Collaborative training builds occupational hygiene capacity in southern Africa



INTRODUCTION
Workplace Health Without Borders (WHWB), in collaboration with the New Partnership for Africa's Development (NEPAD) Agency, presented the Occupational Hygiene Training Association's (OHTA, www.OHlearning.com) ‘Basic Principles of Occupational Hygiene’ (W201) training course at the Sherbourne Hotel in Kitwe, Zambia, from 23 to 27 July 2018. Other partners of the training course were the Government of Zambia (Ministries of Health, Mining, and Labour), the Government of South Africa, and the School of Public Health, University of the Witwatersrand, South Africa. WHWB (www.whwb.org) is an international non-profit organisation founded in 2011, with the main objective of addressing the limited expertise that exists globally for the prevention of workplace disease and injury. Membership is voluntary and comprises professionals across various disciplines within occupational health, the most prominent being occupational hygiene. The WHWB international organisation is based in Canada, with several branches across the world, e.g. WHWB-USA and WHWB-UK. Through its established and growing network of professionals who volunteer their time and expertise, WHWB is able to offer capacity-building in the broad occupational health field, through collaborations that benefit under-served populations and vulnerable workforces across the globe.

To date, the WHWB activities have focused primarily on training, mentoring, development and translation of guidance materials, and technical assistance to build knowledge and capacity in occupational health and hygiene. The NEPAD Agency (www.nepad.org) is the implementing agency of the African Union (AU) that facilitates and coordinates the development of NEPAD continent-wide programmes and projects, mobilises resources, and engages the global community, regional economic communities and member states in the implementation of these programmes and projects. The NEPAD broad areas of work are: human capital development (skills, youth, employment, women empowerment); industrialisation, science, technology and innovation; natural resources governance and food security; and regional integration, infrastructure and trade.


United we stand, divided we fall – Participants, facilitators, organisers and coordinators of the WHWB-NEPAD occupational hygiene training course held in Kitwe, Zambia, from 23 to 27 July 2018 Photograph: NEPAD
 
BACKGROUND TO THE TRAINING
This training initiative was held under the umbrella of the Southern Africa Tuberculosis (TB) and Health Systems Support (SATBHSS) Project which was launched in December 2016 as part of the response to the TB challenge in the southern African region. It is being implemented in four countries, viz. Lesotho, Malawi, Mozambique and Zambia, with spill-over benefits across the Southern African Development Community (SADC) region. The background to the Project has been reported previously in this Journal.1 Very broadly, the aim of the Project is to (i) improve the coverage and quality of TB control and occupational lung disease services, and (ii) strengthen regional capacity to manage the burden of TB and occupational lung diseases. Mining is an important economic contributor in the SADC region but this comes with a heavy burden of high TB incidence rates. This is due to poor working conditions in mining environments, such as prolonged exposure to respirable dust, poor ventilation, and inadequate control of hazards. The situation is exacerbated by inadequately skilled occupational hygienists who evaluate occupational exposure to hazards such as silica dust, and recommend appropriate control measures. The Project also aims to advise both the government and private sector of dust exposure control limits and dust management policies and standards. It is expected that the training will build a cadre of experts who will support the development and implementation of a standardised approach to the occupational hygiene principles of identification, evaluation, monitoring, and control of hazards, thereby ensuring healthier workplaces.  

TRAINING COURSE OBJECTIVES AND LOGISTICS
An introductory course was offered, outlining the broad principles of occupational hygiene as the basis for anticipation, recognition, evaluation, and control of hazards encountered in the workplace. Course ­participants were active occupational health/hygiene professionals, ­willing to continue their training to become certified occupational hygienists. It was expected that, upon completion of the introductory course, the participants would be able to motivate and provide support for practitioners (in both the public and private sectors) in their own countries, to start the process of establishing their own occupational hygiene associations, for example, thus growing the profession in Africa. A total of 19 delegates, as well as a NEPAD staff member from South Africa, participated in the training and wrote the examination (open book format). Participants represented the following SADC countries, and were mostly employed at inspectorates of the respective Departments/Ministries of Labour, Mining and/or Health: Lesotho (7), Mozambique (2), Malawi (2), Zambia (8), and South Africa (1). The training was funded by the World Bank and there was no charge to participants. NEPAD Agency made the required logistical arrangements and covered the travel and accommodation costs of the facilitators and the course participants. The training course was officially opened by Mr Absalom Ndlovu, Chief Occupational Hygienist of the Occupational Health and Safety Institute (OHSI) in Zambia. A further two authority representatives visited the training venue to offer their good wishes for the success of the training initiative: Mr John Bosco Makumba, World Bank Senior Operations Officer in the Zambia Office, and Dr Karen Brudney, Infection Control Specialist from the Centers for Disease Control and Prevention (CDC) in the USA.

The course was presented by WHWB through the following voluntary facilitators:
 Mr Peter-John (Jakes) Jacobs (Course Director and Main Facilitator)
 Ms Goitsemang Keretetse (Facilitator)
 Ms Claudina Nogueira (Portuguese/English Translator  and Facilitator)  Prior to commencement of the course, all participants stood for a moment of silence to remember the more than two million people who die annually as a result of workplace diseases and injuries. The facilitators worked well together and supported one another during all aspects of the training.

Training duties were equally divided between the facilitators, with the following benefits:
1. The workload was distributed and facilitator fatigue avoided.
2. Learner fatigue and boredom were avoided through a mixed approach to facilitation.
3. Facilitators were able to talk to their specific areas of expertise and share their own experiences, resulting in more to share and better learnings for participants.
4. Easy translation and personal contact and assistance was provided for Portuguese speakers.  

Logistical assistance and technical arrangements were handled by NEPAD; the two main role players being: • Mr Norman Khoza (Senior Programme Officer – Occupational Health and Safety Specialist) • Ms Nthabiseng Moiloa (Project Administrator) Special credit needs to be given to NEPAD and, in particular, to the two role players, for the professional manner in which course arrangements were made and for the excellent logistical support ­provided before, during and after the training. Facilities and accommodation were of a high standard, and a sound engineer and two translators were available for the entire week to enable simultaneous translation and to provide technical support. It can be said: “It all came together very well on the day/week”.


Kitwe quintet jam session – Facilitators and organisers of the WHWB-NEPAD occupational hygiene training course. L to R: Goitsemang Keretetse (Facilitator), Peter-John (Jakes) Jacobs (Course Director and Main Facilitator), Nthabiseng Moiloa (Project Administrator), Norman Khoza (Project Coordinator), Claudina Nogueira (Facilitator and Translator)  Photograph: NEPAD


Pop quiz aces – Zambian occupational hygienists Joseph Sindawa (left) and Absalom Ndlovu (centre) display the coveted prizes awarded to them by Course Director, Peter-John (Jakes) Jacobs (right), as a fitting reward for paying attention in class Photograph: Claudina Nogueira  

OUTCOMES OF THE TRAINING COURSE
The course covered a large volume of information, focusing on basic principles of occupational hygiene, and ran for five days, with attendees receiving homework at the end of each day for discussion at the start of the following day. All participants displayed a positive attitude throughout and actively participated in group work and class ­discussions, and it was evident that there was a ‘hunger’ for the information provided. Attendees worked late into the evenings in groups, completing homework and preparing for the following day’s feedback sessions. The individually-sealed written examination papers were couriered to WHWB in Canada for marking and moderating, and the results were provided to all candidates, individually. All candidates achieved marks of 70% and above. The Director of the OHSI, Dr Connard Mwansa, visited the training venue during the examination session, to hand out certificates of attendance. During the week, participants were afforded the opportunity to visit the OHSI facilities in Kitwe, which are within walking distance of the training venue. The OHSI is a statutory agency in Zambia where miners report for mandatory annual medical examinations (as per the requirements of the Workers Compensation Act No.10 of 1999). Miners, on first presentation to the Institute, are assigned a unique Institute number which becomes their personal number for the duration of their working time in the mining industry. All the miners’ information is entered and stored in the OHSI medical files: information comprises health status of the miners and chest radiograph reports. The OHSI medical panel is mandated to read all chest radiographs and laboratory findings, and to award medical certificates.2 More recently, the medical examinations and facilities at the OHSI have been made available to the general public, farmers, self-employed entities, small and medium-scale business enterprises, and companies other than mines, that are concerned about the occupational health and wellbeing of their employees. The dates of the OHTA training course in Kitwe coincided, fortuitously, with the launch of ‘Vision Zero’ in Zambia, and a visit from two technical experts from the National Institute for Occupational Safety and Health (NIOSH, USA), Ms Anita Wolfe and Mr Travis Markle, who were at the OHSI to install state-of-the-art B-reader equipment. This advanced technology will be combined with training of identified readers (medical doctors and radiologists), planned for November 2018. This new capacity will assist the OHSI, and the country more broadly, with upscaling their occupational health services. The ultimate aim is to benefit the mining workforce in Zambia, in terms of their ongoing medical surveillance, as well as compensation for occupational disease, where applicable. Ms Anita Wolfe, a public health analyst, visited the training venue during the week-long course, and addressed course participants on her own experiences with screening for, and active case-finding of, coal workers’ pneumoconiosis (CWP), also known as ‘black lung’, in the USA. Since early 2017, NIOSH has offered a series of free, confidential health screenings to coal miners as part of the ‘Coal Workers’ Health Surveillance Program’, for which Ms Wolfe is the coordinator. The screenings are intended to provide early detection of CWP, a serious but
preventable occupational lung disease in coal miners caused by breathing respirable coal mine dust.3

Post-course evaluations by participants revealed three critical elements:
1. The need for the training to be spread out over a longer period – one week was deemed by most participants to be too short;
2. The need for further training, to build on this introductory module, i.e. the intermediate OHTA training modules; and
3. The need for more time to be spent on practical sessions for demonstration and use of occupational hygiene measuring equipment, and the possible inclusion of a worksite visit.  The training intervention was deemed a resounding success.

Key recommendations include:
1. Use the current group of course attendees as a ‘learner pool’ and support them through the OHTA intermediate training modules, to the point of international certification – IcertOH.
2. Use the same group of facilitators to present the intermediate modules to the ‘learner pool’ for the purpose of continuity.
3. Extend the course duration to eight days, i.e. lectures from Monday to Sunday, with the examination written on the Monday directly after the training. In the final wrap-up session of the training course, prior to the examination, all course participants, facilitators and support staff (the sound engineer and translators) were asked to articulate a ‘take-home message’ of their main learnings, and how they would apply their newly-acquired occupational hygiene knowledge to contribute actively to reducing the global burden of fatal occupational disease and injuries. (ILO Statistics: ‘Work-related fatal injuries and diseases have increased to 2.78 million per year (of these, approximately 2.4 million are linked to work-related disease), increasing the global cost of the failure to adequately address occupational safety and health concerns to an estimated 3.94% of global GDP per year, equivalent to US$ 2.99 trillion’).4

The following commitments are a sample of ‘take-home messages’ shared by the participants:
1. ‘Create two Whatsapp groups (one comprising all course participants and the other all Zambian participants, for improved in-country collaboration) for the purposes of continuing with this occupational hygiene capacity initiative. Linkages and networking efforts are required, at international, national and enterprise levels, because very little can be accomplished, at an individual level, to effectively contribute to supporting national agendas and policies (e.g. in Zambia), as well as international efforts.’
2. ‘Use the information acquired on this course to influence state departments and change the mindset of authorities, in terms of introducing a sustainable culture of occupational hygiene, to take full advantage of (and benefit from) the current mineral boom in Mozambique.’
3.‘Facilitate training of inspectorates in their own countries (e.g. in Mozambique), and contribute to building platforms that go beyond training of inspectorates, to include active communication with other ministries.’
4. ‘Return to Lesotho to present a proposal to the Commissioner of Mines to substantiate the need for conducting routine health surveillance in workplaces, and how informed control measures can reduce occupational exposures.’
5. ‘This training has come at the right time for Malawi, since the mining regulations are currently under review. New insight gained from the training can benefit inspectorate activities in both informal and small-scale enterprises.’
6. ‘This training will enable the monitoring of various activities in Lesotho; I will work closely with the Safety, Health and Environment departments to enable a more practical approach to the control of exposure experiences.’
7. ‘The informal sector remains the biggest challenge in Zambia. I will engage this sector more, by targeting welders and spray painters, and building relationships with them, to establish informal groups for discussion on the risks of occupational exposures, and their controls.’
8. ‘I will submit a comprehensive report on the training, emphasising the need to develop the occupational hygiene discipline (instead of focusing only on safety aspects). l undertake to have all the existing equipment calibrated properly for active use, and to work collaboratively with other institutions involved in occupational hygiene inspections, with the ultimate long-term aim of establishing an Occupational Hygiene Association in Zambia.’
9. ‘The information around asbestos exposure has been an eye-opener; also, I have learned a lot about noise-induced hearing loss, and will share these new learnings with other colleagues who work as ­interpreters, particularly in the mining and construction industries. I have also learned about safety measures that must be applied at home, and not only in the workplace.’
10. ‘I have learned a great deal about the effects of mercury exposure and will share this information, particularly as the practice of using mercury to extract gold in informal mining activities is very common in the Zambian villages that I know.’
11. ‘I will compile articles about this training initiative and disseminate these via the use of various information channels, e.g. submissions for consideration to the newsletters of the International Occupational Hygiene Association (IOHA), the International Commission on Occupational Health (ICOH), and the Occupational Health Southern Africa Journal.’  

FUTURE PLANS
• The facilitators commited to assisting participants with the preparation of their respective motivations to managers, by sharing support information and documents on occupational exposures, e.g. the ILO and WHO reports on the burden of occupational disease and injuries; and literature on mercury-free methods for extracting gold in artisanal mining.  

REFERENCES
1. Khoza N, Chamdimba C, Mkandawire H. Managing crystalline silica dust to intensify the fight against TB: a regional approach (Report). Occup Health Southern Afr. 2018; 24(3):84. 2. Ngosa K, Naidoo RN. The risk of pulmonary tuberculosis in underground copper miners in Zambia exposed to respirable silica: a cross-sectional study. BMC Public Health. 2016; 16:855: DOI 10.1186/s12889-016-3547-2. 3. The National Institute for Occupational Safety and Health (NIOSH). Coal Workers’ Health Surveillance Program. Available from: https://www.cdc.gov/niosh/topics/cwhsp/default.html (accessed 20 Aug 2018). 4. International Labour Organization (ILO). Safety and Health at Work: Hope and challenges in development cooperation. The example of an EU-ILO joint project ‘Improving safety and health at work through a decent work agenda’ (2013). Available from: https://www.ilo.org/safework/projects/WCMS_215307/lang--en/index.htm (accessed 20 Aug 2018).  

Report by:
Peter-John (Jakes) Jacobs – Training Course Director and Main Facilitator
(WHWB Member, IOHA President 2018-2019)
e-mail: pjjacobs@sedulitas.co.za
Claudina Nogueira – Training Course Facilitator and Translator (English/Portuguese)
(WHWB Board Member, ICOH Vice President for Scientific Committees 2018-2021)
e-mail: claudinanogueira@hotmail.com
Goitsemang Keretetse – Training Course Facilitator
(Lecturer – School of Public Health, University of the Witwatersrand, South Africa)
e-mail: goitsemang.keretetse@wits.ac.za
Norman Khoza – Coordinator of the Project
(NEPAD Senior Programme Officer – Occupational Health and Safety Specialist)
e-mail: normank@nepad.org


Peter-John (Jakes) Jacobs and Norman Khoza are SAIOH Council members; Goitsemang Keretetse is a SAIOH member. Claudina Nogueira is a SASOM ExCo member and was a SAIOH Council member until the end of 2018.  

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