Asbestos is a known human carcinogen. A range of cancers including mesothelioma, lung, laryngeal and ovarian, gastro-intestinal cancers are among the types experienced by those living and working with asbestos. Internationally there are a number of countries that mine, produce and export to developing countries, increasing the burden of disease.
South Africa (SA) mined 3 forms of asbestos, which was widely used in the construction sector, and still remains in many older buildings such as schools, hospitals and homes.
Asbestos mining and use in production was banned in SA in 2000, however many vulnerable groups remain exposed as demolishing and some refurbishments exclude the need to have competent, experienced contractors to do the work. The Asbestos Regulations were promulgated in 2001 guide the measurement and management of asbestos removals.
Two case studies are described that indicate the existence of and the management of asbestos during high pressure washing.
There is a paucity of statistics available to determine the numbers of those who have developed occupational or environmental diseases. Claims through compensation and class action have been made and awarded through trusts, which manage the award of compensation.
Recommendations include the need to ensure competency among those removing asbestos, with regular medical surveillance to ensure early identification of symptoms.
From an occupational health (OH) perspective, occupational health practitioners (OHPs) generally view their approach from an occupational perspective. In other words, the relationship between work and symptoms relating thereto, i.e. noise exposure leading to noise induced hearing loss (NIHL).
Thus a link should point to a causative agent (London, 2006, Collegium Ramazzini, 2010). All forms of asbestos cause asbestosis, and cause malignant mesothelioma, lung, laryngeal and ovarian cancers (Collegium Ramazzini, 2010).
Three types of asbestos, namely amosite, chrysotile and crocidolite asbestos have been mined extensively in South Africa (SA). Asbestos deposits in SA are in the Northern Cape as well as Swaziland, among other. 97% of the world’s crocidolite was mined, and where 100% of the world’s amosite was mined. Not all deposits were mined (Nelson and teWater Naude, 2015).
All three forms of asbestos were widely used in asbestos cement building material, that include cement sheets and roofing materials. Thus many older buildings have asbestos sheeting, among other. The maintenance of structures requires continual maintenance and repair, which in turn exposes such workers to the long-term asbestos related diseases caused by exposure (Phillips, Renton, Badenhorst, 2006).
Worldwide the tragedy of the asbestos pandemic is that ARDs are preventable and alternative products exist (Collegium Ramazzini, 2010). It is clear that there is a continued need to raise awareness.
Legislative requirements relating to asbestos removal
Asbestos mining, and the production of asbestos containing products for industrial use was banned by the DoL in 2000, and the Asbestos Regulations were enforced in 2001. An updated revision now called the ‘Asbestos Abatement Regulations’ are shortly to be released for comment, that will increase the attention and requirements for its safe removal. Updated requirements include the need for an asbestos inventory, risk assessments, regulated asbestos zones and clearance certificates.
Maintenance and cleaning of structures containing asbestos products is needed on such structures from time to time as part of general maintenance. The Department of Labour (DoL) promulgated the Asbestos Regulations in 2001, which require the registration of contractors who remove asbestos.
Only registered contractors are authorised to work or remove asbestos products. Further to this, the regulations require that approved asbestos inspection authorities (AAIAs), accredited through the DoL, are able to measure and monitor asbestos levels that identify levels and the most appropriate means of management.
AAIAs are required to monitor and maintain a register of asbestos. Removal may only be done following the submission of an asbestos removal plan, outlining the method of removal and disposal. However, work on cement sheeting and cement products are exempt from the Asbestos Regulations.
Furthermore, the term ‘demolition’ has been problematic as such work does not need to be completed by registered contractors, or managed by AAIAs. As such, the contractors doing such removal could be exposed to highly friable asbestos products, and be at high risk of developing mesothelioma over time (RSA, 2001, Phillips, et al., 2006).
While there is no AAIA evidence to confirm the existence of asbestos in older state buildings in SA, it has been noted through observation structures such as schools, hospitals and buildings contain asbestos in sheeting, among other (asbestos.com, 2016). The procurement processes dictated to by the SA National Treasury require that close to 30% on a project should be made up of local labour, or small to medium, micro enterprises (SMMEs) (Deacon, 2016).
Nelson and teWater Naude (2015) cite the World Health Organization (WHO) mortality database between 1994 and 2008, who, in turn reported that SA had the highest mortality rate of ARDs among the youngest age groups (younger than 50 years).
Higher rates of ARDs are likely where high levels of crocidolite exposure is noted, both in occupational and environmental exposure. Men are most likely to contract an ARD from occupational exposure and women from environmental exposure.
Rates among different race groups differ, with much lower reports among black males, however this is most likely due to poor record keeping, and lack of available health services.
Case studies identifying asbestos
A case study that sought to identify homes built with asbestos roof sheeting in the Johannesburg township of Soweto, found that a total of 63% of houses were older than 20 yeas, and most with corrugated asbestos sheets. Asbestos material was a cheap option and with good insulation pre-2000, and for many years was believed to be a safe option.
However, it was identified that 53% of such homes could have infants exposed to asbestos, and potentially at high risk of developing mesothelioma while still young (Phillips, Renton, Murray, Garton, Garton, Tylee, and Rees, 2007).
A further case study reported on by Phillips, et al. (2006), reported that an asbestos roof was cleaned using a high-pressure washer, where the water pressure exceeded 150 bar. Water was not collected and the asbestos contaminated runoff and spray was carried by wind into the surrounding area.
The runoff and spray contaminated soil and surrounding plants. When using a high-pressure washer, a fibrous asbestos mat is produced, and reservoirs of asbestos fibres in gutters and surrounding areas.
An AAIA was utilized to monitor the area, which resulted in the work being stopped, an accredited asbestos removal company procured to take over the work still required. All the surrounding brickwork and cement were wet wiped and vacuumed, plants were wiped down or removed, and soil removed. Costs for the cleaning and safe removal resulted in a doubling of the cost of the original work quoted for.
Occupational diseases from asbestos exposure
Sawry, Rees, and Kielkowski (2006) cite that of the 163 lung and pleural diseases, pneumoconioses were reported from the manufacturing and power generation sectors. Pleural plaques reported form asbestos and metal manufacturing and power generation.
A total of 12 mesothelioma cases were reported from a number of sectors, including construction. Asbestos was reported as causative in 52% of lung and pleural diseases (Sawry et al., 2006).
There are no safe levels of exposure. There are those who purport that chrysotile is safer, and less likely to cause mesothelioma. However, the National Public Health Institute of Quebec (INSPQ) has published more than 15 papers indicating a failure of being able to handle asbestos safely. Canada, until recently has exported asbestos to developing countries.
Given the inability to use asbestos safely, Pat Martin, a member of Canada’s parliament, and a former asbestos miner made the statement “If we in the developed world haven’t found a way to handle chrysotile safely, how can we expect them to do so in developing nations? (Collegium Ramazzini, 2010).
A number of compensation cases have been made in South Africa and Swaziland, which is a landlocked neighbor with South Africa. teWater Naude (2014) notes 2003 as an important year for compensating those diagnosed with asbestos related diseases (ARDs). What is important to note is some of the settlement was identified for environmental rehabilitation. To date, the 2 companies who were involved were Cape PLc and Gencor.
The Gencor claim resulted in the formation of the Asbestos Relief Trust (ART). Cape PLc originally only had 5 claimants in 1997, rising to 7500 in 2001. The ART covers claimants up until 2028, due to the long latency of ARDs.
A third settlement in 2006 with the Swiss Eternit Group established the Kgalagadi Relief Trust (KRT), managed by the ART. also Settlements further include those who contracted an ARD through environmental exposure (teWater Naude, .
Records are being collected through Surveillance of Work-related and Occupational Respiratory Diseases in South Africa (SORDSA) programme, established in 1996. The SORDSA reporting programme indicated a reduction of reported cases, which was noted as more likely to be due to a reduction in reporting rather than a reduction in the number of incidence rates.
Sadly, the SORDSA programme ended, a further programme has yet to take its place.
Occupational health surveillance should be considered to identify secondary consequences of domestic environments. The poor level of state facilities is a major challenge, as most health professionals are not trained to link signs and symptoms that are being missed due to the lack of knowledge regarding such issues.
The extended lag time or latency period could be as long as 40-50 years (London, 2006, Collegium Ramazzini, 2010). Under reporting of occupational diseases is a perennial problem in SA, with no statistics available from the Compensation Commissioner, and indicated in Figure 2 (Deacon, 2004, DoL, 2017).
Many OH services are focused towards the formal sector, however, work is increasingly occurring in the informal sector, and the consideration of domestic environmental aspects, such as exposure of tailing dumps and dusts from mines. In some cases, asbestos products are used In the Northern Cape, the tailings of crocidolite mines were used as surfacing materials for roads, and general buildings.
Many communities where asbestos was mined are among the highest in the world, who have been diagnosed with mesothelioma. Prieska, Kuruman and Koegas in the northern Cape, being such places (London, 2006, Nelson and teWater Naude, 2015; asbestos.com, 2016).
Conclusions and Recommendations
It is clear that there is a range of highly vulnerable groups at risk from exposure to asbestos and asbestos containing products, commercially and environmentally. Infants and young children in residential areas where asbestos roof sheets still exist, as well as where asbestos mine tailings are.
The confirmed cases of occupationally related mesothelioma are greater among males, with females being exposed through mainly environmental causes. SMMEs and local labour are a further high risk and vulnerable group as they are not permanent workers.
SMMES and local labour may be more likely to complete work to remove asbestos sheeting currently exempt from compliance with the Asbestos Regulations.
Trusts do exist that compensate those who have contracted mesothelioma from both occupational and environmental sources, but reporting remains an issue.
Recommendations include that asbestos is continued to be treated as a carcinogen, and no exemption for removal of any sort is allowed, irrespective of work. Only approved AAIAs and contractors therefore should be allowed to remove asbestos, so that vulnerable groups are protected.
There is a further need that workers, or those environmentally exposed, should be on a register and be followed up on an annual basis to provide treatment and support should there be any signs or symptoms of ARDs. Reporting and measuring of asbestos dusts from environmental and construction activities, among other should be aggressively promoted.
Asbestos.com.2016. Mesothelioma in South Africa. https://www.asbestos.com/mesothelioma/south-africa/ accessed 06 April 2017.
Collegium Ramazzini. Asbestos is still with us: Repeat call for a universal ban. Occupational Health Southern Africa, March/April, pp: 32-35.
Deacon, C. 2004. The Health Status of Construction Workers. Unpublished Magister Curationis Thesis. University of Port Elizabeth, South Africa.
Department of Labour. 2001. Asbestos Regulations. Government Printer, South Africa.
Department of Labour. 2017. The Asbestos Regulations. Department of Labour Conference, Umhlanga Rocks, Durban.
Deacon, C. 2016. The Effect of the Integration of Design, Procurement, and Construction relative to Health and Safety. Unpublished PhD Thesis, Nelson Mandela Metropolitan University, South Africa.
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Nelson, G, and teWater Naude, J. 2015. Epidemiology of Malignant Pleural Mesothelioma in Africa. Malignant Pleural Mesothelioma: Present Status and Future Directions, Tommaso Claudio Mineo (Ed), Bentham Science Publishers, pp: 95-113.
Phillips, J, Renton, K, Murray, J, Garton, E, Garton, E, Tylee, B, Rees, D. 2007. Asbestos in and around Soweto dwellings with asbestos cement roofs. Occupational Health Southern Africa, pp. 3-7.
Phillips, J. I., Rention, K, Badenhorst, C. 2006. Potential health hazard from cleaning asbestos cement roofs: a case report. Occupational Health Southern Africa, pp. 20-22.
Sawry S, Rees D, and Kielkowski, D. 2006. Occupational respiratory diseases in South Africa results for non-mining industries from SORDSA, 2000–2003. Supplement to Occupational Health Southern Africa, pp. S3-8.
teWater Naude J. 2001. The sotry of the Asbestos Relief Trust – Part 1. Issues in OH. Occupational Health Southern Africa, pp:12-14.