India’s hidden epidemic

The Ottawa Citizen, October 27, 2008

Canada’s Asbestos Time Bomb Part 3

This week in Rome, 126 countries will debate whether chrysotile asbestos should be added to a ’watchlist’ of dangerous chemicals. Canada, which exports 95 per cent of the chrysotile asbestos it mines, has vetoed the addition in the past, arguing the material can be used safely. Critics at home and abroad call Canada’s position "self-serving." In a four-part series on the eve of the Rome talks, Katie Daubs examines the past and present of Canada’s asbestos legacy.

— -

MUMBAI — On the slow train out of Mumbai, a girl in a yellow dress sings. Her voice rises and falls as the car rattles on the tracks. She points to her stomach, and looks at the passengers with big eyes.

Pralhad Malwadkar digs into his pocket and gives the girl a few rupees. Others grudgingly do the same, forced by his example.

Mr. Malwadkar is, by nature, kind and by profession, compelled to help. On this Sunday in August, he carries a white tote bag filled with X-rays and handwritten medical forms. He works for the Occupational Health and Safety Centre in Mumbai, an organization set up by unions to address occupational health issues. He visits sick workers to update himself on their health, exchange information and encourage them to apply for compensation.

It is challenging, sometimes futile work. When he was first hired, he helped workers with diseases caused by exposure to cotton dust and noise-induced deafness. Then, in 2004, the union sent him to Hindustan Composites, an asbestos-cement factory, to find out if workers were sick from years of handling asbestos.

He, along with a doctor and an assistant, waited outside the factory for several days to talk with the men to see if they had any symptoms of lung disease, especially difficulty breathing. They used what Mr. Malwadkar calls a "lungmometer," which measures lung capacity to assess the workers’ health status. Many didn’t understand why the three were there, and some didn’t bother getting examined.

They examined close to 300 men, and 160 had symptoms that required X-rays. Only 99 showed up for the X-rays, and of those men, 41 were diagnosed with asbestosis. Thirty-six of the men launched a compensation claim in 2005. The factory relocated in 2006, and none of the men have received compensation.

Now Mr. Malwadkar heads back to the northeast corner of the city where some of the sick men live, near the now-empty factory. He meets men like Yeshwant Peje, who has asbestosis, a disease that scars the lungs and can be fatal. Inside his peach-coloured house, Mr. Peje is sick, but has received no compensation. His English is limited: Canada, asbestos and bags, he says.

Mr. Peje explains he wore cotton gloves and a mask on a daily basis. Today, his asbestosis makes him breathless and drains his energy for most things, aside from a bit of yoga in the morning.

He is not bitter. "The risk was assumed," he says through a translator.

Such is the legacy of this country’s miracle fibre: indestructible in heat and cheap to produce.

It’s everywhere — in the asbestos-cement roofs and walls of slum communities, and also in the lungs of an unknown number of workers who are sick from the effects of working with asbestos.

Unlike poverty, asbestosis is hidden in India. It does not sing on trains or beg on the streets. The disease is misdiagnosed, underreported and forgotten, says Madhumita Dutta, a founding member of the Ban Asbestos Network of India.

As India struggles to improve conditions for workers, critics such as Ms. Dutta fear that an already-hidden epidemic will grow as asbestos products, such as the asbestos-cement roofs, spread across the country, providing shelter to the poor. Construction workers and even homeowners may become ill if the asbestos sheets are cut and the asbestos is exposed.

India is Canada’s biggest market, and Canada has been criticized heavily by the medical profession for continuing to export 95 per cent of the asbestos it mines to locations like this. Canada, India’s third-biggest supplier of chrysotile asbestos and the main advocate that it can be used safely, does not monitor workers’ health from afar. A ruling by the Supreme Court of India requires that asbestos-cement factories monitor workers’ health for 40 years, because most asbestos-related diseases have latency periods of several decades. But Ms. Dutta says no factory monitors health after retirement.

"We have a plethora of legislation and court orders, but lax enforcement," she says.

The Citizen went to India to see what the situation on the ground is like. A visit to a factory was not possible. What follows are the accounts of industry representatives, doctors, workers and inspectors that paint a picture of a country that is trying, but some say failing, to meet the requirements to protect, diagnose and compensate workers.

In an office tucked into the Maulana Azad Medical College, the first words from the doctor’s mouth are ominous.

"We are in a perilous situation," says Dr. T.K. Joshi, the college’s director of occupational health. He says asbestos imports are rising, asbestos-cement plants are proliferating and more and more products are being handled outside the factory, where people aren’t fully aware of the risks.

Dr. Joshi has been making noise about asbestos since an American colleague told him his country was being set up for an epidemic of asbestos disease. After Dr. Joshi organized a 2001 conference and questioned India’s ability to control exposure, he says, he went without pay for eight months. He says he stays because his words mean more here. But it has come at a cost. Even among doctors, there is pressure to be quiet.

"They say, ’Don’t talk about asbestos use, talk about tobacco!’" he says. "There is always a bigger problem in India."

In 2006, India, along with Canada and a handful of other countries, vetoed the addition of chrysotile asbestos to the Rotterdam Convention’s Prior Informed Consent list. Chemicals on the list are deemed dangerous, and countries that import them are warned.

India is a country of 1.1 billion people, rapidly developing while encumbered by poverty. Slum dwellers have cellphones, but no clean water. Upper-middle class neighbourhoods crank the air conditioning, while grocery stores in poor neighbourhoods suffer blackouts. It is a country where pigeons nest on flashy new hospital signs describing "state-of-the-art facilities."

In this place of chaotic contradictions, Dr. Joshi says there are simply too many people who come in contact with asbestos to ask them all to take precautions.

As he turns to face a computer screen littered with PDFs, he gives a brief rundown of India’s asbestos history. The country has used the mineral for decades, but it’s only been the past few years that asbestos-cement factories have proliferated, providing rooftops for India’s poor. According to his statistics, where there were 32 asbestos-cement factories in 2003, there are now 131. They produce pipes, brake pads and roofs. It is the roofs, especially, that are a sign of the country’s development: more durable than a thatched straw, less work than clay tile.

New asbestos mines are banned in India, but tremolite and chrysotile mines that existed prior to the ban are still allowed to operate. They do not produce enough asbestos to meet the increasing demand, so Indian companies import from Russia, Brazil, Canada, Zimbabwe and Kazakhstan. Dr. Joshi says that, in the ’90s, the government lowered tariffs on chrysotile asbestos, making it a crucial component of India’s newly liberalized economy. Asbestos from Canada flowed, with assurances that its hazards could be regulated.

The Chrysotile Institute is a Canadian body funded by the asbestos industry and the federal government with a mandate to promote the safe use of chrysotile asbestos abroad. The institute conducts safety workshops and provides training in countries like India.

But critics like Gopal Krishna, of the Ban Asbestos Network of India, say those seminars do not translate into action. Mr. Krishna went to one a few years ago. "They told us something about walking across the road, that you have to walk safely and take precautions — that safety is all about controlling risks," he says. "I said, ’We have to ensure people can read before we can control risks’."

Brigadier Sethi, of the Asbestos Producers Cement Manufacturer’s Association, says conditions in Indian factories are on a par with international standards.

A 1995 Supreme Court order dictates that fibre levels have to be kept below one fibre per cubic centimetre, which is the same standard as in Quebec, but 10 times more lenient than in Ontario.

"You know, maybe there’s the odd case where someone would have told you that (the rules aren’t enforced), but the people who are actually handling the fibre, they all take proper precautions," he says.

Dr. P.K. Nag, the director of the National Institute of Occupational Health (NIOH), says the institute has not done many studies on asbestos recently. The institute examines all kinds of occupational problems, and asbestos is just one. He points to a 2005 study from the Central Labour Institute that shows that asbestos exposure in asbestos cement and brake assembly factories in Mumbai is low.

"Except in some cases, most of the factories are within one fibre per cubic centimetre. A couple of places it was more than one, in a couple of places, less than one," he says.

In comparison, studies done by the NIOH in the ’70s reported fibre levels of 20 fibres per cubic centimetre at asbestos-cement factories.

"Those days are gone," says Dr. Nag. "The situations are not the same today. Asbestos factories are well-managed, in the organized sector."

Dr. Nag says there is no information about the risks in the construction sector, where many of the asbestos-cement products are used.

"As a scientist, I know asbestos has long-term effects. It is very difficult for us to see the gravity of the problem, because we have not made any long-term followup," he says.

Recently, the Ban Asbestos Network of India called the neutrality of Dr. Nag’s institute into question when an access to information request revealed the institute had received 16 lakh rupees ($36,900 Canadian) from the asbestos industry for a 2006 study.

"We get money from different agencies, primarily government bodies. We do not know. It is not our lookout," Dr. Nag says. "We are neutral. It’s a government body, directly under the ministry of health and family welfare."

Indian factories fall under the purview of the Indian Factories Act and case law. Workstations where asbestos is processed have to be enclosed, asbestos wastes have to be safely disposed of, asbestos levels have to be monitored, workers have to be properly protected, medical exams have to be given to workers, and medical records have to be kept for 40 years.

Although there is adequate legislation, critics like Dr. Joshi question whether there is enough manpower to enforce the rules.

Before he retired in 2006, Vijay Kumar Sharma was one of eight inspectors in charge of 8,000 factories in the New Delhi region. Six of those were asbestos-cement factories.

He says with the current number of inspectors in his region, it would take 10 years to inspect all 8,000 factories once.

Mr. Sharma agrees that there have been marked improvements since the 1995 Supreme Court order. He says management provides masks, but workers don’t necessarily wear them because they are uncomfortable.

"Occupational safety is nowhere enforced strictly," he says, adding that a fundamental problem is even getting unions to record the names of their workers on a master roll.

Dr. S.K. Dave, an adviser at the Gujarat Cancer and Research Institute and a former director at NIOH, says no one wants to take the issue seriously. "On paper, everything is there, but in reality, it is a minimum of things that are happening."

Clément Godbout, president of the Chrysotile Institute, says the situation is under control in India. He says there are wet processes to keep the dust down, and automation so employees don’t have to handle the fibres. He says asbestos doesn’t get sent to "Mom and Pop" operations, and Canadian companies have agreed to terminate contracts with companies that aren’t being safe.

"(Do) we have the responsibility as a Canadian to make sure that nothing’s going to happen anywhere?" he asks.

He says it’s impossible to see all the factories and meet all the workers.

"I have to talk to the industry, the government, the labour industry, I have to say, ’Take these conditions, make sure you don’t make the mistake we made 35 years ago, or this is the result you’re going to get if you’re not doing this.’

"We have done our job, and we try to do it the best we can."

Mr. Malwadkar goes from home to home with Anthony Venezes, a union representative who speaks impeccable English and who, like Mr. Peje, worked at Hindustan Composites, making asbestos-cement sheets. He was there for 29 years.

He has difficulty breathing, but is not as sick as the other men to be visited this day. He credits his homemade mask, yoga and bananas; he eats eight a day.

In the ’60s and ’70s, masks were only worn when the factory’s British owners came to visit. In the ’80s and ’90s, masks were worn sporadically. A machine to expel the asbestos dust was used, but run at a low setting to save money, he says. He says in 2002, safety measures were stepped up, and masks were given out every day.

Mr. Venezes takes Mr. Malwadkar to visit 63-year-old Baban Shirgaonker, who works inside his son’s printing shop. Mr. Shirgaonker sets up a few plastic chairs and sends a small boy for tea. In the shop, he helps his son print birthday cards and wedding invitations, and there’s also a phone booth where customers can make long-distance calls.

Mr. Shirgaonker was diagnosed with asbestosis after meeting Mr. Malwadkar at the factory gates and being tested. He explains through a translator that when he was 19, he got a job as a machine operator at the factory. His job was to cut the asbestos brake liners for scooters and cars. Sometimes he wore a mask.

Mr. Malwadkar reaches into his tote bag and pulls out Mr. Shirgaonker’s X-ray. He holds it up to the light and points to the small spots on the middle and lower part of the lungs. These spots — asbestosis — make it impossible for Mr. Shirgaonker to breathe with ease.

He says the company sent them for medical checkups every year, but they were never told if there was a health problem

"We asked them and they said, ’Nothing has happened to you, all the reports are clear’," Mr. Venezes says. In Mr. Shirgaonker’s case, the men say, doctors and lawyers at the company attribute the illness to smoking and drinking.

But Mr. Venezes explains all the men used to drink heavily because there were rumours that alcohol would "kill the fibre" in their lungs.

The men laugh.

"It wasn’t good stuff, either," says Mr. Venezes. "It was home-grade, awful alcohol. Awful stuff."

Every time Mr. Malwadkar visits the 41 men who have claims, the news is the same: the case is pending. Always pending. Other workers won’t even bother to fight. One of the biggest problems he faces is getting the men to follow through with their claims. Many don’t believe anything will come of it, and others are too sick to worry about matters that won’t be important when they’re dead.

"They think, when we were in the factory, they didn’t give us anything, why would they now? It’s closed and moved," Mr. Malwadkar says.

"Some men were so illiterate. They were gardeners, roadside workers, and they were given more payment as a helper at the factory. Most of the people just needed to get jobs," Mr. Venezes says.

It is very difficult to get a diagnosis for an asbestos-related disease in India. Dr. Joshi says many doctors don’t know what to look for, and Madhumita Dutta, of the Ban Asbestos Network Of India, says there are many misdiagnoses of tuberculosis.

Dr. Joshi has a hodgepodge of statistics from states that report occupational disease: four cases of asbestosis in West Bengal in 2000, none in 2001. One case of asbestosis diagnosed in the entire country from 1978 to 1983. In 2003 and 2004, no asbestosis reported in Tamil Nadu.

Critics say India desperately needs diagnosis centres with physicians trained to identify these diseases, and a national registry. As it stands, there are only bits and scraps of information.

"Just because there’s a lack of evidence doesn’t mean there’s a lack of a problem," says Ms. Dutta. "It’s criminal."

Ms. Dutta says in four decades of heavy asbestos use, 34 cases of asbestosis have been compensated by the official compensation body, the Employees’ State Insurance Corporation. She says three cases of mesothelioma have been compensated by a private company.

Through one access to information request, Ms. Dutta discovered 107 cases of mesothelioma diagnosed between 1985 and 2005 at the Tata Memorial Hospital in Mumbai. Mesothelioma is a lethal, rare cancer that affects the lining of the lungs, and is increasingly common in Canadian communities that used to thrive on asbestos.

Ms. Dutta says no work histories were taken of the men and women who had mesothelioma at the Tata Memorial Hospital. They were never formally acknowledged or given a certificate for compensation.

No one in India could provide definitive numbers of how many people have been affected by exposure to asbestos. By taking asbestos-mortality rates from Europe and the U.S. and applying them to the Indian population, Gopal Krishna, of the Ban Asbestos Network of India, estimates 30 people die every day of an asbestos-related disease. He says this is a conservative estimate.

The government of Canada does not collect data on asbestos-related diseases in importing countries. Instead, it refers inquiries to the International Agency for Research on Cancer’s publication, Cancer Incidence in Five Continents, Volume 8. If you look there, you won’t see Baban Shirgaonker or Yeshwant Peje.

As the sun begins to set, Mr. Peje, Mr. Venezes and Mr. Malwadkar stare at the closed-down factory, which is 500 metres away from its white gates. The word asbestos, cast in iron, is two feet above their heads. All around the factory, new apartments and shopping malls are going up.

When the Citizen reached Hindustan Composites by phone, a representative requested an e-mail message. Multiple e-mails were sent to different company addresses, but no response has been received.

In India’s Asbestos Time Bomb, a book published by occupational rights groups, a letter written from the Hindustan Composites plant manager to a trade union representative sheds light on the company’s stance:

" ... the conclusions drawn by you, that workmen listed are affected by asbestosis are far-fetched, not supported by sound medical inferences and are with certain motives. The company has qualified medical practitioners for regular checkups and maintains the records as per the rule and regulations as laid down by the Directorate of Industrial Safety & Health."

Mr. Venezes and Mr. Peje — two men who never got to see their health records — take another look at the factory, say goodbye and return home. Mr. Malwadkar takes an auto rickshaw to the train station.

It is completely dark by the time the train reaches his stop. A lover of the German language, Mr. Malwadkar says, "Auf Wiedersehen!", laughs and walks away.

This won’t be his last visit to see the men. He will go back in a few weeks.

He might even go wait outside the gates of Hindustan’s Jalna plant, which is a 12-hour train ride away.

"I may go up there ... to go and see," he says. "In fact, it is necessary."

© The Ottawa Citizen 2008