Background and Overview
The various components that make up the DOEH have, over the years, developed skills in all areas of occupational and environmental health. As a result, the members of the DOEH have been providing clinical, research and educational services to a wide range of stakeholders, including government, business, workers and communities.
Members of the DOEH have served on the National Commission established by the then Minister of Health, Dr. Nkosazana Zuma into Occupational Health Services for South Africa. The final report was submitted in 1996. In keeping with the findings of the report, proposals for OHS delivery in KZN were developed for the provincial government.
Currently, members of the DOEH serve on the national Technical Committee for Occupational Diseases, established within the Office of the Compensation Commissioner in the Department of Labour. This committee is responsible for the development of protocols for the assessment and compensation of existing occupational diseases, as well as the development of legislation governing new compensable occupational diseases.
Members of the DOEH have served on various Commissions of Inquiry, investigating workplace as well as environmental health problems.
King Edward VIII Occupational Medicine Clinic
The Department manages the tertiary level specialist Occupational Medicine Clinic at King Edward VIII Hospital. This is one of three such clinics in the entire country, and the only one in the province. This clinic was established by Dr. Barry Kistnasamy in 1994, while a consultant in the Department of Community Health, together with Prof Umesh Lalloo, Head of Respiratory Medicine at UKZN.
The clinic operates one-half day per week (Tuesday mornings), and is staffed by our registrars and consultants. Referrals are usually from the private sector – mostly from occupational medicine practitioners or occupational health nurses from industry, although referrals from family practitioners is not uncommon. Other sources of referrals are trade unions, managed care organisations in occupational health and infrequently, self referrals.
Apart from providing a much needed service to the community, the clinic also serves as a critical training ground for our registrars. Although respiratory diseases makes up the bulk of the presenting cases, other conditions such as neurological, dermatological and haematological case presentations are also seen.
Other clinical service work includes participating in the Employee Health Services at King Edward VIII and Inkosi Albert Luthuli Central Hospital, as well as private consultations for workers requiring such services.
Occupational Medicine, Hygiene and Audit Servies
The Workers’ Health Programme (WHP) at the Nelson R. Mandela School of Medicine has been an active unit providing specialist levels of health care and services in occupational and environmental health since 1994. Currently the WHP is staffed by trained occupational medical practitioners and occupational hygienists, with a wide array of skills and experience.
The following category of services in occupational medicine, hygiene and audits are available:
Occupational Health and Safety Audit
Apart from the audit of the Occupational Health Service, more comprehensive audits of occupational health and safety approaches in the workplace should be done. This will include evaluation of the health services as above, but also include evaluations of the environmental monitoring, effectiveness of health and safety management systems and structures, such as the OHS management committee and health and safety representatives committees, evaluation of processes and procedures that may be in place, compliance with legislation and compliance with internal or industry wide standards etc.
Occupational Health Service Audit
In order to ensure that the Occupational Health Service at workplaces are meeting the objectives for which they were established, regular audits are necessary. Our Programme has been involved in such audits. These include review of human and financial resources invested into the service, the impact the service has on the health of the workforce and the effectiveness of specific surveillance programmes that exist. Audits can be conducted of the entire health service or of specific programmes, e.g hearing conservation programme, respiratory surveillance programme.
Occupational Health Service Development and Management Systems
The Programme has been instrumental in the development of general and specific occupational health services for industry and the public sector. These include both medical surveillance as well as environmental monitoring programmes. Medical programmes in general include pre-placement, routine and exit medicals, as well as surveillance and biological monitoring for specific hazards. Protocols and programmes are developed following evaluation of hazards and estimation of risk at each workplace. These are done in accordance with national legislation and internationally recognised standards.
A step beyond review of data and historical records is the conduct of a proper epidemiological study to describe hazards and its effects on health or to determine associations between exposure and health effect. This is useful especially if a company is using unique substances or processes in production. A scientific study assists in the understanding of these associations, and provides the company with information of future liability or lack thereof. With the increasing pressure of litigation on companies several years after even ceasing operation, the ability to disprove liability provides reassurance to workers, management and shareholders.
SPECIALIST CLINICAL SERVICES IN OCCUPATIONAL MEDICINE
Staffed by two full time and two part time medical practitioners in occupational medicine (OM), the Programme has been responsible for running one of only three public sector tertiary level occupational medicine clinics in the country. The latter clinic based at King Edward Hospital has been in operation since 1994. The OM consultants provide comprehensive medical services, either through the public service structure or by private consultation. These services include:
- work-up for compensation claims
- recommendations on rehabilitation
- appropriate placement within the workplace
- fitness to work/disability assessments
Through the public service mechanism, the OM consultants have access to the specialist services of respiratory physicians, orthopaedic surgeons, ENT specialists, radiologists, audiologists etc. This allows for comprehensive diagnostic work-up of clients.
Through the services of the occupational hygienist, workplace assessments allow for making decisions about the most appropriate placement of workers following illness or injury.
RISK ASSESSMENTS AND HEALTH HAZARD EVALUATIONS
Two occupational hygienists in training are employed in the Programme. Both with at least two years of experience in occupational health and safety, have the ability to conduct qualitative workplace risk assessments and health hazard evaluations. These activities include reviewing the full inventory of chemical, physical and other hazards present in the workplace, determining which presents with the highest risk, and from this prioritising, which should be controlled. Recommendations for control of hazards will be provided. These activities also include determining whether the workplace complies with legal standards under the Occupational Health and Safety Act, and its attendant regulations, especially the Regulations for Hazardous Chemical Substances and the Environmental Regulations for Workplaces.
RECORD REVIEW, DATA ANALYSIS AND HEALTH PROFILE DETERMINATION
Companies routinely collect a whole range of occupational health and safety data, either for monitoring purposes or to comply with legislation. These include health data (e.g audiometry done annually in terms of legislation, lung function testing etc) or environmental data (e.g. noise measurements, levels of chemical exposure etc). However, most companies simply store this information away, rather than subject this to any form of review or systematic analysis. This valuable data provides no input into the effectiveness of the systems that have been instituted by management. By carefully analysing data for trends or other peculiarities, valuable insight will be gained which will allow for either modification of the monitoring programme, changes to operational procedures etc. This may mean an immediate savings for the company (stopping a programme because the data shows no benefits are being generated) or long term savings (improved health of the workers, reduced absenteeism etc).