workers' rights

Asbestos harms the health of millions of Indian workers. Will the government finally move to ban it?

The Conference of Parties to discuss three conventions that aim of protecting people from hazardous chemicals is underway in Geneva.

Last July, 41-year-old Rajesh Vyas, a resident of Ahmedabad, died of mesothelioma – cancer of the protective layer of the lungs called mesothelium. Medical experts believe that exposure to any form of asbestos can cause mesothelioma.

Rajesh Vyas did not work at an asbestos factory but his father Kalidas Vyas worked as an engineer at Gujarat Composite, a factory in Ahmedabad that manufactures asbestos cement roof sheets. The family lived in a colony for the factory’s workers and their house was in front of an asbestos waste dump site. This is where Rajesh Vyas grew up and it is likely that he was exposed to asbestos there.

The Occupational and Environmental Health Network India, a network of victims groups, trade unions, civil society groups and labour groups across India, has identified at least three more cases of cancer linked to asbestos exposure among workers at Gujarat Composite – one with cancer of the tongue, another with cancer of the epiglottis and one man who, like Rajesh Vyas, died of mesothelioma.

Asbestos – specifically chrysotile asbestos also known as white asbestos – is used in a number of industrial processes like the manufacture of asbestos-cement sheets and pipes, brake shoes, brake linings, clothes and ropes. It is also used in cement construction like roofing, jointing and gaskets and asphalt coats and sealants. Asbestos is one of the most hazardous materials that workers at Alang shipyard, who dismantle old and decommissioned ships, handle.

Thousands of people in India are directly exposed to asbestos while working in factories and handling the material. As asbestos gets stuck to the clothes and hair of these workers, they might pass particles of asbestos on to other people they come in contact with and thereby millions more have secondary exposure. Asbestos fibres, when inhaled, and reach the lung start to damage the lung cells and result in asbestosis, which is chronic inflammatory and scarring of the tissue of the lungs resulting in shortness of breath, a cough, loss of appetite and weight, chest tightness and pain and clubbed fingers. The risk of lung cancer among people exposed to asbestos is seven times higher compared with the general population. Moreover, the symptoms of asbestos exposure take between 10 and 40 years to manifest.

The asbestos burden

The World Health Organisation finds that the global burden of mesothelioma is unclear but points to studies that indicate that about 43,000 people around the world die of the disease every year. The average incidence of asbestos-related cancer in the United States is one case every year in every 1,00,000 people, according to the records maintained by the National Cancer Institute for the years between 1975 and 2010. Mesothelioma deaths in the United Kingdom progressively increased from 153 deaths in 1968 to 2,360 in 2010 and have stayed at this level.

The Central Labour Institute in India finds that there is a 7.25% prevalence of asbestosis among workers in the country. Approximately 80% of mesotheliomas occur in men exposed to mineral fibres at workplaces and sometimes in their family members or in persons who live near asbestos sources, according to the Central Pollution Control Board.

Although asbestos is banned in many countries around the world, it continues to be used in India, the largest importer of the material. Asbestos and asbestos-containing products are manufactured in more than 150 factories in India. About 77% of these units are located in Gujarat and Maharashtra alone. According to a report of the Working Group on Environmental and Occupational Health in India there are between two million and three million active workers suffering from exposure to asbestos and other dangerous fibres.
This is why the Conference of Parties to the Basel, Rotterdam and Stockholm conventions, three conventions drawn up with the aim of protecting people from hazardous chemicals, that is currently underway in Geneva is important for workers in asbestos-related industries in India.

The three international treaties

  • The Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and Their Disposal is an international treaty designed to reduce the movements of hazardous waste between nations.
  • The Stockholm Convention on Persistent Organic Pollutants is an international environmental treaty that aims to eliminate or restrict the production and use of persistent organic pollutants. 
  • The Rotterdam Convention on the Prior Informed Consent Procedure for Certain Hazardous Chemicals and Pesticides in International Trade is a multilateral treaty to promote shared responsibilities in relation to importation of hazardous chemicals

Representatives of the Government of India are participating in the conference where there will be discussions to include asbestos on the Prior Informed Consent list. Countries exporting substances on this list need to notify and get informed consent from the importing country before sending the materials across. Asbestos-exporting countries like Russia, Kazakhstan, Brazil and Zimbabwe are likely to do everything they can to stall the inclusion of asbestos in this list.

Asbestos has been banned in 55 countries. Nepal banned the toxic material in 2014 and Sri Lanka is in the process of phasing it out. India, however, has been reluctant to stop the import and use of asbestos.

India’s stand at previous convention discussions has been inconsistent. In 2011, a representative of the environment ministry argued that it must be declared a hazardous material. In 2013, India opposed listing chrysotile asbestos as a hazardous substance. India has also resisted the inclusion of asbestos in the Prior Informed Consent list, citing lack of data.

No data is available to establish the prevalence of Asbestos disease in small and medium scale enterprises using Chrysotile asbestos. Lack of such data has been an issue of greater concerns of the stakeholders and the Government for making a policy decision for inclusion of chrysotile asbestos under the Annex-3 of the Rotterdam convention to which India is a signatory to ban the same.

— Report of the Working Group on Occupational Safety and Health for the Twelfth Five Year Plan

Even if asbestos is included in the list, asbestos will not be banned in India, as it should be.

In 2009, the United Progressive Alliance government introduced The White Asbestos (Ban on Use and Import) Bill, 2009 in the Rajya Sabha, but it never became law. Now, Anil Dave, the new environment minister in the Narendra Modi government has said that the use of asbestos should be minimised and should eventually end.

The hope is that now, the Indian representatives will back the minister’s words with action at the Conference of Parties and insist on its inclusion in the list – a move that could help save thousands of workers, their families and communities.

The writer is the national coordinator of the Occupational & Environmental Health Network India.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

At the Emory University Hospital in Atlanta, visitors don’t have to worry about navigating their way across the complex hospital premises. All they need to do is download wayfinding tools from the installed digital signage onto their smartphone and get step by step directions. Other hospitals have digital signage in surgical waiting rooms that share surgery updates with the anxious families waiting outside, or offer general information to visitors in waiting rooms. Many others use digital registration tools to reduce check-in time or have Smart TVs in patient rooms that serve educational and anxiety alleviating content.

Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

At the Hospital Leadership Summit hosted by Abbott, some of the speakers from diverse industry backgrounds brought up the role of entrepreneurship in order to deliver on patient experience.

Getting the best from collaborations

Speakers such as Dr Naresh Trehan, Chairman and Managing Director - Medanta Hospitals, and Meena Ganesh, CEO and MD - Portea Medical, who spoke at the panel discussion on “Are we fit for the world of new consumers?”, highlighted the importance of collaborating with entrepreneurs to fill the gaps in the patient experience eco system. As Dr Trehan says, “As healthcare service providers we are too steeped in our own work. So even though we may realize there are gaps in customer experience delivery, we don’t want to get distracted from our core job, which is healthcare delivery. We would rather leave the job of filling those gaps to an outsider who can do it well.”

Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

  • Check-out management: Exclusive waiting rooms with TV, Internet and other facilities for patients waiting to be discharged so as to reduce space congestion and make their waiting time more comfortable.
  • Space for emotional privacy: An exclusive and friendly space for individuals and families to mourn the loss of dear ones in private.
  • Online patient organizer: A web based app that helps first time patients prepare better for their appointment by providing check lists for documents, medicines, etc to be carried and giving information regarding the hospital navigation, the consulting doctor etc.
  • Help for non-English speakers: Iconography cards to help non-English speaking patients express themselves and seek help in case of emergencies or other situations.

As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.