Tackle the Silent Killer

In December 2021, Prime Minister Narendra Modi gifted agate bowls (akik) made by artisans from Khambhat region of Gujarat to Russian President Vladimir Putin during his latest visit to India. And while these gifts have reached diplomatic heights, what has remained untold are the tales of misery of agate workers who often suffer from silicosis, the irreversible disease that not only scars the lungs and reduces life expectancy. lives, but also puts workers at imminent risk of contracting tuberculosis (TB). .

While India has set a target of eliminating tuberculosis by 2025 and is paying attention to its comorbidities, including HIV, diabetes and malnutrition, the fourth – silicosis – has been neglected. Now, with India’s 2025 TB elimination goal less than two years away, Gujarat scientists are stressing the need to pay attention to the occupational risk of silicosis, which takes about a year to diagnose. decade.

For example, Dhiren (name changed) (35 years old), resident of Morbi, who was diagnosed with silico-tuberculosis in January 2023. After working in a tile factory for a decade, it was only after seven other years of working in a warehouse that he was diagnosed with a deadly combination of lung diseases. The father of three worked in a warehouse transferring 50kg bags of silica-based powder into 25kg units. He has been inhaling dust for several years and is now unable to do heavy work. He is not alone.

Even as the Gujarat Gram Shramyogi Kalyan Board on October 3 released financial assistance of one lakh rupees to the families of nine workers of Surendranagar who died of silicosis in 2016-20 after an NGO complaint to the National Human Rights Commission (NHRC), researchers say they are paying attention. Attention should be paid to early subradiological silicosis, which cannot be detected by radiography or chest CT for several years.

Call for a national program
Researchers are now calling for a national silicosis control program and have gone so far as to state that complete elimination of tuberculosis is almost impossible without it.

In an article published in the Indian Journal of Tuberculosis in May 2023, Dharmendra Singh, Bidisa Sarkar and Kamalesh Sarkar assert that “elimination of tuberculosis requires prior control of silicosis, including sub-radiological silicosis.”

Their study included 380 workers (205 in glass industries and 175 in non-glass industries) to assess pulmonary tuberculosis and underlying silicosis. CB-NAAT tests detected tuberculosis in 46% of glass workers and 4% of non-glass workers. Of the 205 glassmakers, 76 were affected by Silico-TB.

Corresponding author Dr Kamalesh Sarkar, who retired as a G-scientist from ICMR, told Mirror: “With underlying silicosis, there is more possibility of contracting tuberculosis. Silicosis makes detection of tuberculosis difficult, increases the risk of multidrug-resistant tuberculosis and uncertainty about the results of anti-tuberculosis treatment. We do not know the fraction of the number of Silico-TB patients to the total TB burden in India. Tuberculosis cannot be eliminated without the fight against silicosis.

However, a tuberculosis specialist from the Indian government, who declined to appear publicly, said: “Silicosis will not help eliminate tuberculosis, but will only treat a fraction of it.” Silicosis needs to be a priority, but it will not significantly reduce the TB burden in India.

Dr. Mihir Rupani, Scientist-E at the National Institute of Occupational Health (ICMR-NIOH), Ahmedabad, discovered, through three studies, the need to implement collaborative bi-directional TB-silicosis screening in areas where workers are exposed to silica dust. His research also highlights the need to include silicosis in the TB care model.

Dr Rupani said, “Silicosis control is important for last mile elimination of TB. Once we bring down the TB incidence rate to 100 per lakh, those remaining after 2030 will have Silico-TB. But we must act now to make an impact by the end of the decade. »

Dr Sarkar stressed the need to detect subradiological silicosis, otherwise the burden will increase over the next 15 years. Notably, NIOH and NIV jointly developed a point-of-care blood test to detect silicosis 10 years earlier than conventional methods. The ICMR is expected to unveil it by the end of this year.

Jagdish Patel of the People’s Training Research Center (PTRC), who has worked with silicosis patients for three decades, told the Mirror: “Until exposure to silica continues, tuberculosis cannot be eliminated. Silica is omnipresent and affects workers in 85 to 90 professions.

Generational curse in Gujarat
In fact, there are several industries in which multiple generations of families work in the same trade, with several members dying relatively young. Patel said: “We used to see this in the Khambhat agate industry. But it is also prevalent in the stone statue-making community of Dhrangadhra and the tribal families of Jhalod working in the quartz-cutting industry.

Dr Rajesh Solanki, vice-chairman of the national technical expert group of the National Tuberculosis Elimination Program (NTEP), said: “In Khambhat, we were trying to avoid undue harm to akik workers by trying solutions to reduce flying dust and even giving medicine. But when we asked silicosis patients about leaving the industry, they responded that they had no other job options and that, in many cases, generations worked together in the same industry.

Patel talks about a Sompura family of which today only one member is alive: “Kalpesh Sompura died of silicosis in December 2017, and his younger brother Ashish (38) died of Silico-TB in March 2021. Both were stone sculptors. Their father, Umakant, who was in the same profession, had also died young but was never even diagnosed. Their mother is the only surviving member of the family.

The burden of dust in India
Dr. Rupani explained: “Our paper in Nature Scientific Reports shows that silicosis increases the risk of TB relapse, high chances of developing MDR TB, evidence that underlying silicosis leads to unfavorable outcomes in the treatment of tuberculosis and that silicosis is directly associated with mortality and tuberculosis. treatment failure.
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An NIOH study estimates that the number of workers exposed to silica dust in India will reach a staggering 52 million (5.2 crore) by 2025.

Target facts

Notably, India’s TB elimination target includes an 80% reduction in incidence rate and a 90% reduction in mortality compared to 2015, as well as reducing patient expenditure to zero . India needs to bring down the incidence rate to 44 per 1 lakh and mortality to 3 per 1 lakh. Notably, the National Tuberculosis Prevalence Survey in India 2019-2021 pegged the prevalence rate of tuberculosis in Gujarat at 137 per 1 lakh.