| 4. In which ways is the initiative creative and innovative?
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The objectives of the service improvement are
1. To reduce dust Use the engineering method in decreasing dust at the sources with wet process combining with ADDIE model (Analysis-Design-Development-Implementation-Evaluation). It consist of
a) Decreasing dusts at the sources: implementing a model of dust reduction device, then install at the sandstone cutting tools, and using water in reducing dusts. 5 users conducted an experiment to improve the device, reduce the cost, and magnification of results.
b) Decreasing dusts at home: apply the principles of adjusting working atmosphere at home which can be a criteria of dust-free house arrangement, make a public hearing from sandstone-cutting workers, ask for volunteers in organizing 5 dust-free house and then extend results.
2. To search for people who are at the greater risk, diagnose, and cure with medical treatment faster
Proactively triage people who are at the greater risk. It will help to triage silicosis patients thoroughly, accelerate time of diagnosis, and adjust the diagnosis process by increasing utilization of result from X-Ray film read by B-reading specialists apart from using the record of dusts contact. This can make the diagnosis more specific and faster.
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| 5. Who implemented the initiative and what is the size of the population affected by this initiative?
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The ODPC 9 created a participation process in studying and analyzing the problem conditions. Also, it did a public hearing and summarized a learning lesson, and worked with the agency network and the general public to listen to the opinions and the needs in order to solve the problems and set up a guideline for Silicosis control and prevention per below:
1. The problem of having a higher amount of dust than allowed by the standard in the working environments and having no body protection from dust lead to Silicosis. Therefore, an implement was in place per below:
1.1 controlling dust amount in working environments with the dust reduction device
1.2 controlling dust amount in residences and communities by using the in-house dust reduction measure so that the dust amount is at a safe level for the stone cutting workers and the neighbors, together with monitoring working environments by constantly assessing the amount of dust so as to reduce the dust amount at the dust sources effectively and thus reducing the chances of developing Silicosis
2. The fact that providing occupational health services among the group of informal labors and aliens allowed to work was not up to the standard and did not cover those who were prone to Silicosis. This led to severity of the illness and death among the patients. Therefore, to prevent this, a management system for occupational health services was set up, so that the workers can have equal rights to the standard of health services per below:
2.1 Active Finding – to fully cover those with high risks and the patients in the
areas
2.2 Diagnosis and Treatment
2.3 Enhancement for a quicker and more timely Referral System
2.4 Rehabilitation -- so that the patients can return to work and so as to mitigate the severity of the illness and reduce the rate of death from Silicosis
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| 6. How was the strategy implemented and what resources were mobilized?
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1. Inventing the device model in reducing dust- by using a budget and materials from the ODPC 9 and working with professors from Suranaree University of Technology. Sandstone cutting entrepreneurs are advised to invent and develop their own devices to reduce dust. Cost can be reduced from 1,500 baht to not exceed 500 baht. Entrepreneurs use their own budget to invent the devices and utilize all area. But in terms of implementation, there was a conference to inform the entrepreneurs and the stone cutting worker, in groups and in person, to provide instructions and to ask for a cooperation from the entrepreneurs and the stone cutting workers who did not have an employer, to find a dust reduction device, so that every stoner cutters had a dust reduction device. The budget and the materials to make the dust reduction devices were from the entrepreneurs, the stone cutters or partially supported by the Local Administration Organization.
2.Making a prototype of the dust-free house - by using the budget and materials from OPCD 9 together with the house owners. For implementation, a public hearing was conducted among the stone cutting workers who worked at home and the people in the community, to provide instruction and ask for a cooperation from the public health volunteers to make their house a dust-free house, and make sure that every house that cut stones do the same. Local Administration Organization issued a legal code using the dust-free house criteria, to control stone cutting at home. It also held activities to continually promote dust-free house competition. The budget and materials were from the house owners and partially subsidized by the Local Administration Organization.
3. Control and Prevention of Silicosis for children who will become the next generation of stone cutting workers – for the children studying in both non-formal and informal education, to make sure that they know how to protect themselves and their family members, there was a workshop meeting to make a curriculum on Silicosis and its control and prevention. The curriculum consisted of general knowledge of Silicosis, how to use personal protective equipment, how to use the dust reduction devices, and how to make their house dust-free. The teachers who teach Health Education were trained by the local Public Health officials. And the knowledge was incorporated into one of the subjects of the Basic Educational Curriculum. The media master was supported by the OPCD9 and the budget for the workshop meetings was subsidized by the local Public Health Service units.
4. Occupational Health Service System – the OPCD 9, together with the Bureau of Occupational and Environmental Diseases (BOED), provided workshop trainings to improve the capability of the local Public Health Service officials, an improvement and a standard guarantee assessment, and the services of occupational health in the local areas. The occupational health services consist of conducting an active finding for those at high risks once every year, and monitoring the problem conditions or the local needs, using the budget from the Local Administration Organization and the Public Health Service units. For diagnosis, medical treatment and patient transfer, the budget will be from Public Health agencies. In addition, for the skill improvement of certified X-Ray B-readers, the budget will be from Occupational and Environmental Diseases Bureau, Department of Disease Control and hospitals under their supervision. As for patient rehabilitation, the budget will be from the Local Administration Organization and Public Health Service units in the local areas.
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| 7. Who were the stakeholders involved in the design of the initiative and in its implementation?
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1.The Ministry of Public Health has a policy to enhance the improvement of the public health in informal labor. There was a meeting with the agency network of the Public Health Service units, education institutes, the Local Administration Organization and the Pollution Control Department, to create a framework for enhancing the improvement of the public health for informal labor for the stone cutter group. This was proceeded through the committee which consists of the Subcommittee of the Improvement of the public health works, the Provincial Subcommittee of Public Health, the Provincial Subcommittee of Clinics for work-related Diseases and the Provincial Subcommittee of Silicosis, so that there was a collaboration among each unit , thus the same direction and sharing in resources.
2.The Local Administration Organization used legal mechanism in using local ordinances so as to prevent silicosis according to the frame work of managing the budget of the District Health Fund. This benefited the control of occupations and arrangement of the environment conditions in the communities, and also promoted working safely and built the economy in the areas.
3. Cooperation of the stone cutting workers and the choosing of the representatives. This helped control the compliance of the guideline and the local ordinances in terms of Silicosis prevention.
4.The OPCD 9 together, with Suranaree University of Technology, came up with an innovation of the dust reduction devices that are installed onto the portable stone cutters. It took 3 years to develop, so as to have a device that does not require electricity, light in weight, uses less water and low budget.
5.The ODPC 9 is the hub for the film reading system by physicians(B-reader), which there are only 3 of them in the areas. This helped in gathering and forwarding the x-ray films, thus the diagnosis faster and more accurate.
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| 8. What were the most successful outputs and why was the initiative effective?
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1. The dust reduction device can effectively reduce the quantity of dusts in sandstone-cutting factories up to 88% and those in the houses up to 80% (from the evaluation on the effectiveness of dust reduction). The sandstone-cutting workers and the members in the houses are highly satisfied with the dust reduction device (at 93.33% and 92.50%, respectively).
2. The wider groups of people who are susceptible to silicosis have been screened (up to 90.14%). Susceptible persons and patients are faster diagnosed and treated, from longer than 6 months to only within a month. In the primary state of silicosis treatment, the patients are treated the same as tuberculosis patients. Therefore, complete diagnosis would reduce at least 140 tuberculosis patients (41.18%), leading to less consumption of expensive tuberculosis medication during treatment (between THB 2,400 and THB 1,000,000 /person/year) and decreased impact on health from adverse drug reactions (ADR)
3. Collaboration networks were established to prevent and control Silicosis per below:
1 Regional Level (North-Eastern): 1 network
2 Health area level: 4 networks
3 Provincial level: 4 networks
4 District level: 12 networks
This leads to the national policy of control and prevention of Silicosis, a push in operations, and a collaboration and an integration of work and resources. It created a wide circle of learning, created 3 common guidelines that are 1) Silicosis diagnosis and treatments 2) follow-up house visits and 3) an active finding. It also leads to the establishment of an Expert Center of Work-related Lung Diseases in a central hospital (Nakhon Ratchasima Maharaja Hospital) at the Tertiary Care level to provide treatments for the patients who have complex work-related diseases.
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| 9. What were the main obstacles encountered and how were they overcome?
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1. Dust reduction device needs a battery and a water pumping machine. This requires the dust reduction device to be charged and recalibrated every time before use. It adds more steps to the process and takes more time in order to operate the device. The stone cutting worker, as a result, came up with a new way that yielded a similar result, in which they used the benefit of water pressure by installing the water tank at a high level instead of using a battery, in order to reduce the cost and the steps of use. Apart from this, the OPCD 9 also gathered a list of venders that sell related materials for the benefits of making and maintaining a dust reduction device.
2. Wastewater from the dust reduction device installed at the sandstone-cutting machine and from cleaning the floor with cutting sandstones: The solution is to advise how to get rid of wastewater with appropriate and hygienic manner by setting up wastewater drainage, disposable water outlet, then reuse the treated water for other purposes in order to prevent impacts on the neighboring areas and the community.
3. High expenses for becoming a dust-free house (averagely THB 2,000 /house): Normally, the house-owners have low income (THB 300 per day on average) and high household expenses. Therefore, they cannot afford certain expensive equipments, such as a fire extinguisher (THB 700-THB 900). The solution is to suggest them the replacements, knowledge on how to prevent, store and get rid of the materials that can cause fire, as well as on basic fire prevention and extinction, while receiving subsidies from the local government.
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