By Gina Bernhardt
We were warmly welcomed to the National
Institute for Occupational Health (NIOH) by David Rees. He gave us an excellent overview of the
purpose and functions of NIOH’s around the world. Although their value is questioned in some
countries, they are beneficial in creating a critical mass of occupational
health expertise for the country.
The
South African NIOH adds value by:
·
Knowledge generation, through
research, surveillance, and reviews;
·
Developing human resource
capacity; eg. occupational toxicologists;
·
Provision of advisory and information
service, assisted by collaboration with international agencies;
·
Provision of specialized
laboratory services, including toxicological, pathological, microbiological
& immunological;
·
Provision of policy support.
Jim Phillips heads up the pathology lab
which analyses lung-heart autopsy specimens of ex-miners for the whole of South
Africa. Apart from the benefits at an
individual level (for the families of the deceased), this system provides
comprehensive surveillance data. Reports include trends in the incidence of
occupation lung diseases in miners, as well as other findings such as the
incidence of undiagnosed tuberculosis.
Building on a previous study at the NIOH,
which found that only around 20% of medium-sized masks fit South Africa faces, Jeanneth
Menganyi, in the occupational hygiene section, is involved in a study looking
at the fit of facial masks relative to the facial characteristics of an
individual. These findings will
potentially influence both mask design and occupational health policy.
The National Cancer Registry’s (NCR)
purpose is to identify cancer risk factors in South African populations. It is currently based within the NIOH and has
a surveillance and a research arm. The
surveillance system is pathology based, receiving reports from all labs in
South Africa. However this system
results in reporting bias – ie. cancers that are not diagnosed pathologically (such
as late stage pancreatic and liver cancers) are not represented. The registry though will be moving towards
case-based surveillance, following legislation in 2011 that makes cancers
notifiable. However this system is
struggling as funding to the NCR has shrunk due to financial difficulties in
the NHLS. A case-control study within
the research arm of the NCR has been running since 1995, recruiting newly
diagnosed cancer patients from Barogwaneth Hospital. Over 20 000 cases are on their database
which contains a wealth of detailed risk information.
http://www.nioh.ac.za/
After lunch, we had a visit to the Medical
Bureau for Occupational Diseases (MBOD) and the Compensation Commission for
Occupational Diseases (CCOD). They deal
occupational disease claims covered under ODMWA (and not COIDA claims). The MBOD committee reviews around 60
submissions per day, whereafter cases eligible for compensation are handed over
to the CCOD for administration of their lump sum. Submissions to the MBOD are reportedly
processed within 6 months, and the CCOD processes claims 2-3 months after all
required documentation is received.
Richard Cooke, a family physician who is passionate
about rural-health, joined us for a late afternoon chat under the trees, back
at the hotel. He stimulated discussion
on “what is rural?”; “what are some indicators that describe rurality and the quality
of services in these areas?”; “ what is “rural-proofing” of policies?” and “what
can be done to strengthen health services in rural areas?” Rural populations are often disadvantaged,
even by the health system; if we are to strive for equity, these populations
need to be prioritized. He is involved in the Wits department of family physicians and also at Rural Health Advocacy Project (RHAP). http://www.rhap.org.za/
