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The inhalation of significant amounts of silica dust over an extended period of time may result in the development of silicosis, a potentially fatal, irreversible, fibrotic lung illness. Silicosis typically only manifests itself after significant occupational exposures. The disease has a long latency period and may clinically present as an acute, accelerated, or chronic disease. Silicosis can be categorized as acute silicosis, accelerated, and chronic on the basis of radio‐ logical findings and length of silica exposure.In some cases, silicosis may be associated with the concomitant development of other diseases, including tuberculosis, cancer, or autoimmune disease. There is currently no known cure or efficient treatment for silicosis. Numerous federal and state agencies have introduced stringent measures to avoid the development of silicosis in some employees as a result of the link between occupational exposure to silica and the subsequent development of the disease. These regulations generally emphasize adequate ventilation on job sites and limiting the amount of time workers may spend in potentially exposing environments.The epidemic of silica-associated disorders is common among workers of low and middle-in‐ come countries like India, China, Brazil, and South Africa.In a developing country like India, mining is one of the important occupations with approximately 1.7 million workers at ahigh risk of exposure to respirable silica.Many attempts have been made for mitigating the prevalence of silicosis as it is one of the major global health hazards. As silicosis is incur‐ able but a preventable disease, awareness about its causation is the main tool for its prevention. The present study was conducted to assess the awareness for silicosis among the among quartz and feldspar mine workers of Beawar, Masuda, Nasirabad and Kishangarh sub-districts of Ajmer.

1. V. Leso, L. Fontana, R. Romano, P. Gervetti and Ivo Iavicoli (2019) in their research gave the design to assess the hazardous properties of AS dusts, levels of exposure in workplaces, and the effectiveness of protective equipment appears to be needed to increase awareness concerning AS risks and induce employers, employees, and all factory figures that are engaged in prevention to take action to define/adopt proper measures to protect the health of exposed workers.

2. D. Rees and J. Murray (2020) in their paper analyzes the exposure to crystalline silica dust causes multiple diseases, but silicosis and silica dust-associated tuberculosis (TB), in particular, are the two diseases that remain high on the list of occupational health priorities in low-income countries and that still occur in some high-income countries. The prevalence of silica-related TB is exacerbated by the human immunodeficiency virus (HIV) pidemic in low-income countries. This review describes the morphology of silica and the variable potency of the different forms. Sources of crystalline silica are discussed, with emphasis on less commonly recognized sources, such as small-scale mining operations and agriculture.

3. Jana Adamcakova and Daniela Mokra (2021) reviews new information on the pathophysiology of silicosis and points out several promising treatment approaches targeting silicosis-related pathways. They have proposed various methods of precaution for stone workers for prevention from silicosis.

Study Area

Ajmer District is situated in the center of Rajasthan state lying between 25o38’ and 26o58’ North latitudes and 73o54’ and 75o22’ East longitudes. The district is surrounded by Jaipur and Tonk districts in east and Pali district in west, Nagaur district touches its north boundaries while Bhilwara district lies in the south. The total geographical area of Ajmer district is 8481 Sq. Km. The district has no natural division. Feldspar deposits are scattered in large area of Ajmer district. The principal occurrences are in Beawar, Masuda, Nasirabad, Kekri, Sarwar and Kishangarh tehsils. The feldspar deposits of Ajmer district are largely potash bearing. The quality of feldspar produced in Ajmer- Beawar area is good with Potassium content 11% to 14% which meet the world market standards. The most significant feldspar producing sites, where high grade feldspar is being mined, are the potential areas of the Jawaja group, Makrera-Rajgarh group, and Tilora-Piproli group of mines.

Fig: Location Map of Study Area

Impacts on Health

Quartz and feldspar minerals contain silica. Ball mill units pulverize these minerals in different mesh sizes for various industrial uses. Pulverization process of quartz and feldspar generate fine silica dust containing respirable suspended particulate matter (RSPM). Diameter of RSPM is less than 2.5 micrometer. Constant exposure of this silica dust results in severe lung diseases like Silicosis, Silico-tuberculosis, Bronchitis, and Bronchial Asthma in the workers of quartz and feldspar pulverizing industry. Prolonged exposure to loud noise can impair hearing of workers. Exposure to silica dust causes skin disorders like dermatitis. Among the health problems, ‘Silicosis’ is a major occupational health risk of quartz and feldspar pulverizing industry.

Fig: A Labourer of Ball Mill Covered in Silica Dust

Silicosis

Silicosis is the most common and the most historic occupational disease known to mankind. Hippocrates has described a condition of “breathlessness” in miners. The disease has been known as Miners’ Phthisis, Masons’ disease, Grinders’ asthma, Potters’ rot and Stonecutters’ disease. Visconti used the term “silicosis” to describe the disease caused by inhalational exposure to silex. (Greenberg, M. I. 2007)

There are an estimated 11.5 million workers exposed to silica dust in India in both organized and unorganized sectors (Jindal, 2013). Rajasthan is known for its stone works and stone industry for centuries. Workers exposed to high concentrations of silica dust and at risk for silicosis include those working in foundries, the building sector, sandstone/granite drilling, quartz and feldspar pulverising mills, stone-grinding, agate cutting and polishing, and silica mining.

Health Survey

Questionnaires for health survey were designed to gain important and useful information quickly and inexpensively. It included questions on awareness of prevailing health risks of quartz and feldspar pulverizing industry of Ajmer district and social benefit schemes for silicosis patients.

For this study, we have selected three tehsils as the study samples out of the 7 tehsils of Ajmer district in which pulverizing units are most concentrated. The Sample - 1 is of Beawar and Masuda tehsils, Sample - 2 is of Nasirabad tehsil and Sample – 3 is of Kishangarh tehsil. These tehsils were selected for samples because they have highest number of pulverizing units and maximum production in Ajmer district.

Sample – 1

The sample includes 78 workers of the pulverizing industry of Beawar and Masuda tehsils. Positive response of knowledge was given by 70.08% workers, 16.24 % were not able to decide and 13.67 % were not aware of health issues on skin, hearing and respiratory system. Tuberculosis and Bronchial asthma diseases were heard by all of them, but the clinical features were known to 32% and 60.25% workers respectively. The disease silicosis name has been heard by 52 patients (66.67%) and only 22 (28.20%) have known about the clinical features in Beawar and Masuda. 41 workers (52.56%) were aware about the health care facilities available for mining and pulverizing industry workers, 30 (38.46%) were not able to say but 7 (8.97%) were completely unaware. Social benefit scheme for silicosis workers in which government provide Rs. 1 lakh for certified patients and Rs. 3 lakhs to deceased were known to 60.25% workers, however 17.94% workers were completely unaware of the scheme.

Sample – 2

The sample includes 62 workers of the pulverizing industry of Nasirabad tehsil. Positive response of knowledge was given by 69.52% workers, 11.76% were not able to decide and 18.18% were not aware of health issues on skin, hearing and respiratory system. The disease silicosis name has been heard by 25 workers (40.30%) and only 5 (8.06%) have known about the clinical features in Nasirabad. 12 workers (19.30%) were aware about the health care facilities available for mining and pulverizing industry workers, 21 (33.80 %) were not able to say but 29 (46.77%) were completely unaware. Social benefit scheme for silicosis workers in which government provide Rs. 1 lakh for certified patients and Rs. 3 lakhs to deceased were known to 35.48% workers, however 24.19% workers were completely unaware of the scheme.

Sample – 3

The sample includes 47 workers of the pulverizing industry of Kishangarh tehsil. Positive response of knowledge was given by 65.96 % workers, 12.06 % were not able to decide and 21.98 % were not aware of health issues on skin, hearing and respiratory system. The disease silicosis name has been heard by 26 patients (55.31%) and only 15 (31.91%) have known about the clinical features in Kishangarh. 24 workers (51.06%) were aware about the health care facilities available for mining and pulverizing industry workers, 15 (31.91 %) were not able to say but 8 (17.02%) were completely unaware. Social benefit scheme for silicosis workers in which government provide Rs. 1 lakh for certified patients and Rs. 3 lakhs to deceased were known to 48.93% workers, however 29.78% workers were completely unaware of the scheme.

Table: Summarized Responses of The Questionnaire

 

Result of Health Survey

The total sample size included 187 workers from Beawar, Masuda, Nasirabad and Kishangarh tehsils. Positive response of knowledge was given by 68.98% workers, 13.72% were not able to decide and 17.29% were not aware of health issues on skin, hearing and respiratory system. Tuberculosis and Bronchial asthma diseases were heard by all of them, but the clinical features were known to 32% and 60.25% workers respectively. 77 workers (41.17%) were aware about the health care facilities available for mining and pulverizing industry workers, 67 (35.83 %) were not able to say but 43 (22.99%) were completely unaware. Social benefit scheme for silicosis workers in which government provide Rs. 1 lakh for certified patients and Rs. 3 lakhs to deceased were known to 51.87% workers, however 22.99% workers were completely unaware of the scheme.

Fig: Use of Mask and Protective Gear by Workers

Pain and Plight of Silicosis Patients of Rajasthan

The silicosis detection and certification process has been criticized from beginning. MK Devarajan of Rajasthan State Human Rights Commission (RSHRC) has stated that says the detection mechanism is only just falling in place. “Actual numbers could well be in lakhs”. The process of certification made the “workers being treated like footballs”.

1. There have been several protests by the silicosis patients in many districts of Rajasthan in last few years. Silicosis patients protested that the government should release compensation money in time, since they suffer a disease that cannot be cured. They further stressed that People were not getting the compensation even years after certification as administrative glitches often delay release of compensation money.

2. The financial assistance of Rs. 1 lakh on diagnosis and compensation of Rs. 3 lakhs after death are a little help. Silicosis patients want the government to release the full amount of Rs. 4 lakhs while they are still alive. “Why wait until we die? The money should be given to while they are still alive, so they can use it to prolong their lives and increase the quality of lives of their families” (The Times of India October 20, 2016). GO Mine Labourers’ Protection Campaign has raised the issue that why the patients have to visit the TB Hospital just to know if they have tested positive? Isn’t that a shame, in a country that bandies about terms like ‘Digital India’?

3. Silicosis patients want pension, not compensation after death. A PIL was accepted by Rajasthan High Court, Jodhpur in November 2018 that the compensation given to families of victims should be made available in form of pension while they are alive for meeting medical expenses. (The Times of India November 21, 2018)

4. There is a welfare board for construction workers but the same is not for the mining industry despite its large contribution to state’s economy. Mine Labour Protection Campaign demands for constitution of the Mine Worker Welfare Board.

5. The process of getting certified by the board has been time consuming. Multiple departments are involved in issuing of certificates, and the pendency is huge. Agents and brokers have become active in few districts for easily providing certificates. There have been reports of providing forged silicosis certificates for Rs. 10,000. (Dainik Bhaskar March 01, 2018)

6. Rajasthan state Government has taken the disease very seriously and several initiatives have been taken. The Government has initially constituted Pneumoconiosis Board in SMS Medical College and six other government-run medical colleges in the state. Now there are Medical Boards at each district level while screening is available at Community Health Center level. The Government of Rajasthan has started online portal for Silicosis patients’ registration for screening and disbursement of grant. (NIB Silicosis 2018 May)

Analysis of Online Silicosis Registration and Grant Disbursement Portal

1. After the start of online portal for Silicosis Grant Disbursement, A total of 26138 patients have been registered for screening in Rajasthan upto 22ndJanuary 2021. Out of those 13144 patients (50.28%) are pending for screening at Community Health Center or Medical Board levels. Maximum numbers of cases of silicosis (6589) have been registered in Jodhpur district, followed by Karauli (3414), and Bharatpur (3160).

2. On comparing the screening rate of different districts, we noticed that there is a huge variation in pending for screening cases in different districts ranging from 5.88% to 85.50% as shown in figure 7.16. Similarly, we also noticed that the rejection rate of different silicosis boards also varies from nil to 91.51%. We compared the data of Karauli and Bharatpur districts, the two adjacent districts which are having similar type of industries.

3. There were 3414 and 3160 patients registered in the districts of Karauli and Bharatpur, respectively, however the screening processes in these areas differed greatly; the pendency rates were 85.50% and 23.38%, respectively, the difference was statistically significant (p<0.01). Similarly, out of screened patients 91.51% claims were rejected at Karauli while the rejection rate was only 36.83% in Bharatpur, the difference was statistically significant (p<0.01).

Table: Summary of Silicosis Patients in Different Districts of Rajasthan

CHC: Community Health Center; MB: Medical Board

Source: Silicosis Patient Summary Report (22-01-2021)

The study was based on both primary and secondary data. 1. Primary Survey: It was a personal questionnaire-based study conducted among quartz and feldspar mine workers of Beawar, Masuda, Nasirabad and Kishangarh sub-districts of Ajmer. The study was conducted in July 2022, and was based on questionnaire interview methodology to examine silicosis awareness. The study subjects (n=190) were 30 years or more. The questionnaire was divided into different sections as shown further in the paper. The questionnaire was administered both in Hindi and the Marwari language; it took approximately 5–10 min for each subject to complete the questionnaire. 2. Secondary Data: It was procured from the Silicosis Patient Summary Report generated by the Medical Board of Rajasthan. It was further analyzed for segregating the screened patients and pending cases. Also, the disbursement of grant was reviewed. 3. Data were processed using Microsoft Excel software and maps were prepared using QGIS.

Udaipur district had minimum pendency (5.76%) and none of the screened case was rejected, while Karauli had very high pendency of 85.50%, and most of the screened cases were rejected (91.51%). The table – 7.4 clearly shows the discrepancy in the efficiency and processing. Though the guideline has been formed but the functioning of different boards is not uniform and time bound. Similarly for claim distribution there has been huge discrepancy.

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