Sometimes we get so busy chasing concepts that we miss seeing what is right under our nose. And sometimes, we see it so often that we very readily forgive ourselves for ignoring what is obviously wrong.
This is the case with manual handling of garbage in Bangalore. Majority of Bangalore’s garbage is collected, transferred and handled manually, with minimal or no safety measures. Yet, it hardly figures in anyone’s plan of Waste Management for the city. Where human labor is cheap and human life is easily snuffed, who is even thinking about the health & safety of garbage workers?
The issue first hit us when we started to work on improving collection in the wards of Rajajinagar constituency. We would be told that there are 25 Poura karmikas on roll, and in reality there would be 24. When asked about the missing roll, the answer would be a simple “death ayathu”(the person died). This is not death after retirement. This is death while in service, at a relatively young age of 40-45 years. And it is more common than you think.
Our team decided to dig deeper and understand the health hazards for Poura karmikas, and the first such effort was a comprehensive medical assessment, screening and treatment that we undertook over the last one week. It brought to light common problems among garbage workers such as joint pains, cuts & wounds, etc. and more complex problems like vericose veins, arthritis, anemia, etc which might be related to their work conditions . This report is intended to share the findings from the health screening and treatment process. The data gathered is from 170 Poura Karmikas from 3 wards. It is not a conclusive data in terms of sample size and data collection process, but it sure brings to notice some very obvious health concerns for Pourakarmikas engaged in manual handling of garbage.
It will be hypocritical of us to continuously provide Pourakarmikas access to healthcare, while making them handle garbage manually and thus create reasons for their ill health in the first place.
The objective of the health screening was not only to provide access to quality healthcare facilities for Pourakarmikas, but to also get an understanding of the occupational risks leading to poor health, so that prevention can be taken up more seriously.
Before the medical screening by doctors, our team undertook a detailed pre-screening of 170 Pourakarmikas in each of the 3 wards under consideration. The pre-screening gathered all basic information such as name, address, weight, etc and their medical history. The frequency of ailments in the last 1 year was noted. The findings from the pre-screening are as follow:
Total number pre-screened: 170
|Frequently occuring ailment||No. of Pourakarmikas who complained about it|
|Nausea & Vomiting||18|
|Joint & Backache||104|
|Cuts & Wounds||18|
|Asthma / Breathing problem||6|
|Fever & Cold||29|
|Stomach upsets (eg. Gastric)||32|
|Oral / Tooth problems||31|
|Early Menopause (before age 40)||19|
|Irregular Menstruation (before age 40)||7|
|Burning while urination||5|
|Excessive white discharge||5|
The pre-screening involved our team spending sufficient time talking to each Pourakarmiks to understand their health & other issues related to this work. Across wards, PKs were at first afraid to tell us anything because they thought we will share the information with the BBMP and that will affect their chances of being made permanent. They were all contract workers and most have been around for 10-20 years, hoping that some day they will be made permanent. It took quite a lot of reassuring and convincing them that the information will be kept confidential and it is only to take care of their health. When they did open up, here are some of the things we heard.
- It is very common to have cuts and wounds due to glass pieces in garbage. So common, that they don’t even feel it is a problem and mentioned it only when we specifically asked. One elderly lady, however, was severely affected by a needle which pricked her 5 months ago. It gave her severe skin problems with oozing pus and bleeding all over her body. She is just about recovering from it now.
- Majority of female Pourakarmikas have joint pain – backache, knee pain, shoulder and hip pain. Many have reached menopause and find it difficult to push the heavy carts. One Pourakarmika had a slip disc a month ago while emptying the push cart.
- One Pourakarmika, aged around 40, very hesitantly said that everytime she lifts a heavy load or pushes the cart, her uterus slips down and makes her very uncomfortable. She has been quietly suffering from it for about 10 years. This is a condition called Uterine Prolapse.
- Early menopause and scanty menstruation among women less than 40 was observed. Changing the cloth/pad during menstruation, while at work, is very difficult and could result in poor hygiene habits. The Pourakarmikas have little chance of taking rest or changing at frequent intervals due to the nature of their work. They usually begin their day at 5 am and work till 11 am, then break for breakfast (some skip this) and again work till 2pm. Some of them take up other jobs such as that of a house-maid after 2pm
- Around 4-5 women said they had epilepsy (fits). One among them, a 33 year old, is not taking any medication for it and had an attack just a week ago, when she bit her tongue badly.
- Several women, being over 40 had blurred vision, but had never thought of getting their eyesight checked. Few women had prescriptions for spectacles, but didn’t have the money to buy it.
- Headaches are extremely common among all the workers. Several women experience dizziness and weakness. Some have fainted during work. While many are likely to be Anemic, an added reason is that most of them skip breakfast due to the early work hours and have a very late lunch. One of the women knew very well that she is Anemic and having low B.P., but does not take any medicines as she cannot afford it.
- Several Pks have gastric problems and chest burns, probably due to the improper eating and excessive tea and tobacco habits. Yet, the women cannot quit chewing betel leaf & tobacco and say that it helps them constantly spit out all the dust that gets into their mouth while sweeping.
- One woman has had a breast cancer surgery done a few years ago. Another woman has had a heart surgery done. For such women, pushing the cart gives them severe chest pain. But they never complain fearing that they will lose their job.
- Many men expressed burning sensation while urinating and often skip breakfast. Most said that it was difficult to bear the stench of garbage and feel like vomiting. Since men are more involved in direct handling of garbage, especially during transfer, some had problems like diarrhoe and vomiting after starting this job. Again, cuts & wounds were very common among men.
- Some men were constantly under the influence of alcohol or other substances to be able to bear the stench and nature of work involved. There were also a few women who admitted to be alcoholic.
- One of the garbage auto driver’s lost 3 toes of his left foot when his auto tipped due to excessive load.
- Many of the women’s husbands had died and they were single earning members. For 6 of these women, their dead husbands were also Pourakarmikas. The reasons for their death included TB, Dengue, Heart Attack and Kidney failure. Most of the dead husbands were under 45 years of age and died in service.
- More than 60% have ESI cards, but only a handful of Pourakarmikas actually use them. While distance and long queues is a major reason, other reasons are that they do not get a day off to go to a hospital. In addition, if they find out about an ailment, they feel that they will lose their job. Hence, they avoid going to a doctor altogether.
The medical screening was undertaken by a team of volunteer doctors and eye technicians. 3 Senior General Physicians, 1 Dermatologist, Ophthalmology team from Narayana Nethralaya, Gynecologists from The Bangalore Hospital and Dental team from Narain Sewa Sansthan, were not only kind enough to offer their services voluntarily on the day of the camp, but also offered further treatments at low or no cost, following the camp. Around 30 non-medical volunteers assisted in organizing and facilitating the screening process. MLA of Rajajinagar constituency Shri Suresh Kumar and BJP for Better Bengaluru facilitated the sponsorship of medicines and facilities for the camp. We ensured that all those requiring medicines were given the same at no cost. The 3 wards covered were Basaveshwarnagar Ward 100, Kamakshipalya Ward 101 and Shivanagar Ward 107. The data from across the 3 wards on the day of the screening camp is as follows:
Total number of Pourakarmikas who attended
Age-wise distribution of those who attended the screening camp
|20 – 30 years||28|
|30 – 40 years||69|
|40 – 50 years||30|
|> 50 years||12|
Data of the referred cases:
Note: Several patients have multiple referrals and hence the totals of referrals will not add up to the total number of people referred.
A total of 93 Pourakarmikas have been referred for further treatment. While majority require dental and refractive error correction (spectacles), there are those requiring surgery as well. According to the doctors present, a number of the health issues are directly related to their occupation.
For instance, Dr. Geetha Kumarswamy, a senior General Physician, said “Menopausal women should not be made to lift heavy loads as their bones become soft after menopause. This is why so many of them have body aches”. Some have arthritis and post menopaual osteoporosis. Dr. Geetha also said that “the problem of vericose veins happens due to the long standing hours, and headaches are so common among such workers since they are constantly out in the sun with no protection”.
Dr. Kumudini Ganguly, senior Gynecologist said “More than 90% of the women are Anemic. It could be due to poor nutrition, since they only eat rice and no vegetables, or it could be due to roundworm infection due to poor hygiene conditions of such workers.” Given that Pourakarmikas are constantly and directly in contact with garbage, Anemia due to worm infection is a good possibility.
Dr. Sachin, dentist, observed that “Most of them chew tobacco and around 3-4 of them have white patches which might even be indications of oral cancer”. For most Pourakarmikas, the job they do cannot be done without the aid of tobacco. They reasons given by the Pourakarmikas was that tobacco helps them become insenstive to the terrible stench, keeps them from feeling thirsty while at work and some of them felt that it helps them spit out all the dust that gets ingested during street sweeping.
While the efforts of our team will be to ensure completion of treatment for the screened Pourakarmikas and easy access to healthcare, the entire process will be superficial if it is not accompanied with efforts to prevent manual handling of garbage. Most often, what comes to mind, is providing gloves. But the type of gloves provided cause more harm than good, with Pourakarmikas complaining of fungal infections due to the poor aeration and thickness of the gloves. Besides, many of the problems are not limited to direct contact with garbage alone.
Even the most simple step of introducing long handle brooms will help Pourakarmikas who have to bend and sweep the streets otherwise. Measures such as providing caps will protect them from the sun and reduce headaches. Masks and gum boots will be of much help, especially for the male workers who do the manual collection of garbage from ground and transfer to the compactor/truck. Gloves, with better aeration and dexterity need to be designed. Long handle rakes and spades need to be provided to each Pourakarmika engaged in manual lifting of garbage from ground.
While small measures such as the above can be a good start, it is not a complete solution. We need to really think how manual handling can altogether be avoided. While mechanization in street sweeping and introducing mechanical grabs to clear garbage on ground will be a positive addition, we need to immediately ensure that Door to Door collection is mechanized instead of using pushcarts. Women, especially those who have reached menopause, should not have to push or lift heavy loads and ideally should only be engaged in street sweeping, with appropriate protective gear. The tendency of contractors and the BBMP to save costs and add more pushcarts instead of autos needs to be closely monitored and understood in the light of the health hazards to the women engaged in door to door collection through pushcarts.
Majority of manual handling happens in garbage transfer from pushcarts or autos to Compactors & trucks. While automatic tipper autos are now being introduced in a few wards, their limited capacity (about 300 kgs as against 500-600 kgs of the regular auto) requires multiple trips to the compactor, affecting the predictability of collection. Larger capacity primary collection vehicles such as 1 ton four wheel tip trucks and semi-closed mechanized Transfer Stations will go a long way in preventing manual handling of garbage.
We might also need to relook at the idea of door to door collection replacing community bins, resulting in over 10,000 litter spots across Bangalore, which are entirely being cleared manually. In cities like Ahmedabad and Surat, both Door to Door collection and customized capacity Community Bins co-exist and are understood to be crucial from the point of view of health & sanitation.
In our urgency & determination to introduce newer concepts to Waste Management, you and I have failed our Pourakarmikas. It is time we wake up to the issue and start acting to prevent manual handling of garbage.