SASOM Annual Congress 2017

 SASOM ANNUAL CONGRESS 2017

Summary of papers presented

This year’s South African Society of Occupational Medicine (SASOM) Congress took place on 9 and 10 June at the Protea Hotel by Marriott, Oliver Tambo International Airport, Kempton Park, Gauteng. The meeting of the SASOM Executive Committee (ExCo) was held on the evening of 8 June. The Congress was attended by delegates, invited presenters, session chairs and exhibitors who came from far and wide within South Africa and from beyond our borders.

The Congress offered participants a comprehensive and varied programme aligned with the theme ‘Challenges in Occupational Health – doing right, at the right time’, which sought to include elements relevant to ethics and legislation for all the topics presented. The Congress organising committee takes this opportunity to thank and recognise the contributions made by the presenters, exhibitors and delegates in making the Congress a success.

Prof. Daniel (Daan) Kocks, SASOM Chair, opened the Congress by welcoming the participants, and Prof. Mary Ross, SASOM ExCo and Honorary Life Member, chaired the first session. The first presentation, titled ‘Employee wellness programmes: the good, the bad and the ugly outcomes’, was delivered by Dr Mojaki Mosia, Human Resources Executive of the National Health Laboratory Service (NHLS). This was followed by ‘New dimension for business in wellness and disease management, including HIV and TB’, presented by Mr Simphiwe Mabhele, a technical specialist on HIV/AIDS and the world of work, representing both the International Labour Organization (ILO) and the South African Business Coalition on Health and AIDS (SABCOHA). The latter organisation coordinates the response to HIV and tuberculosis (TB) on behalf of its members, and is instrumental in shaping healthy communities by building capacity in monitoring, evaluation and research in the private sector in terms of workplace health. Although SABCOHA is confronted with ongoing challenges, its achievements include the establishment of networks in all provinces; successful implementation of the HIV Counselling and Testing Campaign; and the development of a National Strategic Plan on HIV, TB and Sexually Transmitted Infections (2017-2022). For the private sector to effectively respond to HIV and TB, it will require a coordinating mechanism, a plan for implementation, and a well-developed reporting and monitoring system.

Dr Arne von Delft, a public health medicine registrar at the University of Cape Town, and co-founder and core group member of the NGO, ‘TB Proof’, captivated the audience with an interactive and engaging presentation, titled ‘Unsafe and unfair: when working with TB becomes living with TB’. His account of his own experience and that of family members who contracted TB provided much food for thought for the Congress participants. He highlighted the under-appreciated risk of occupational TB faced by healthcare workers across the world, but especially in high-burden settings like Southern Africa. The epidemic remains poorly documented, fuelled by stigma and a lack of occupational health information and training. Dr von Delft reviewed recommended TB transmission control measures and existing occupational health systems, highlighting gaps and limitations in the currently available TB prevention options. His presentation included the screening of a very poignant and courageous testimonial video of a healthcare worker who contracted TB and subsequently died from the disease.

The second session was chaired by SASOM ExCo Member, Dr Basil Dhaniram, and started with Dr Sophia Kisting, Executive Director of the National Institute for Occupational Health (NIOH), presenting a paper titled ‘Healthy and greener workplaces support sustainable economies’. It highlighted the fact that workplaces can be utilised more optimally to prevent both occupational and environmental exposures to a number of hazards, and to reduce the associated burden of disease; and that the goal of environmentally sustainable economies cannot be attained without the active contribution of an informed world of work.

The next presentation was by Dr Tladi Ledibane, senior lecturer and community health specialist in the Department of Community Health of Sefako Makgatho Health Sciences University, and former Medical Director of the Medical Bureau for Occupational Diseases (MBOD), who delivered a talk titled ‘The Occupational Diseases in Mines and Works Act (ODMWA): challenges faced by the certification community’. He spoke of many challenges and made recommendations for improvement, in terms of how the ODMWA has failed to adapt to the increasing demand of access to medical screening for both active and ex-mineworkers, and how the Certification Committee established by the ODMWA is understaffed, underfunded and, consequently, ineffective and inaccessible.

The second session ended with an animated panel discussion on ‘The need for a mandatory paradigm shift in occupational health for Africa’. The panel members were the presenters from the first and second sessions, and the discussion elicited much interest and engagement from the audience.

The third session followed the break for lunch and visits to the exhibitor stands, and was chaired by the SASOM Secretary, Dr Jenny Sapire. First up was the invited international keynote presentation, delivered by Prof. Seong-Kyu Kang, Vice President of the International Commission on Occupational Health (ICOH), responsible for the National Secretaries Portfolio, and Chair of the Department of Occupational and Environmental Medicine of Gachon University Gil Medical Centre in Incheon, Republic of Korea. Prof. Kang enjoyed a long and distinguished career at the Korea Occupational Safety and Health Agency (KOSHA) until his retirement in 2016, and was the Chair of the Organising Committee of ICOH 2015, the 31st ICOH Congress which was held in Seoul in 2015. Prof. Kang delivered a very interesting presentation titled ‘Three decades of occupational health in Korea: development and economics’. He spoke of how the development of occupational health in a country can be classified into three phases – external, internal and social environmental – and how each of the three phases is associated with its own unique challenges, constraints and controversies, and what respective solutions are recommended. His presentation included a number of case studies related to emerging risks in the newer technologies and work sectors in Korea.

The next two presentations were dedicated to the topic of ergonomics. Ms Bulelwa Huna from the Department of Labour (DoL) presented the ‘Development of the draft ergonomic regulations’ and how their essence is to promote collective ownership and interactive collaboration in the implementation of initiatives and interventions in the workplace. Prof. Cas Badenhorst from North West University, and member of the DoL Technical Committee on Ergonomics, presented ‘Ergonomics: part and parcel of Occupational Health Services’. He gave an overview of the key elements of ergonomics programmes, how the benefits of these programmes go beyond the health and wellness of employees, and how the role of health services in any ergonomics programme is widely accepted, but not always understood or appreciated.

The last session of the day, also chaired by Dr Sapire, was dedicated to SASOM sister organisations in occupational health. Dr Penny Orton, Honorary Life Member of the South African Society of Occupational Health Nursing Practitioners  (SASOHN) and senior lecturer in the Department of Nursing at the Durban University of Technology, presented ‘Occupational health nursing: empowering the profession through the verification process’. She focused on the challenge to the occupational health nursing profession in terms of the Continual Professional Development (CPD) of practising nurses in the field who, in many instances, have been in the profession for decades. The South African Nursing Council is in the process of introducing CPD for all nurses in order to maintain their annual professional licensure, wherein SASOHN will play a critical role.

As a wrap-up to the first day of the Congress, Mr Kenneth Hlungwane, President of the Southern African Institute for Occupational Hygiene (SAIOH), delivered a talk titled ‘The occupational hygiene profession: challenges and the way forward for better service provision’. He spoke of how the process and operations involved in growing the occupational hygiene profession, offering accredited registration for practitioners in Southern Africa, and understanding how SAIOH can best support current and future members, have many challenges, which change regularly and require constant review and improvement. He discussed some major changes that SAIOH has made to its structure and operational procedures over the past four years, for better service delivery.

The SASOM Congress hosted the ICOH Regional (African) National Secretaries Meeting as a side event to the Congress on 9 June 2017. The meeting was chaired and facilitated by Prof. Kang, and attended by four ICOH National Secretaries: Dr Cheikh Cisse from Senegal, Dr Blessing Garamumhango from Zimbabwe, Dr Adriaan Combrinck from South Africa, and Dr Keitany Kibor from Kenya (the last via Skype participation). Two ICOH Board Members, Ms Claudina Nogueira (South Africa) and Dr Dingani Moyo (Zimbabwe) also attended the meeting in person.

The second day kicked off with a session chaired by  Dr Tladi Ledibane, with the introduction of the first of two presentations by Dr Terry Marshall, a virologist and molecular biology specialist from Ampath. Dr Marshall presented ‘Ebola virus disease: an overview’, and covered the virology and history of Ebola outbreaks, clinical features, and some treatment and prevention aspects. Her presentation included a description of the recent epidemic in West Africa.

The second presentation was by Dr Frank Fox, SASOM Honorary Life Member and former SASOM Secretary, now working as an independent occupational medicine specialist in Ireland. In a first for a SASOM Congress, Dr Fox’s PowerPoint presentation was delivered with his pre-recorded commentary, after which he connected remotely via Skype to the Congress to answer questions from the audience. His presentation, ‘Practical issues in medical ethics for occupational physicians’, focused on the fact that ethics get so much attention and are constantly on the agenda for Continuing Medical Education, because medical councils around the world require constant refreshment of knowledge on ethics. He indicated that various bodies have published guidance on ethics for occupational health practitioners; discussed the documents that have been published by ICOH, SASOM and the Faculties of Occupational Medicine in both the UK and Ireland; highlighted the differences between the various guidance documents; and drew attention to some practical problems from daily practice.

His presentation was followed by the first of two presentations by Ms Kathie Jansen, Assistant Director for Healthcare Waste Management of the Gauteng Department of Health. Ms Jansen’s presentation, ‘Hazardous biological waste: the importance of healthcare risk waste as an aspect of occupational hygiene risk management’, detailed how better management of healthcare risk waste can lead to minimisation of the risk stream, cost saving, reduction in needle stick injuries, a decrease in back injuries, and a better understanding of hazard identification and risk assessment for evaluation of the healthcare risk waste stream.

The second session was chaired by SASOM ExCo Member, Dr Oliver Ndhlovu, who introduced the first speaker, Prof. Rajen Naidoo, Head of Discipline: Occupational and Environmental Health, at the University of KwaZulu-Natal. Prof. Naidoo gave an informative and stimulating presentation titled ‘Informal sector: getting the basics right’, which highlighted that the changing world of work has seen a tremendous increase in informal work globally, and that this informal work differs between established and developing countries. In the latter, the informal sector is characterised by vulnerabilities in income, job security, occupational risks and access to healthcare. The policy infrastructure that encourages the growth of the informal sector most often excludes considerations for the protection of the health of informal workers, although it remains the responsibility of governments to ensure that informal sector workers enjoy the same rights to safe and healthy workplaces as their counterparts in the formal employment sectors. Prof. Naidoo’s presentation included some case studies of his work in the informal sector.

The presentation, titled ‘Accreditation of healthcare facilities in Africa’, was delivered by Ms Jacqui Stewart, the CEO of the Council for Health Service Accreditation of Southern Africa (COHSASA). The Council works with public and private healthcare facilities to introduce quality and accreditation. The presentation described how COHSASA has introduced a graded recognition award to encourage facilities that do not achieve the full accreditation at the first attempt, and a number of case studies were presented to illustrate the work carried out by COHSASA. To date, 525 full awards have been made. Accreditation is part of both quality improvement and assurance, and maintaining accreditation standards ensures continuous quality improvement and patient safety.

The third presentation, ‘Occupational health nursing practice: daily challenges’, was delivered by Sister Lindie Jansen van Rensburg, an occupational health service provider in private practice. She discussed how occupational health services should be risk-based, affordable and effective; and how, aside from the challenges related to legislative and ethical frameworks, further challenges are encountered on a daily basis, in terms of the employer and employee in relation to occupational health.

The last session of the day was chaired by Dr Steve Goosen, SASOM ExCo Member, who introduced Prof. Alta Schutte, from the Department of Physiology at North West University and Director of the Medical Research Council Unit for Hypertension and Cardiovascular Disease. Her presentation, ‘The recent progression in hypertension and its related risk factors in South Africa’, showed that, in recent decades, the transition of populations in many African countries, from traditional lifestyles to urbanised environments, seems to have contributed to the significant escalation of hypertension and cardiovascular disease in black populations. In Sub-Saharan Africa, which is burdened by a high prevalence of both infectious and non-communicable diseases, urgent concerted efforts and research capacity are required to curb the wave of hypertension and its consequences.

The second presentation of the afternoon was delivered by Dr Tladi Ledibane, who continued the ODMWA theme introduced on the first day by focusing on compensation aspects in a talk titled ‘ODMWA: the long and winding road’. Dr Ledibane spoke of the challenges faced by the now integrated MBOD and the Compensation Commission for Occupational Diseases (CCOD), where processes are complex, confusing, ineffective and inefficient, resulting in an ever-increasing backlog of compensation cases, a reduced number of applicants, and a decreasing number of processed claims and associated benefits being paid. In addition, multiple policy and legal frameworks across various departments (Labour, Health and Mineral Resources) add to the complexities and impact negatively on the welfare of mine workers. He made some recommendations to streamline services and improve access and efficiency.

The next talk was delivered by Dr Terry Marshall, who continued the Ebola theme from earlier in the day, with a presentation titled ‘Victim, vector or both – the ethics of managing Ebola: the disease and the epidemic’. Her second presentation explored the dilemmas encountered in ethically managing Ebola virus disease in individual patients, particularly in terms of their rights versus the public’s health rights; the rights of the staff managing the patient; and the rights of the population potentially exposed to the virus. The presentation included access to therapeutic and preventive interventions.

The last presentation of the Congress, the second delivered by Ms Kathie Jansen, was titled ‘Hazardous biological waste – healthcare risk waste case studies’ and discussed case studies to highlight awareness of dumping scenarios as well as hazard identification and the importance of conducting Hazard Identification Risk Assessments (HIRAs). The dumping of healthcare risk waste constitutes a service failure in terms of contracts, as well as a failure to comply with legislative requirements.

A few of the exhibitors held a lucky draw during the second day of the Congress, and a handful of delegates walked away with some superb prizes, ranging from occupational health technical equipment to hampers of eats and other decadent treats.

Ms Claudina Nogueira and Dr Adriaan Combrinck gave a short ad hoc presentation on ICOH and the benefits of membership, as well as an overview of the upcoming 32nd Congress, ICOH 2018, which will be held in Dublin, Ireland, from 29 April to 4 May 2018, and the important dates for registration and abstract submission. Various members of the audience requested application forms to join ICOH, and plan to reap the benefits of the reasonable membership fees that are applicable to those from developing countries.

Prof. Daan Kocks declared the Congress closed on the afternoon of the second day, and thanked all who contributed to making the Congress possible. Delegates who completed and submitted the Congress Evaluation Forms for both days earned 16 Continuing Professional Development points (CEUnits), from the South African Medical Association, for full attendance.

 

SASOM Congress delegates 
Photograph: Dr Arne von Delft, © TB Proof



Congress delegates, with and without masks, participate in the interactive presentation delivered by Dr Arne von Delft of ‘TB Proof’
Photograph: Dr Arne von Delft, © TB Proof



The lunches and teas were served in the same venue where the exhibitors displayed their stands, promoting networking and discussion opportunities between Congress attendees
Photograph: Claudina Nogueira



The SASOM Congress hosted the ICOH Regional (African) National Secretaries Meeting. From left to right: Prof. Seong-Kyu Kang (ICOH Vice President for National Secretaries), ICOH Board members Ms Claudina Nogueira (South Africa) and Dr Dingani Moyo (Zimbabwe), ICOH National Secretaries Dr Blessing Garamumhango (Zimbabwe), Dr Adriaan Combrinck (South Africa), and Dr Cheikh Cisse (Senegal)
Photograph: Claudina Nogueira



Delegates attending the session on ergonomics
Photograph: Dr Arne von Delft, © TB Proof



The NIOH was one of the exhibitors at the Congress
Photograph: Claudina Nogueira


SASOM 2017 ANNUAL GENERAL MEETING AND CONFERENCE

The next SASOM Conference/Academic Day will take place on 25 November 2017 to coincide with the Annual General Meeting (AGM) which will be organised and hosted by the SASOM KwaZulu-Natal Chapter, at the Coastlands Hotel in Umhlanga, KwaZulu-Natal.

SEMINAR ON DRIVER FITNESS AND CERTIFICATION

Collaboration between SASOM and Rolling Rehab

A seminar on driver fitness and certification was hosted by Ms Caroline Rule of Rolling Rehab (www.rollingrehab.co.za) on 5-6 May 2017, at the Golden Pipit Conference Centre, Club View in Centurion. Ms Rule is an occupational therapist (OT) with a special interest in driving assessments for people with impairments, as well as vehicle adaptations for drivers with physical limitations. The core content of the seminar covered the newly revised SASOM guidelines on driver fitness, presented by the document’s author/editor, Dr Greg Kew, a specialist in occupational medicine and senior lecturer at the University of Cape Town. Dr Kew is also Chair of the Western Cape Chapter of SASOM.

Other presentations at the seminar included issues specific to the OT functional assessment of impaired drivers, and vehicle adaptations by Ms Rule; a personal journey and useful guidance on the legal aspects of fitness certification by Mr Eugene Searle, a lawyer living with a physical disability; and an overview of relevant sections of the National Road Traffic Act by Mr Japie Mbele, Deputy Director of Licensing Standards in the Department of Transport.

There was an impressive turnout of 71 delegates, most of whom were OTs, but other attendees included psychologists, doctors (a neurologist, two rehabilitation doctors and two occupational medicine practitioners), and an occupational health nurse. In addition to Mr Mbele, two other representatives from the Department of Transport attended the seminar, including the Director of Compliance, Ms Laetitia Botma.

The seminar comprised four parts. The first addressed general issues, including the legal framework for driver testing and fitness to work (FTW) certification, the origins and scope of the guidelines, and the validity and legal standing of the guidelines. The second addressed a general approach to implementing an FTW testing programme, introduced new terms and definitions in the guidelines, and discussed general criteria for fitness to drive and the issue of notification of impaired drivers (by an impaired driver to a Member of the Executive Council (MEC), according to the definitions given in the National Road Traffic Act). The third part covered the section in the SASOM guidelines in which specific impairments in various organ systems are addressed (notably, neurology, metabolic conditions, etc.). The fourth session comprised case studies which were co-hosted by Ms Lizette Swanepoel, the head of the OT driver testing facility at the University of Stellenbosch.

Very positive feedback was given by the delegates who learned a great deal. They were also pleased to be able to contribute to the content of the final document.


 

Presenters and organisers of the Seminar on Driver Fitness and Certification. From left to right: Mr Japie Mbele (Licensing Standards, Department of Transport), Ms Caroline Rule (Rolling Rehab), Mr Eugene Searle (lawyer in private practice) and Dr Greg Kew (SASOM and UCT)
Photograph: Rolling Rehab


WORKSHOP ON HAZARDOUS BIOLOGICAL AGENTS
At the request of the DoL, SASOM participated in the Hazardous Biological Agents (HBAs) Workshop, held on 29 June 2017, to initiate discussion on amending the Regulations for Hazardous Biological Agents (2001). The programme was co-ordinated and led by the DoL with inputs on various aspects of the regulations from representatives of the NIOH (Dr Tanusha Singh), SAIOH (Jaco Pieterse), SASOHN (Denise Minnie), and SASOM.

Prof. Mary Ross initiated the SASOM contribution with a presentation on ‘Medical surveillance for employees exposed to biological agents’. She emphasised the need for surveillance, not only for healthcare workers who are indeed a high priority group, but also for workers as disparate as those working with animals, in agriculture, with waste, and occupational travellers such as expatriates and the military. A limitation of the current regulations is that, despite inclusion of ‘self-employed’ workers, they do not actually cover the informal sector, comprising several million workers.

SASOM sponsored Dr Bart Willems from the Western Cape, and as a representative of the NGO ‘TB Proof’, to complete the SASOM input. Based on his own experience of contracting occupational TB, and with a relative who contracted occupational multiple drug-resistant (MDR) TB, Dr Willems gave a riveting presentation on the dire threat of the TB epidemic to vulnerable healthcare workers in South Africa. The SASOM input engendered active discussion on healthcare workers in general and, particularly, the need to reclassify HBAs such as MDR and extreme drug-resistant (XDR) TB.

The DoL will be establishing an expert group to assist with the amendment of the HBA regulations.

 

Report by:

Claudina Nogueira

SASOM ExCo Member and ICOH Board Member

 e-mail: claudinanogueira@hotmail.com

Greg Kew

Chair: SASOM Western Cape Chapter

e-mail: Greg.Kew@eoh.com

Mary Ross

SASOM ExCo and Honorary Life Member

e-mail: profmaryross@yahoo.com

Jenny Acutt

Project Co-ordinator in the SASOM National Office

e-mail: info@sasom.org

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