Demand from India’s booming construction industry for granite, sandstone and other minerals has seen the commissioning of more and more stone quarries in mineral-rich states like Madhya Pradesh.

For the people employed by the quarries, however, the work is not only dangerous but potentially lethal. Thousands of workers toiling in hundreds of quarries in Madhya Pradesh inhale air filled with silica and other particulate matters that cause respiratory diseases like tuberculosis, asthma, and, more worryingly, silicosis.

Silicosis is a terminal disease that occurs when a person’s lungs are exposed to silica dust particles over an extended period of time. Doctors have trouble accurately diagnosing silicosis as its symptoms, and the X-ray images of silicosis sufferers’ lungs, are easily confused with those of tuberculosis victims. This often results in the administration of incorrect medicines which can cause further physical complications.

A 17-year-old victim of silicosis in India's Madhya Pradesh State. Photo: Inder Bisht
A 17-year-old victim of silicosis in India’s Madhya Pradesh State. Photo: Inder Bisht

In a 2014-15 survey by Indore-based non-governmental organization Nai Shuruwat, 1,721 people were found to be suffering from silicosis in the Alirajpur, Dhar and Jhabua districts of Madhya Pradesh. In the Mandsaur district alone, 674 people had died of silicosis.

“Out of the 1,721, at least 589 are now dead… and the number would have increased now,” Nai Shuruwat member Rakesh Chandore said. He added that silicosis patients should be given medicines based on their symptoms as the disease is incurable.

According to the International Labor Organization, one million people are exposed to silica dust in India every year. Among workers employed at mines across the country, 230,000 people are estimated to be at risk of contracting silicosis, according to the Directorate General of Mines Safety.

Misdiagnosis

Former stone mine worker Keshu, 39, of Panna’s Mazha village has taken anti-tuberculosis medicines for the last 10 years, without much relief. He is bed-ridden for the most part of the day and hasn’t gone to work in the last seven years. Keshu was diagnosed with silicosis in 2011 by Delhi-based NGO Environics Trust.

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Silicosis patient Keshu at his village in Panna district, in India’s Madhya Pradesh state. Photo: Inder Bisht

In 2011, the organization diagnosed 78 people as silicotic at a medical camp in Panna district. According to Panna district hospital, however, the number of silicosis patients in the district by 2018 was 41, out of which 14 cases were only detected in 2017.

Former director of the National Institute of Occupational Health, Dr Habibullah Saiyed, said most doctors do not take into account the occupational history of a patient, which is pertinent for making a silicosis diagnosis.

“The diagnosis of silicosis is based on occupational history, [as well as] X-ray images and supportive laboratory data on the significant presence of silica in the patient’s work environment. Under the Factories Act, the permissible levels for silica in factories are laid down, but to the best of my knowledge none of the industrial hygiene laboratories run by the factory inspectorate has the facility to measure silica levels,” Dr Saiyed said.

Environics Trust’s occupational health expert Mohit Gupta said there is no trained and experienced doctor at the Panna district hospital who can read X-ray plates and connect them to other symptoms to make a correct diagnosis. “It’s very difficult for a doctor to pick up on silicosis by looking at the X-ray result of a patient as it looks very similar to that of a tuberculosis patient,” Gupta said.

In Jhabua district’s Jaunsar Matavada village, 38- year-old Khirji mostly stays at his home, performing only light household chores like cutting vegetables and helping in cooking. He recounted how 12 years ago he left his work in Godhra, Gujarat and rushed home following the death of two of his fellow miners. Prior to their deaths, they had symptoms similar to silicosis.

“I got scared and returned home. I thought I had survived the disease and started working in the fields. But three years after returning from Godhra, I started experiencing breathlessness, coughing, and chest pain. Gradually I stopped going to the fields and realized that I too would die eventually,” Khirji said.

Khirji no longer attends the government hospital because the doctors there invariably give him anti-tuberculosis medicines. “I prefer taking tablets from a private medical store even though I have to shell out money from my pocket,” he said. Doctors at the government hospital conducted an X-ray test of his chest but never disclosed the results. “They just told me that the report had been forwarded to the district magistrate’s office,” he said.

Doctors are also usually reluctant to diagnose a patient as silicotic so they can avoid lengthy court proceedings. “You can claim compensation from your employer if you are diagnosed with silicosis. But there is a legal process to fulfill, and in such cases the doctors could be called into court to give evidence. So it’s far more convenient for the doctor to put the patient on a tuberculosis course and the patient won’t return for another six months,” Gupta said.

Continued exposure

Silicosis is an irreversible disease, and its only possible solution is a lung transplant, which can be extremely costly as well as not being uncertain of success.

At earlier stages of the disease, when it has minimal impact on a victim’s lungs, silicosis is also difficult to detect. In the absence of an accurate diagnosis, a patient continues to work in a silica-infested environment and exposes his lungs to yet more deadly silica dust. “Because there is no other work opportunity in the area people continue to work in mines until they become incapable of working. So their exposure doesn’t stop,” Gupta said.

“Secondly, they don’t take nutritious food. When they go to a doctor, he puts them on a strong antibiotic for tuberculosis which puts immense pressure on their body. In the absence of nutritious food the medicines do more harm than good to patients,” he said.

Amid general lack of awareness and the government’s inefficiency and apathy, thousands of undiagnosed cases of silicosis in the region are suspected, according to Panna-based activist Yousuf Beg. In 2011, the National Human Rights Commission ordered a medical team of government doctors to check suspected cases, and when the team visited the district that year, 18 people were diagnosed as silicotic.

“In our second camp in 2012, 78 people were diagnosed as silicotic but the government hasn’t acknowledged it yet. Out of those who have been diagnosed with the disease, only four have posthumously received an ex-gratia amount of Rs 300,000 (US$4,100). The promise of a monthly pension by the state government is not yet realized,” Beg said.