collaboration with Asbestos Disease Awareness Organisation (ADAO), National Institute of Occupational Health (NIOH), African Union Development Agency (AU-DA) recently hosted a successful webinar on Asbestos. Moderated by Ehi Iden President of OSHAfrica with Linda Reinstein CEO of ADAO (USA) gave the keynote address Other participating speakers were Dr Dingani Moyo (Zimbabwe), Norman Khoza (South Africa) and Wale Bakare (Nigeria), with guest appearances of Alec Farquhar, co-ordinator of Asbestos-Free Canada and Kevin Hedges on the Board of Directors of Workplace Health without Borders (WHWB). Participants were welcomed by Dr Thuthula Balfour Vice-President, OSHAfrica who commented that asbestos still causes a lot of ill health on our continent and she launched the webinar which ran for almost two hours.
To set the scene, Iden gave us the shocking statistics that only 7 countries in Africa - South Africa, Algeria, Egypt, Djibouti, Gabon, Mauritius and Mozambique - have legislated against asbestos. He then continued “Asbestos is known to have hazardous properties, yet it is still used in Africa, even though it is the cause of ill health and cancer leading to a certain death. We desperately need to do further research, but Africa unfortunately suffers from data gap prohibiting this research. We know that for over 100 years Africa was the highest exporter of asbestos in the world” He then asked “Why are governments so quiet?” before handing over to Linda Reinstein.
Linda Reinstein, President of ADAO resides in America and opened with the sobering statement that although America has a long and tragic history with asbestos, it still continues to import this deadly product. She shared a slide which illustrated that during 1906, the first asbestos-related disease was recorded. That was 116 years ago, and yet it continues to be mined and used, even though its dangers are broadly known. Asbestos is found in many products, from industrial to household products, and to illustrate her point, Reinstein showed us a photo of children’s crayons.
Often the problem comes down to ignorance. Worldwide there are still 5 asbestos producing countries: Russia, Kazakhstan, China, Brazil and Zimbabwe .It is unlikely that mining in these countries will stop anytime soon, therefore, it is necessary for everyone to be properly educated in the dangers of asbestos. Workers especially those who handle asbestos, or work near it must be educated in its dangers and trained in its safe handling. Unfortunately this doesn’t always happen. And with tragic consequences, the industry sometimes uses misinformation to get their product sold. Available statistics tell us that 250,000 people worldwide are still dying as a result of exposure. But due to the lack of data, especially in Africa where many people die in the rural areas with no record of their causes of death, these figures are probably way higher. Those companies who do not honestly track the causes of their employees’ deaths, must also take part of the blame.
With asbestos found in so many places, dangerous levels of exposure increase during times of disaster. This was seen after the terrorist attack on New York’s World Trade Centre when buildings collapsed and asbestos dust filled the environment. The tragic consequences will be felt for many years to come. There is also a danger of secondary exposure when a worker returns home still wearing the same clothes he wore at work which are covered in asbestos dust. Reinstein’s interest in asbestos started after her husband, Allen succumbed to Mesothelioma. She spoke about Allen, about his illness, about the time they still had.
together when he was ill, and then she spoke about the loss to her family. There are millions of other Allen Reinstein's, but they are all anonymous to us. My father Alec and his younger brother Isaac were also victims of asbestos, both losing their lives to mesothelioma during the 1990s. They worked in different places and lived in different cities. Isaac was a sheet metal worker and Alec worked in a factory that cleaned bags which were used to transport asbestos. The workers were not supplied with PPE and there was no ventilation. At the time he didn’t know about the dangers of asbestos and nor did any of the 80 workers he spent his days with. It was the early 70s and although Doctors already knew about its deadly effects, there was no public awareness. When he was diagnosed and asked where he could have picked up the disease, he couldn’t remember at first. Working with asbestos at the time seemed a non-event. Twenty years later it was no longer a non-event. When we tried to find out how many of the other workers had also died from asbestos exposure or were living with ill health due to it, we found that all documentation was lost during a fire, leaving us with no data.
Reinstein then raised the point that living near good medical facilities, Allen had good medical care throughout his illness. But worldwide, many sufferers don’t have that luxury. They live in rural areas far from any hospital and good treatment is out of their reach. It is for this reason she emphasized that all countries must act as one. All countries must collaborate, communicate and act together to get asbestos banned and populations educated about its exposure.
“I think that international companies should be held responsible. Countries that have no asbestos legislation need to know that they must have prevention methodologies and occupational medicine interaction. Along the way, we will have many failures, but we must turn those failures into successes. Asbestos knows no boundaries and borders. We must embrace education, advocacy and community support and take it to the next level so that everyone knows what we know. Can we prevent exposure to asbestos to eliminate the disease? I say yes!” she concluded.
Occupational Medicine, Health and Hygiene
Ehi then introduced Dr. Dingani Moyo who opened with the statement “Africa has been the biggest exporter of asbestos for over 100 years. This is a painful truth and it’s our responsibility to do things differently going forward”. Asbestos exposure cannot be solved in isolation, it is part of the occupational health and safety discipline. But, access to OSH world over is only at 15%, and even less in Africa leaving a holistic approach to OSH still a fantasy. A strategic paradigm therefore needs to be embraced which will see the development of organised OHS services, and asbestos an occupational health hazard that must be managed in a systematic way by all countries. Its elimination and management must be looked at holistically, all the way from mining to usage to the supply of PPE otherwise it will continue to be with us for even longer than is necessary.
The long latency period from exposure adds to the difficulty of its management and will see it being part of the occupational health discipline for a long time to come. Although primary prevention is vital, it is too late for the millions who have already been exposed. Exposure that may have happened during their past working lives, from living near asbestos mines, or other high risk areas such as railway lines, or even children who played in asbestos dumps. The frightening reality is that even those countries who have banned asbestos, still carry a heavy burden of asbestos related diseases amongst their populations who are daily presenting with the illness. Surveillance systems must be put into place for those already exposed, and medical facilities to take care of these people who present with the disease and who need psychological support is necessary. Thousands of people are suffering now and thousands more will develop the disease and suffer into the future. Even if we see total elimination now, the disease will live with us for many years to come.
“It is a challenge for every country to manage this ongoing problem properly. We need to build capacity in the field of OSH to spread the word and therefore create awareness. We need to embark on evidence based knowledge and to characterize the burden of these problems in our countries. Even those countries who have banned asbestos cannot be complacent”, concluded Dr. Moyo.
Policy and Political Commitment
Norman Khoza highlighted that although asbestos is an occupational and public health issue throughout the African continent, the African Union unfortunately still has a limited understanding of occupational health and safety and asbestos which is part of it. Too many countries in Africa do not have enough public health commitments, and poverty which is widespread also plays a role. With only 7 countries out of 54 having banned asbestos, this issue needs to be addressed urgently and changes in policy and political commitment need to be made. Awareness must be taken to the doorstep of parliament and our message must be packaged so that parliamentarians really understand the problem. Without a proper understanding, many governments and corporates will see it as a balancing act between the economy and health of the people. Asbestos is an occupational health hazard and for it to be properly managed, must be treated as such.
Management of the problem must start with political commitment through the implementation of national asbestos policies, implementation of regulations and declaration of protocols. Countries need to develop policies not only in the workplace, but also recreational facilities, hospitals, schools, anywhere that asbestos is found. Asbestos mines in our communities need to be identified, a list drawn up and strict legislation implemented. National asbestos strategies for the management of asbestos in factories, public and private institutions where asbestos can still be found must also be legislated. Thorough risk assessments must be done. Asbestos inventories are necessary to understand where asbestos is to be found and how to contain it. Where there is no budget available to remove it, then it must be contained with everyone understanding that it cannot be disturbed. If asbestos is not disturbed, it is not dangerous. But the lack of data on our continent remains the problem, we cannot achieve this without data.
Khoza then gave some examples of asbestos usage on the continent: “Our problem is widespread. Last year we were summoned to assist in Lesotho after a storm damaged a huge hospital and hail damaged the roof which was made of asbestos. Until then there had been no problems with the hospital. But the storm changed all of that. I went with Dr. Moyo and other professionals to do an assessment and give advice. In other situations, I have seen photos of principals stand in front of their schools and behind them you see a piles of asbestos just lying around”. Using South Africa as an example where asbestos is legislated, Khoza then said that a lot can be learned from South Africa where laws and legislations are continually overhauled with exposure limits rewritten, updated and changed.
“The African Union is looking at a protocol that will govern operational authenticity and compel all African countries to sign and commit. Unfortunately, resistance and a lot of the problems lie with international companies who operate in Africa. Many of them apply different standards in Africa to what they apply in their home countries. This can be fought if governments in African countries are truly committed. It is sometimes hard to articulate the problems that we have. To achieve our goals, we need to hold policymakers accountable. I cannot emphasize strongly enough that we need to drive a data policy”, concluded Khoza.
Asbestos in Nigeria
Wale Bakare spoke mainly about the problems still experienced in Nigeria which he said “regretfully is not one of the countries that has banned asbestos”. Since 2011 the National Environmental Construction Regulations have been in place in Nigeria and Section 14 addresses asbestos. The updated National regulations now advise that asbestos should no longer be used in new construction, but even if this was achieved, the latency period of asbestos exposure remains a problem. During the oil boom of the late 1900s, asbestos was imported on a huge scale into the country. Housing developments sprung up using the cheapest products available which of course was asbestos. Now 30-40 years later many of these houses are degrading and asbestos fibres are being released into the living space of the occupants. This brings to the surface another hurdle the country faces which is the acute lack of awareness among the people who do not understand the inherent danger in the use and handling of asbestos. The challenge for the country is to achieve an all-encompassing ban.
In Nigeria, there is an appalling lack of data. Wale has tried to get data on how many people have actually lost their lives or suffered from an asbestos-related disease. As of 2018, the data available shows only 140 related asbestos diseases in the country, a country that has used over 1.1million tons of asbestos and has a population of over 200 million. “This is totally impossible” continued Wale “Some people don’t realise that they are suffering now from exposure of 40 years previously”.
During environmental awareness week in 2015, the Commissioner for Works in Lagos State advised people to remove all the asbestos roof sheets from the homes. Her intentions were good and she even suggested that they put the discarded sheets in the front of their homes which would be collected by the State. This well-meaning suggestion highlighted the lack of awareness of the dangers of asbestos - if a government official didn’t understand, you cannot expect the general population to understand. Since then there has been a marginal improvement in understanding and awareness, but it is still abysmally low and is the reason asbestos is not getting the attention it deserves.
Like his colleagues, Wale believes asbestos needs to be managed holistically. But motivating for a total ban in countries where asbestos is used for economic reasons will be met with resistance, especially among those who know that undamaged asbestos which is left alone is not a health risk. However, there are a lot of new building developments across the continent, where old houses are demolished to make way for modern ones and exposure is rife with dire consequences. Although asbestos was used extensively in roofing, flooring, plumbing and sanitation, very few precautions are taken when these houses are broken down.
“The New-Jack reaction is to rip-off anything that contains asbestos in your homes or workplaces. Please do not do that. Removal needs to be done in a safe manner, so rather leave them in place if they are not broken. No dose of asbestos is acceptable, no matter how small it is. We must synchronise our actions through OSHAfrica. Our countries must meet the minimum levels of education about asbestos. Everyone, in every country must be enlightened about asbestos. Minimum levels of precautions must be put into place. The disposal of asbestos must be strictly monitored. The menace of this material must be known”, concluded Wale Bakare.
Lessons from Canada and abroad
Illustrating the fact that the long latency period is a reality and a problem, Alec Farguhar, Co-ordinator of Asbestos-Free Canada told us that although Canada banned asbestos in 2018, they still have 2,000-4,000 deaths every year from asbestos cancer. Their fight to get asbestos banned was long and hard and took decades to achieve against the powerful Canadian asbestos industries, one of the most significant influential industries in the country. From 1880-2012 Canada exported vast quantities of asbestos from all over the world, directly causing the death of many. Canada now has a Workplace Health Without Borders working group on asbestos. With a lot of expertise in that group, their aim is to have an impact on the struggle and real frontline situation of workers with a focus on promoting substitutes for asbestos. “Hopefully other places won’t have to re-learn all the lessons we learned the hard way. You can pick up on our lessons. We know what it is like to fight a powerful adversary”, concluded Alec.
Kevin Hedges on the Board of Directors of Workplace Health without Borders, and a former President appeared briefly promising commitment and support from the organisation.
To drive home the point that is asbestos is dangerous and rife, Iden in his closing comments reminded us that asbestos is found in thousands of products we encounter on a daily basis and not only roofing sheets, fire blankets, water supply pipes, clutches, brake linings, gaskets of automobiles, both toys for children as well. Some products only have traces of asbestos, but many with high asbestos contents are silently infecting us. When asked if OSHAfrica is working together with the ILO, he confirmed they are. For example, together they are studying water contamination and looking at the implementation of monitored dumping sites across Africa where a disposal certificate must be supplied. In some of the countries where up to 70 percent of the population may be living in houses constructed with asbestos, the correct procedure for removal and disposal has to be taught.
OSHAfrica’s collaboration with many organisations both in Africa and beyond has put it onto a better pedestal to start driving an initiative across the continent, with this webinar as the starting point. He suggested that OSHAfrica should launch a movement to get petitions signed directed at countries that have not banned asbestos. He believes that if education campaigns across Africa were implemented, people would not buy asbestos knowing the risk. He also wants smokers to know that asbestos exposure for them will increase their chances of lung cancer. But to drive all these policies, data is needed, and data across Africa is lacking. Data can only be collected if governments are committed, if organisations and Doctors collate and provide the correct information and if medical support and care is taken to the rural areas.
To an overwhelming support, OSHAfrica agreed to form the African Asbestos Prevention and Control Programme. Participants were told it is their moral responsibility to go back to their country with this initiative, to make their policy makers accountable, and fight for changes, including a review in legislation and the improvement of working conditions.
“Some countries have a zero asbestos policy in their workplaces. In the UK, asbestos awareness training, the law compels anyone working in construction to undergo asbestos awareness training. We need to do the same. If we do not fix it now, our children and our grandchildren will become victims of our silence. We are morally bound for the future of Africa. We must all stand together and build the Africa that we want. We want the world to hear what we, OSHAfrica is doing.” concluded Iden.