By: Chris Williamson of Trader Vic
According to MA Hermanus, well known hazards include dust and noise from rock breakages. The release of harmful gasses in underground mining remain synonymous with a lack of air and light for miners and ergonomic hazards go hand-in-hand with mining simply due to the heavy equipment handled by miners and the cramped conditions they work in.
In the bigger picture, Hermanus says that occupational injuries can have social and economic implications for individuals of a vast proportion. He says they have economic impacts in the form of direct and indirect costs for society as a whole. Included in the direct costs are:
Costs associated with damage in the workplace
Costs of interruption of production
Income to dependants
The cost associated with care given by family and the community
The Mine Health and Safety Act of 1996 (MHSA) arises out of the findings of the Commission
Its main features are that:
Employers bear primary responsibility for a safe and healthy work environment
Risk-management approaches to addressing health and safety hazards are mandatory
Workers have rights to participate in health and safety, to health and safety information, to training and to withdraw from dangerous workplaces
Tripartite institutions are charged with responsibilities to develop policy, legislation, regulations and promote a culture of health and safety.
The Mine Health and Safety Milestones
In 2003, at the Mine Health and Safety Summit, following in-depth discussions, stakeholders agreed to the implementation of certain targeted milestones. These were aimed at addressing specific health and safety concerns in the mining industry. Hermanus says it is important to note that these milestones are merely an intermediary step to achieving target of zero fatalities and injuries, silicosis elimination and the elimination of noise-induced hearing loss.
The milestones associated with this target are:
In the gold sector: To achieve by 2013, safety performance levels at least equivalent to current international benchmarks for underground metalliferous mines (i.e. the average of the safety performance of mines in the US, Australia and Canada)
In the platinum, coal and other sectors: To achieve by constant and continuous improvement, at least equivalent performance levels to current international benchmarks.
By December 2008, reduce 95% of exposures to below the occupational exposure limit for respirable crystalline silica of 0,1mg/m3 (these results are individual readings and not average results)
After December 2013, using present diagnostic techniques, cause no new cases of silicosis to occur among previously unexposed individuals (previously unexposed individuals are workers who would not have been exposed to silica prior to 2008, for example workers who are new entrants to the industry in 2008, or who have worked on mines or in occupations in which silica exposures were absent)
The present noise exposure limit specified in regulation is 85dB (A). The milestones associated with this target are that:
After December 2008, hearing-conservation programmes must ensure that deteriorations in hearing are no greater than 10% among occupationally exposed individuals.
By December 2013, the total noise emitted by all equipment installed in any workplace must not exceed a sound pressure level of 110dB (A) at any location in that workplace.
Jessica Spence provided the following information on Metatarsal protection: “The foot can be divided into three subsections: the rear-foot, the mid-foot and the forefoot. The forefoot consists of five phalanges or toes and the corresponding rays or metatarsal bones. The big toe or hallux has two phalanges, while the other four toes each have three. The metatarso-phalangeal joints form the transversal arch of the foot (the ball of the foot). The forefoot plays a big role in the propulsion phase of ambulation.
The mid-foot includes five irregular bones: the cuboid, navicular and the three cuneiforms. These bones form the medial and lateral arches of the foot and serve largely as shock absorbers during walking and running. The angles and positions of these joints determine the height of the arches.
The mid-foot has many ligaments but these are far less prone to injury when compared with the soft tissues in the rear- and forefoot. Injuries in the mid-foot are usually limited to stress fractures of the bones in the area caused by repetitive overuse (usually in athletes) or fractures caused by trauma (example: a heavy object dropping onto the area).
The rear-foot consists of the talus and the calcaneus (the ankle and the heel). The two long bones of the leg, the tibia and the fibula, are connected to these two bones at the subtalar joint (the ankle).
Injuries to the Foot: From Above the Foot:
On a balance of probability, the forefoot and the mid-foot are primarily vulnerable to injuries from above the foot, while the rear-foot has limited exposure to this risk. Gravity-triggered objects fall in a vertical direction, normally perpendicular to the surface on which the foot is resting.
Historically, the highest frequency of foot injuries has been to the forefoot area, in particular to the toes of the foot. As these bones are at the furthest extension of the foot they are the most exposed to danger. An awareness of the necessity for protection to the toes mothered the invention of the steel toecap to act as a barrier against impact to the toes in industrial occupations, and this has proved to be a highly successful safety feature over many years worldwide.
However, because of the ergonomic need to flex the foot during ambulation, the steel toecap system is limited to protecting only four toes of the foot – the small toe remains exposed to injury. Injuries to the mid-foot are less frequent but carry greater long-term consequences in terms of rehabilitation and cost. For example, amputation intervention in this area has infinitely more consequence than just for the forefoot parts, while injuries are normally crippling. The mid-foot has only recently become a focus of attention for the occupational health industry worldwide.
In South Africa, in addition to a heightened awareness of workplace safety through the Occupational Health & Safety Act of 1983, SIMRAC* [what is SIMRAC?] has cultivated the need to aim for a zero-harm target for mineworkers and the mid-foot would fall within this vision.
|Metatarsal Report - Diabetic foot ulcer
From Underneath the Foot:
Injuries to the rear-foot are usually of the nature of vertical impact from excessive exercise or mechanical bone stress.
However, all three subsections of the foot are equally vulnerable to penetration into the sole from underneath the foot. The trend to softer, lighter and more comfortable compounds for sole footwear in industrial occupations has had the collateral consequence of an increased risk exposure where sharp objects such as frayed cable, nails sticking through wood or broken glass are found in poorly lit workplaces (underground, forestry occupations, etc). To protect feet from these injuries, steel mid-soles are now a standard option for industrial footwear worldwide.
Injuries to the Mid-foot
The single biggest danger to the mid-foot and metatarsals is traumatic fracture from above the foot. For the mining and forestry industries, this is a high risk factor. Thus this report will focus on traumatic fractures and ignore other conditions of the mid-foot related to different causes such as personal hygiene or infection.
Due to the nature of certain occupations, employees may carry heavy objects, be in close proximity to operational machinery, work with heavy tools, or with ore bodies that shift without warning. These offer risk environments for injuries to the metatarsal area of workers’ feet. Traumatic fractures to the mid-foot or metatarsal bones are usually caused by a direct blow or impact, such as a heavy object falling onto this area.
Traumatic or Acute Fractures
Fractures of any foot bones can have a severe impact on mobility and independence and require immediate attention by a physician. Depending on the severity of the break, surgery may be indicated. Always be aware that any surgery adds additional risk of complications.
The signs and symptoms of traumatic fractures include:
Possible cracking sound on impact
Deviation (the fracture has caused an abnormal appearance of the foot)
Bruising and swelling
Complicated fracture: part of the broken bone has pierced the skin
The treatment of fractures depends on the type and location of the break. All traumatic injuries require cessation of activity and the immediate attention of a physician. Normally X-rays are the first course of diagnosis.
The metatarsal bones are delicate, have the highest risk for traumatic break and often are slow to heal. This is because bone healing relies upon good circulation and this area (the mid-foot) has a relatively poor blood supply.
Immediately after a break, the area should be iced. This helps with pain and swelling relief. If the fracture fragments are well aligned the treatment is simply immobilisation for six to eight weeks without any weight-bearing activities. This in itself is a high cost to a company. The physician will often prescribe a removable plastic boot (moon-boot) to ensure healing. Should surgery be required, there are further factors to be considered. Recovery time may be longer and anaesthesia has additional risks.
The key to the treatment of fractures is to protect the feet from the beginning. Always supply your employees with the appropriate foot protection and encourage them with both pro-active and disciplinary measures to use it.
Diabetes – the Modern threat to Africa’s occupational health
Diabetes is a disease that should be taken into account when dealing with traumatic injuries. According to the World Diabetes Foundation, developing countries such as South Africa are experiencing an explosion of this disease. The estimated number of diabetes sufferers in South Africa is about 840 000, but this number is expected to rise rapidly over the next 25 years. According to recent studies, although all races are susceptible, the group with the highest risk of developing diabetes is the black community. This can mean that the labour force of South Africa is placed at the higher end of the risk scale for developing diabetes.
What is diabetes?
Diabetes is a currently incurable disease that results in too much sugar being present in the blood. Type I diabetes is a condition usually diagnosed in the early years of childhood. The pancreas is unable to secrete insulin and thus insulin injections are prescribed. Type II diabetes is a condition where the body is resistant to the insulin it produces. It is usually diagnosed in adulthood and is often classified as a “lifestyle disease”.
What is affected by diabetes?
Complications of diabetes include:
Peripheral vascular disease (damage to the vascular supply in the hands and feet)
Peripheral neuropathy (damage to the nerves in the hands and feet)
Toe amputated due to diabetes
How do we treat diabetes?
Regular screening – the best method of treatment is prevention
A diabetic specialist will prescribe the correct medication for each person
Strict healthy diet
Appropriate protection when working
Feet are a primary occupational tool for workers. Injuries to the foot constitute a high risk factor, and this is why the steel toe-cap has become a standard component in all industrial footwear worldwide. The top of the bridge of the foot – or metatarsal area – is equally vulnerable to injury in active occupations and it has been called the new frontier of foot safety.
Protecting the mid-foot and metatarsals from physical trauma is an excellent and necessary concept. Remember that if an object falls on an employee’s foot resulting in a fracture, that person will be absent from work for a number of weeks, even without complications. Should the fracture be severe, they will be absent from work even longer.
If there is no protection for their fore- or mid-foot and a traumatic fracture occurs, that employee may suffer severe complications that can result in loss of limb and livelihood.
Diabetics are particularly at risk with regard to secondary infections and complications from fractures and they now represent a high proportion of South Africa’s work force.
It is also important for companies to realise that diseases have a huge impact on their employees. If employees are unhealthy, the company may experience chronic absenteeism that affects productivity. Encouraging employees to go for regular screenings encourages a healthy lifestyle. Protecting employees from traumatic fractures, as much as is possible, goes a long way to protecting the health of employees in their occupations and their livelihood. The personal protective equipment industry in South Africa is at the forefront of developing products for the protection of the metatarsal area. Successful worldwide patents have been registered for metatarsal protection for both leather safety footwear and for gumboots.
How can diabetes be a threat to feet?
The foot is a high-risk target for diabetics. Leg and foot problems can arise in people with diabetes due to changes in blood vessels and nerves in these areas. Peripheral vascular disease is a condition in which blood vessels become narrowed by fatty deposits, reducing blood supply to the legs and feet. Diabetes can also dull the sensitivity of nerves. Someone with this condition – called peripheral neuropathy – might not notice a sore spot caused by tight shoes or pressure from walking. If ignored, the sore can become infected and because blood circulation is poor, the area will take longer to heal. Proper foot care and regular visits to a doctor can prevent foot- and leg-sores and ensure that any that do appear don’t become infected and painful. Helpful measures include inspecting the feet daily for cuts or sore spots. Blisters and sore spots are not as likely when shoes fit well and socks or stockings aren’t tight. A doctor also may suggest washing feet daily with warm, not hot water; filing thick calluses; and using lotions that keep the feet from getting too dry. Shoe inserts or special shoes can be used to prevent pressure on the foot.
Diabetic neuropathy, or nerve disease, dulls the nerves and can be extremely painful. A person with neuropathy also may be depressed. Scientists are not sure whether the depression is an effect of neuropathy, or if it is simply a response to pain. Treatment aimed at relieving pain and depression may include aspirin and other pain-killing drugs.
For the diabetic, any sore on the foot or leg – whether it is painful or not – requires a doctor’s immediate attention. Treatment can help sores heal and prevent new ones from developing. Problems with the feet and legs can cause life-threatening problems that require amputation if not treated early. Clearly this comes at a high cost to company and to the individual. mmpr