Killing The Future: Asbestos Use In Asia

Asbestos Experiences of Asian Countries: Thailand

Asbestos Experience in Thailand

Thailand has been using asbestos for more than 30 years in the production of building and friction materials; it is the world's 4th largest asbestos consumer. According to Thai Government data, from 1997-2004, asbestos imports averaged 116,500,000 kg/year and cost USS43.25M33 In 2004, 1,784 workers were employed at 16 asbestos-using factories in Thailand, most of which were located in central Thailand, Environmental monitoring by government agencies carried out since 2000 shows elevated levels of airborne asbestos at many of these factories (7 plants with 1,297 workers); conditions in brake and clutch factories were the most hazardous. Most asbestos (90%) in Thailand is used in the manufacture of asbestos-cement pipes and roofing materials; 8% goes into brakes and clutches and 2% into vinyl floor tiles, gaskets and heat insulating material.

Workplace levels of asbestos contamination in Thailand are higher than those allowed in other Asian countries and often exceed the Thai Asbestos Occupational Exposure Limit (OEL) of 5 f/cc. The dustiest conditions were experienced by those workers manually handling bags of asbestos fiber and using sandpaper to polish asbestos-cement roof fittings. Despite their occupational exposure, lung function tests of 85% of the factory workers and chest X-rays of 97% were normal. Given the high level of asbestos use, it is surprising that not one case of asbestos-related disease has been reported to the national surveillance scheme or the Workmen's Compensation Fund.34 Dr. Kamjad Ramakul, from the (Thai) Bureau of Occupational and Environmental Diseases, is worried: "Since asbestos consumption is increasing and concentrations of asbestos in working conditions are high, especially in brake and clutch factories, we can expect the number (of asbestos cases) to be high in the near future". Possible explanations for the lack of registered cases of asbestos-related disease are:

Research was undertaken in 2003-2004 by the Ministry of Public Health to investigate cases of asbestosis and lung abnormalities amongst people with occupational exposure to asbestos in the production of cement of friction products. Using questionnaires, chest radiographs, HRCT,35 air sampling and physical examinations, 41 out of 140 workers were found to have lung abnormalities. All those exhibiting symptoms of asbestosis reported a past history of occupational asbestos exposure. Air samples collected in 2003 showed that 12 out of 25 samples were over the standard set by teh ACCIH;36 6 out of 40 samples collected in 2004 exceeded the standard. Researcher Vichuda Lojananont believes that:

Dr. Ponglada Subhanachart from the Chest Disease Institute of (Thailand) has identified some cases of lung disease amongst asbestos-cement factory workers. Chest X-rays of 907 workers from one factory were examined by experienced chest radiologists using standard ILO classifications. Where there was a suspicion of asbestosis or early asbestos-related pleural disease, HRCT examinations were undertaken. The results were:

Asbestos Experience in Thailand

Dr. Subhanachart believes that the low incidence of disease could be explained by the fact that most patients are in the latent period or that the systems for reporting these diseases in Thailand are inadequate. Concluding that chest radiographs are a useful tool for the screening of asbestosis and asbestos-related pleural disease, he remains concerned about the high level of false readings and supports the use of HRCT examinations for confirmation in cases with lung lesion profusion>1/1

Responding in 2005 to a report of widespread pleura thickening amongst workers at an asbestos factory in Nakomsithammarat, Thailand, researchers designed and carried out a cross-sectional survey which established that amongst the 40 workers who participated in the study, there were 9 cases of pleural thickening.37Almost all those affected were: older than 50, had a history of smoking, had worked in the factory for more than 25 years and had spent time in the asbestos bag opening department, the stripping and mold department, the asbestos mixing department or the rod mill.

It is ironic that a substance as deadly as asbestos was widely used in hospitals in Thailand. In a cross-sectional descriptive study conducted in March 2006 at Buddhachinaraj Hospital,38 Dr. Nopadol Suchat found asbestos in asbestos-cement roofing materials and sewage pipelines. He recommended that when these materials are removed, a wet process should be used and workers should be provided with personal protective respiratory protection.

Representatives from Thai Ministries speaking at an international asbestos conference in July 2006 agreed that doing nothing about the increasing use of asbestos would exacerbate the predictable epidemic of asbestos-related disease, incur increased medical and compensation costs, alarm the public, strain the economy and compromise the national reputation. To persuade policy-makers of the need for an asbestos ban, a concerted effort is needed, they said, to encourage government agencies to cooperate on initiatives to raise asbestos awareness, collect data and initiate health screening and surveillance of at-risk groups. Thai civil servants stressed the importance of working with local asbestos manufacturers on the transfer to non-asbestos technologies. One Thai doctor proposed that a higher tax be introduced for asbestos products to increase the cost advantage of safer alternatives. Although the best way to protect Thai society from the asbestos hazard is to ban asbestos, until the Government is ready or able to take this step, serious measures need to be adopted and enforced to protect workers and the public from hazardous exposures.

The Department of Labor Protection and Welfare (Thailand) has issued regulations, carried out inspections, undertaken training, developed guidelines and provided information to those working in or administering the asbestos industry. Thai regulations which protect occupational health and safety include the: working Environment Regulation (1977), Harmful Chemicals Regulation (1991), Physical Examination Regulation (2004) and Safety Officer and Safety Committee Regulation. The Government is taking steps to tackle the asbestos hazard by: lowering the threshold limit value from 5 fibers/cc to 2 fibers/cc, setting up criteria to limit hazardous asbestos exposures, providing health surveillance and dust monitoring in small and medium-sized companies and improving the criteria for the diagnosis and compensation of asbestos-related diseases. The ratification of ILO Occupational Health and Safety Resolutions by Thailand will take place in the near future (2007/2008) but ILO Resolution 162: Convention Concerning Safety in the Use of Asbestos (1986) will not be considered at that time.

Notes:

33. Other Asian OELs (f/cc) are: 0.1 in Malaysia and Singapore, 1 in Vietnam and Taiwan, 2 in the Philippines. See also: Takahashi K, Karjalainen A. A Cross-country Comparative Overview of the Asbestos Situation in Ten Asian Countries. Int. J. Occup. Environ. Health 2003;9:244-248.
34. According to calculations by Dr. Antti Tossavainen, every 270 t of asbestos used produces 1 case of mesothelioma in a country. Thailand is currently consuming 121,000 t/year which should produce a minimun of 711 cases of mesothelioma and 2,135 cases of asbestos-related lung cancer/year.
35. HRCT: high resolution computer tomography.
36. ACIGH: American Conference of Industrial Hygienist.
37. The factory employed 145 workers to produce 220 million kg/year of asbestos insulation board using chrysotile asbestos.
38. Buddhachinaroj Hospital is a 904 bed regional public facility with 96 buildings.

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