Report on the SASOM-MEDICHEM Joint Congress, 31 July to 3 August 2019

REPORT

Setting the Scene

The first Joint Congress of the South African Society of Occupational Medicine (SASOM) and the International Scientific Association for Occupational and Environmental Health in the Production and Use of Chemicals (MEDICHEM) was held at the Protea Hotel by Marriott O.R. Tambo International Airport, Gauteng, South Africa. SASOM is an affiliate member of the International Commission on Occupational Health (ICOH) and MEDICHEM acts as the ICOH Scientific Committee (SC) on Occupational Health in the Chemical Industry.

The theme of the Congress was Control of Substances Hazardous to Health: Old and Emerging Issues. Attendees were accredited with 26 CEUnits for full attendance, including two ethics points by the South African Medical Association (SAMA) or four CEUnits by the South African Council for Natural Scientific Professions (SACNASP).

In a true reflection of global collaboration in occupational health, approximately 110 participants (including invited speakers, delegates and exhibitors) attended the Congress, representing 25 countries: Canada, China, Finland, France, Germany, Greece, Kenya, India, Israel, Italy, Kuwait, Lesotho, Malaysia, Mozambique, Namibia, Nigeria, Portugal, Republic of Korea, Rwanda, Switzerland, Thailand, United Kingdom, United States, Zimbabwe, and South Africa.

 

The Main Event

The Congress was officially opened by Prof. Daan Kocks (Chair: SASOM) and Dr Murray Coombs (President: MEDICHEM). A special welcome was extended to the Office Bearers, National Secretaries and representatives of the SCs of ICOH. SASOM and MEDICHEM collaborated in this first joint venture to bring together international professional networks to share their expertise. The chemical industry expertise was represented through MEDICHEM and the International Council for Chemical Associations, most notably for their work in sustainable development, green chemistry and responsible care. Opportunities were created for the local professional occupational health societies, viz. SASOM, the South African Society for Occupational Health Nursing Practitioners (SASOHN), and the Southern African Institute for Occupational Hygiene (SAIOH), to interact and network with the international participants. This platform also allowed for excellent opportunities for workplace practitioners and industry representatives to meet with academic and government institutions.

The stimulating and informative scientific programme included alternating MEDICHEM and SASOM sessions, with the following sub-themes: (i) ‘Setting the Scene: Chemical Exposure Perspectives – Global, Regional, In-Country’; (ii) ‘Chemical Hazards: Occupational Health Ethics and Emerging Issues’; (iii) ‘Chemical Hazards: Role of Professional Networks in Occupational Health’ and; (iv) ‘Health and Chemicals: Learnings and Applications’. Six ICOH SCs, which have overlapping work and research interests with those of both MEDICHEM and SASOM, accepted invitations from the Congress organisers to be officially represented in the scientific programme, viz. SC on History of the Prevention of Occupational and Environmental Diseases; SC on Mining Occupational Safety and Health (SC MinOSH); SC on Occupational Health Nursing (SC OHN); SC on Occupational and Environmental Dermatoses (SC OED); SC on Occupational Toxicology (SC OT); and SC on Industrial Hygiene (SC IH).

The Congress presentations covered a wide spectrum of topics, including global mergers in the chemical industry; safe chemical production; enzyme sensitisations; the epidemiology of asbestos, silica and tuberculosis (TB); environmental toxicology; ethics of occupational health in the informal sector and in the pesticide industry; occupational hygiene and research in mining in Africa; evaluation of sleep in the workplace; response to the global health worker shortage; employee wellness beyond chemical hazards; the burden at work caused by hazardous substances; medical surveillance and bio-monitoring in chemical industries; and accentuating the beneficial aspects of chemicals. The abstracts of all presentations are available here.

 

Learnings from presentations

The learnings shared in the seven keynote and 35 oral presentations provided worthy ‘take home messages’ for all participants. Specific citations from individual presentations follow.
 

‘Occupational diseases are common; common diseases are occupational. Hazardous substances cause a major burden at work both as deaths and Disability Adjusted Life Years (DALYs). Of the 2.78 million deaths in 2017, 980 000 were caused by hazardous substances.’ – Dr Jukka Takala (Finland), ICOH President

 

‘The idea of collecting all the scientific contributions presented at the ICOH Congresses in an organised and interrelated system led to the recent creation of a digital repository of the congress proceedings, starting from 1906 to the present time. The ICOH Heritage Repository will constitute a unique research tool not only for the history of prevention and health and safety at workplaces, but also for current research activities in OSH.’ – Prof. Sergio Iavicoli (Italy), ICOH Secretary General

 

‘Multinational mergers, acquisitions, and divestitures impact occupational health services in the chemical industry; it is important to preserve records and databases so that critical epidemiology data are not lost and future studies can be conducted.’  Dr Paul Gannon (UK / Switzerland)

 

‘While classical epidemiological studies have revealed important causal relationships, hazard identification alone is insufficient to meet today’s occupational health challenges. Prevention of occupational disease will be enhanced as a result of sharpened research methods and interdisciplinary involvement.’ – Prof. Kenneth Mundt (USA)

 

‘Although enzymes are not skin sensitizers, prolonged contact with moist skin can cause irritation which is most likely to occur on the hands, fingertips, and forearms, and in places where clothing rubs against the skin, such as the neck, waist and wrists.’  Dr Steffen Hitzeroth (Germany)

 

‘Although we can learn much from a first world example, the question remains – how applicable can the principles and methodologies of the German systems and guides on occupational disease (particularly those related to silica and nanotechnology) be for South African occupational health and legal practitioners?’  Dr Murray Coombs (South Africa)

 

‘Anthropogenic pollutants may significantly affect the human genome via epigenetic mechanisms. We should focus our resources to reveal epigenetic elements to serve as useful biological exposure indices for the early detection of deleterious effects of industrial pollutants on the human genome.’  Dr Avi Wiener (Israel)

 

‘Decisions about exposure to environmental contaminants and associated health risks of communities are not always based purely on science. Regulatory authorities, legal professionals and members of the public tend to simplify matters, omitting vital steps in the human health risk assessment paradigm. This complicates health risk-based decisions and communication.’  Dr Willie van Niekerk (South Africa)

 

‘The pharmaceutical industry and consumer product enterprises are leading the way in the precautionary approach, precisely because they are in a vulnerable position with respect to liability. We assert that ‘green chemistry’ is not a subset of the universe of chemistry but represents the future of the chemical industry.’  Dr Tee Guidotti (USA/Canada)

 

Manufacturing active pharmaceutical ingredients (APIs) requires a risk-based approach to determine acceptable levels of risk to workers, patients and the environment. The main premise for risk control is to keep API-exposure below a health-based exposure limit (HBEL), i.e. below a pre-specified level at which the risk is low and considered acceptable.’  Dr Jan Lapere (South Africa)

 

‘The increasing potency of pharmaceutical compounds requires control of exposure to very low concentrations. The prevention of occupational over-exposure shall be ensured primarily by collective protection measures (i.e. technical measures, engineering controls) and not simply by the provision on personal protective equipment.’  Dr David Miedinger (Switzerland)

 

‘Pharmaceuticals are life-saving, however, their production is not without risk. A robust and rigorous risk management programme undertaken by a multidisciplinary team that identifies and implements appropriate control measures, is essential to avoid adverse health effects.’  Dr Haidee Williams (South Africa)

 

‘Small farmers in developing countries suffer a deep environmental injustice involving a huge burden of acute pesticide poisoning and long-term health impacts from uncontrolled exposures. Technology for people; not people subject to technology. Science should benefit people – that is everyone’s right.’ – Prof. Leslie London (South Africa)

 

‘Whistle-blowing is both an ethical and a legal obligation. Organisations can ensure a healthy culture of transparency and protect whistle-blowers by promptly and appropriately investigating any disclosure made by an employee or worker to establish the veracity of such a disclosure (regardless of whether or not it is protected).’  Mrs Kalene Watson (South Africa)

 

‘The world of work has changed and the informal sector has become dominant. The practice of occupational health has to change if we are to follow our mission to protect the health of workers.

Bioethical principles may not apply to workers in the informal sector as they do in conventional workplaces; our ethical approaches to informal workers need review.’ – Prof. Rajen Naidoo (South Africa)

 

‘Inherent in nursing is a respect for human rights, including cultural rights, the right to life and choice, to dignity, and to be treated with respect. As occupational health nurses, we respect the South African Nursing Council’s Code of Ethics and the ICOH Code of Ethics for Occupational Health Practitioners. However, ethical decision-making in healthcare settings is a complex issue.’  Dr Penny Orton (South Africa)

 

‘Occupational health nursing practitioners have a responsibility to workers, management and the environment, to ensure that hazardous substances do not affect anyone’s health. This can only be done by fostering high standards of practice, and ensuring that effective regulatory issues are addressed, thus promoting economic prosperity and workplace health.’  Ms Kim Davies (South Africa), representing the ICOH SC OHN

 

‘Asbestos is a banned substance, but its legacy continues to impact on the environment and the economy (cost of removal, remediation of land or encapsulation of asbestos). Its health implications persist and will manifest in the future.’  Dr Jim Phillips (South Africa)

 

‘Across Africa, mining has brought many health challenges, including injuries, pneumoconiosis, occupational TB and noise-induced hearing loss. Some of these continue to be a challenge while new issues are emerging, driven by politics, socioeconomic factors, mining practices, technology and new hazards such as nanoparticles and drug regimens that affect hearing.’  Dr Thuthula Balfour (South Africa)

 

‘The mission of the Namibian Uranium Association is to support the Namibian uranium industry through the continuous development of health, environmental and radiation safety best practices, accessible research, training, and social responsibility. The world has taken note of the responsible manner in which uranium is mined and explored for in Namibia; 59 of the 90 indicators of the Sustainable Development Goals have been met by the uranium industry in Namibia.’  Dr Gabi Schneider (Namibia)

 

‘Mining, oil and gas, and farming (pesticides) are major sources of chemical exposures in Africa. There should be an increased drive to train more occupational hygienists, particularly in West, East and Central Africa, to generate local occupational exposure limits.’  Dr Uche Enumah (Nigeria)

 

‘In mining, a new approach to an old problem is to focus on the mechanism of release, and proactive engineering and operational control solutions, rather than reactive health and occupational hygiene risk management solutions. Measurements are important but we need less monitoring and much more controlling.’ – Prof. Cas Badenhorst (South Africa)

 

‘Throughout the African continent, increasing numbers of workers are employed in high-hazard industrial jobs. Limited studies of occupational disease in agriculture, mining and manufacturing suggest that there is a high prevalence of work-related illness in the populations at risk. The shortage of occupational safety and health specialists is at its worst in sub-Saharan Africa. Substantial investment (in e-learning/teaching/research) will help to address this shortage, with the contribution of Africa’s large diaspora.’  Dr Janvier Gasana (Kuwait/Rwanda), representing the ICOH SC MinOSH

 

‘Lesotho is one of the high HIV/TB burden countries that shelters a considerable number of mineworkers. The joint actions of silicosis and TB have a damaging impact on oxygen saturation and there is a known multiplicative effect of silicosis and HIV on TB. Hence, silica-exposed communities must receive particular attention if we are to win the battle against TB, given the heavy burden of these three conditions.’  Dr Botembetume Maboso (Lesotho)

 

‘Cases of hard metal lung disease highlight the importance of hazard identification, risk characterisation, exposure assessment, medical surveillance, and acting on findings in hard metal and other industries.’  Dr Itumeleng Ntatamala (South Africa)

 

‘The strategies that are part of current occupational hygiene practice in the United States are not widely used in Mozambique due to many constraints. There is a need to engage businesses and stakeholders at all levels, for step-by-step systematic approaches, from the simple to the more complex tools (hazard/control banding toolkits), and to extend the concepts to the protection of the general public and the environment.’  Dr Custódio Muianga (Mozambique/USA)

 

‘As a profession, occupational hygienists have become well-versed in the ‘hard’ sciences, such as physics, chemistry, biology, and the various engineering disciplines. However, we have not really focused on developing the ‘softer’ skills that our profession requires to properly address the psychosocial hazards in workplaces, including the petrochemical industry. We should not lose sight of the psychosocial factors which are well defined in our scope of work.’  Mr Peter-John ‘Jakes’ Jacobs (South Africa)

 

‘For control of substances hazardous to health, industrial hygiene plays an important role when it comes to exposures, prevention and protection. The ICOH SC IH is a professional network that provides assistance in planning and executing industrial hygiene programmes, is involved in knowledge transfer and the identification of international best practices, and leverages global expertise for local challenges.’  Dr Blessing Garamumhango (Zimbabwe), representing ICOH SC IH

 

‘The focus areas of OSHAfrica are to lead OSH research across the African continent, support and be part of a global OSH research platform, support the African Union and other regional economic blocks with OSH expertise, and to spearhead incident and accident reporting processes in workplaces and cities across the African continent.’  Dr Dingani Moyo (Zimbabwe)

 

‘Like many toxicants, technology (the new virtual toxicant?) may have enormous potential for good but must be suitably applied and controlled. If technology is applied properly, efficiencies will result: occupational health services will be of greater value and the anticipated shortfall of occupational health providers in the face of increasing worldwide demand may no longer be a concern. Sound ethics must underpin the leaps in technology development, e.g. guidelines on when to replace people with machines, strict privacy rules, and proper use of genetic data.’  Dr William Buchta (USA)

 

‘A multidisciplinary team approach is needed for compiling a successful Hazardous Chemical Substances management plan, with legal compliance for chemical risk assessment and medical surveillance as minimum requirements.’  Ms Annelize Jacobs (South Africa)

 

‘Occupational physicians play a crucial role in the management of acute poisoning. They must recognise the possibility of missing cases from specific health examinations, and be mindful that occupational hazards can exist in all workplaces across all sectors.’ – Prof. Seong-Kyu Kang (Republic of Korea)

 

‘The global company, Unilever, has an established history of supporting employee health and well-being. ‘Lamplighter’ is Unilever’s flagship health promotion programme, and assesses health risks, nutrition, exercise and mental well-being components to provide bespoke support to the workforce.’  Dr Thirumalai Rajgopal (India)

 

‘There are known associations between quality of sleep and fatigue in the workplace. Significant numbers of patients receive medications for insomnia as a symptom of obstructive sleep apnoea. Objective, accessible, user-friendly, and cost-appropriate profiling of sleep triages insomnia into reduced sleep quality, impaired quality and sleep apnoea, and should therefore improve clinical management.’  Dr Neale Lange (USA/South Africa)

 

‘Doctors, other health professionals, and policy makers should collaborate to ensure standardised registration of non-melanoma skin cancers (NMSC). The reporting rate of NMSC is low, as dermatologists often do not link the disease to occupation. Employers should use tools to quantify exposure levels to UV radiation in the workplace, implement cost-effective control measures for sun-safe behaviours, and ensure regular skin cancer screenings for outdoor workers.’ – Prof. Johan du Plessis (South Africa), representing ICOH SC OED

 

‘Medical surveillance for chemical workers is challenging. It’s about doing things right, and doing the right things. More time must be spent by occupational medicine practitioners on designing and planning the surveillance (based on exposure and toxicology data); there must be improvement in the ‘translatability’ of risk assessments for use in the medical surveillance strategy; cumulative exposures need to be better represented; and occupational health nurses need to be up-skilled in the understanding of risk assessments and industrial hygiene, as these are important contributors to occupational health management plans.’  Dr Greg Kew (South Africa)

 

‘Biological monitoring is a scientifically-developed approach for assessing exposure in the context of occupational health surveillance. The use of biomarkers represents an integrated method of measurement of exposure (internal dose) resulting from complex metabolic pathways, and takes into account toxico-kinetic information and individual susceptibility. It is a rapidly advancing area (innovative methodology) of occupational medicine, requiring a multidisciplinary team approach.’  Dr Nereshni Lutchman (South Africa)

 

‘Biological monitoring can assess exposure by all routes (inhalation, ingestion and skin absorption). It can assess the efficacy of (i) engineering controls at the source of exposure, (ii) human factors and their variability, (iii) implementation of regulations, and (iv) personal protective equipment used by workers.’  Dr Sunisa Chaiklieng (Thailand), representing ICOH SC OT

 

‘Cytostatic drugs are cytotoxic agents used in cancer and chronic disease treatment. Although their benefit is unquestionable, they have been recognised as hazardous to healthcare workers (HCWs) in occupational settings. Non-compliance has been observed in HCWs in terms of following international guidelines, recommendations and protocols, e.g. inadequate use of personal protective equipment, lack of knowledge on toxicity, and not reporting the presence of symptoms upon exposure.’  Dr Noémia Loio-Marques (Portugal)

 

‘The basic principles of emergency management of chemical exposures (burns) are the urgent identification of the causative agent, immediate decontamination, and use of antidotes. Profuse rinsing with water is very often not the best solution, and can do more harm than good.’  Dr Vasileios Vasileiadis (Greece)

 

‘Multiple chemical sensitivity (MCS), or idiopathic environmental intolerance (IEI), is a debilitating condition attributed to exposure to a variety of chemical, biological and other agents. There is no objective evidence that commonly used ‘detoxification’ methods for MCS have any meaningful effects. There are also no objective measures of impairment, and practitioners differ in their assessments. However, although the causes are unknown, the symptoms are real.’  Dr Spo Kgalamono (South Africa)

 

‘Historical factors are critical to the evolution of occupational and environmental health. An understanding of the past is vital for addressing the present and preparing for the future. The history of our discipline is replete with examples of the recognition of hazards and their impacts on health’. – Prof. Rajen Naidoo (South Africa), representing the ICOH SC on History of the Prevention of Occupational and Environmental Diseases

 

MEDICHEM Awards

The Joint Congress organisers, scientific committee members and panel of adjudicators take this opportunity to congratulate the following winners of the MEDICHEM Awards:

• Winner: Young Professionals Programme (YPP) Award – Dr Botembetume Maboso (Mafeteng, Lesotho), for his presentation, “Assessing the burden of silicosis, TB and HIV among Basotho formerly employed in South African mines”

• Winner: MEDICHEM Prize – Ms Annelize Jacobs (Port Elizabeth, South Africa), for her presentation, “World class occupational health in an emerging market environment”

• Runner-up: MEDICHEM Prize – Dr Itumeleng Ntatamala (Cape Town, South Africa), for his presentation, “Hard metal lung disease: old and emerging issues”.

 

Associated events and social function

MEDICHEM held a half-day pre-Congress workshop, titled Chemicals: From Environment to Epidemiology with 12 participants and two international facilitators: Dr Tee Guidotti (USA/Canada), a consultant in occupational and environmental health and medicine, in private practice (post-retirement); and Dr Avi Wiener (Israel), an occupational medicine practitioner from the Israel Institute of Technology (Technion) in Haifa and the Institute of Occupational Medicine, Sheba Medical Centre, Ramat-Gan. Topics were: introduction to environmental toxicology; toxico-dynamics; carcinogenesis; application of toxicology and epidemiology in the modern work environment; and case studies.

The SASOM-MEDICHEM Joint Congress also hosted the following meetings: the MEDICHEM Board Meeting and General Assembly, the SASOM Executive Committee (ExCo) Meeting, the ICOH Officers Meeting, and the ICOH Regional (African) National Secretaries Meeting.

The ICOH Officers Meeting was attended by the ICOH President Dr Jukka Takala (Finland), the Secretary General Prof. Sergio Iavicoli (Italy), the two Vice Presidents, Prof. Seong-Kyu Kang (Republic of Korea) and Ms Claudina Nogueira (South Africa), and two members of the ICOH Secretariat staff (Italy), Mr Pierluca Dionisi and Mr Antonio Valenti.

The ICOH Regional (African) National Secretaries Meeting was facilitated by Prof. Seong-Kyu Kang (ICOH Vice President for National Secretaries) and attended by the ICOH National Secretaries for Kenya (Dr Kibor Keitany), Nigeria (Dr Uche Enumah), South Africa (Prof. Daan Kocks), and Zimbabwe (Dr Blessing Garamumhango); the ICOH National Secretaries for Mali (Dr Birama Diallo) and Togo (Dr Silvere Kevi) attended remotely via Skype.

The official social function was the Gala Dinner. The evening was a traditional ‘outdoor-indoor’ South African style ‘braai’ with a ‘shebeen’ theme, complete with ‘konka’ fires, fairy lights and musical entertainment. ‘Shebeens’ was the name given to illegally operated taverns, mostly in black townships, selling home-brewed alcohol. They also functioned as meeting places for activists of the struggle against apartheid. The sumptuous banquet of typically South African nosh was complemented by an animated and high-energy performance by the drumming outfit, Drum Sound Circles, after which the guests threw caution to the wind, let their hair down and danced the night away to the tunes provided by a disc jockey who played both local and international music, with many ‘blast from the past’ renditions.

 

Closure and acknowledgements

The Congress’ main task – ‘to promote sustained, inclusive and sustainable growth, full and productive employment and decent work for all’ – was accomplished. The outcome of the Congress was well aligned with the recent political declaration at the General Assembly of the United Nations for ‘Universal Health Coverage: Moving Together to Build a Healthier World’ and with the International Labour Organization (ILO) message: ‘We recognise that our efforts to achieve our mission must fit into broader societal and global actions to improve working conditions in all parts of the world. Our common efforts can play an important role to convince and support all governments and employers to invest in responsible labour practices, to achieve our mission; we must use and share our combined knowledge and expertise’; and, more specifically, the ICOH- and ILO-supported call to action – ‘to recognise the fundamental rights of safety and health not only to achieve improved health and safety, but also as support to the Sustainable Development Goals, to call on governments and policymakers to address the links between decent work, occupational hazards and diseases, and implement such rights into decisions and commit to implement such actions’.

The Congress organisers thank the following 16 exhibitor companies who supported the event by displaying their services and products; some companies donated prizes for lucky draws during the Congress: Amtronix (Pty) Ltd, eMoyoDotNetza (Pty) Ltd, Foundation for Professional Development (FPD), H.A.S.S. Industrial (Pty) Ltd, Homemed (Pty) Ltd, iMED Distributors, Kendon Medical Supplies TVL (Pty) Ltd, Medical Solutions, National Institute for Occupational Health (NIOH), Novex Pharmaceuticals CC, Occupational Therapy in Occupational Health (OTOH), Prism Inter Africa CC (Prismia), Rand Mutual Admin Services, Sanofi Pasteur, Sleepfit (Pty) Ltd, and SSEM Mthembu Medical (Pty) Ltd.

Last but not least, the success of the Congress relied heavily on the dedication and long hours of hard word by all involved. SASOM and MEDICHEM would like to thank the Congress Organising Committee and other friends and supporters of both entities who worked tirelessly to plan and organise the Congress, finalise a scientific programme of a high standard, liaise with presenters and delegates alike in terms of logistic arrangements, and be present during the Congress week to assist with all the requirements that an international congress entails.

To view a full photographic account of the conference click here.

 

Report by:
Claudina Nogueira
SASOM ExCo Member and ICOH Vice President
 e-mail: claudinanogueira@hotmail.com
Prof. Daan Kocks
SASOM Chair and ICOH National Secretary for South Africa
e-mail: info@sasom.org
Jaco Botha
Project Coordinator in the SASOM Office
e-mail: info@sasom.org
Dr Murray Coombs
MEDICHEM President and SASOM Member
e-mail: mcoombs@iafrica.com

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