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Doctor May Have Found Early Marker for Silicosis, But Who Will Fund Him?

A pilot study has shown that levels of CC16, a protein, steadily fall as silicosis spreads. For confirmation study, an estimated Rs 1.23 crore is needed.

Jaipur: Deaths from silicosis, a deadly disease that is common among standstone mine workers, can be prevented to a large extent if the efforts of a doctor are financially backed to reconfirm his hypothesis.

Dr Kamlesh Sarkar, director of the National Institute of Occupational Health, Ahmedabad, thinks there might be a way to intervene early and prevent deaths from silicosis. He has studied levels of club cell protein (CC16) in serum as a pilot project among 121 subjects, and found that in healthy people, this protein reads 16.7 nanogram per milliliter. (ngm/ml; a nanogram is one billionth of a gram). However, as silicosis progresses, the count of this protein steadily falls and the range in which this protein is found also serves as an indicator of the severity of the disease. 

Dr Sarkar is hopeful that a larger sample of subjects spread across a wider geographical area would help further confirm his hypothesis. However, he has not yet received the Rs 1.23 crore he needs to conduct the five-year study, testing about 900 subjects in three states repeatedly over five years.

Any disease of the lung, however, would affect the levels of the CC16, and there are doctors who have pointed out that the study would only help assess a proxy bio-marker. However, Dr Sarkar is confident that if doctors also examine the work history of patients, they cannot go wrong when they check this protein level in patients. 

Explaining his stance at a meeting in Rajasthan’s capital, Jaipur, recently, Dr Sarkar said in the case of HIV infection, too, it is impossible to assess prevalence rates by testing large samples of the population. The accepted practice is to test all pregnant women and then arrive at a figure based on that data.

The Rajasthan government is in the process of finalising a draft policy on silicosis, the disease that is claiming a large number of its mine workers, sculptors and gem polishers. 

At a meeting at the state secretariat a few days ago, attended by state officials and United Nations’ representatives, former state human rights commission member MK Devarajan outlined the progress so far and the road still to be travelled. He noted that between 2013 and May 2019, 17,687 cases of silicosis were detected in the state; there were 1,857 deaths from the disease. A total of Rs 194 crore has been given as compensation to those suffering with silicosis or their kin in case of death.

Rana Sengupta of the Mine Labourers Protection Campaign Trust has attempted to underline the need to extend greater protection to mine workers – it is not enough to offer compensation once the disease sets in and the main breadwinner of the family dies, he says. “There is need to explore prevention strategies; there is need for greater scientific management of the mines. Those affected must get pension and social security. Things must move fast when patients are sure to die.”

Mines in Rajasthan are not professionally managed, and a large number of these are very small, working illegally. Rajasthan is the state with the largest geographical area under mining. A total of 32,767 mining leases have been issued in the state. Over 20 crore workers are directly or indirectly engaged in mining and exposed to the risk of silicosis.

Dr Saranya R, a young resident at AIIMS, Jodhpur, conducted a study of 174 mine workers as part of her post-graduate studies recently. She found eight workers suffering from silicosis, who continued to work in the mines. The continued exposure to silica dust would only expedite death, but they were left with no option.

At a two-day consultation in Jaipur on mine workers, Prof Surya Deva of the UN Working Group on Business and Human Rights outlined guidelines for protecting the rights of workers – indicating that the government and firms must have systems in place to ensure dignity to workers.

However, young Bengaluru lawyer Aishwarya Rao pointed out that the laws in India were already quite elaborate – the Mines Act of 1952 lays down such details as the provision of drinking water to mine workers. And not just water, cool water. The problem, many participants agreed, was not lack of legislation. Nearly 95% of all mine workers in Rajasthan hail from dalit communities.

According to government information, the other states where silicosis is prevalent are Gujarat, Puducherry, Haryana, Uttar Pradesh, Bihar, Chhattisgarh, Jharkhand, Orissa and West Bengal among workers in the construction and mining industries.


The writer is an independent journalist.

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