The Future Culture of Mining Safety and Health In North America

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Winnipeg, Ontario
--- Upon resuming on Thursday, September 23, 1999

Plenary Session (Mexico) - Preventing Human Consequences - Séance plénière (Mexique) - Prévenir les conséquences néfastes pour les humains - Sesión Plenaria (México) - La Prevención de Consecuencias Humanas Adversas

MS. MAY MORPAW (Director, Inter-American Labour Cooperation, Federal Co-Chair): As most of you know, my name is May Morpaw. I welcome you to this second day of the conference.

I will ask Mr. Galen Trabant, from the Mine Safety and Health Administration in the United States, to introduce our first speaker this morning and to launch the day for us.

MR. GALEN TRABANT (Industrial Hygienist, Mine Safety and Health Administration, U.S. Department of Labor, Rocky Mountain District): Thank you, and good morning. I would like to extend my welcome also.

As May said, my name is Galen Trabant. I am an industrial hygienist with the U.S. Department of Labor in Denver, Colorado.

Our speaker this morning is Dr. Enrique Valverde. Dr. Valverde is a graduate of the University of Chihuahua in surgery and obstetrics. He is a specialist in occupational health and safety and in occupational medicine.

He is certified by the Mexican Occupational Medicine Council and is also certified by the American College of Occupational and Environmental Medicine.

He is a full member of the Mexican Industrial Health Association, and a member of the Mexican Toxicology Society. He is a founding member of the Occupational Health College of the State of Chihuahua.

Join me in welcoming Dr. Valverde.

DR. ENRIQUE VALVERDE DURÁN (Gerente de Higiene y Seguridad, Industrial Minera México, S.A. de C.V.): Buenos días, el tema que abordaremos esta mañana está íntimamente relacionado con los factores de exposición humana como consecuencias ambientales, para poder entender un poco más a fondo las consecuencias adversas en el trabajo tenemos que partir de los factores condicionantes de la salud humana, el individuo al momento de su nacimiento está constituido por diferentes factores al momento de nacer y desde la gestación el individuo posee una carga de factores genéticos aunado (sp) al metabolismo de factores biológicos así como la evolución y la involución del factor genético.

Estos tres aspectos van a constituir al individuo el cual en el desarrollo de su vida rutinaria va a estar expuesto a diferentes factores de agresión, ellos son agentes del ambiente físico en general, de un ambiente social, de un ambiente psicológico y de un ambiente laboral.

Esto está determinado por hábitos de estilo de vida, de patrones de consumo, de exigencias relativas al trabajo, de uso del tiempo libre.

Hay factores que determinan la estabilidad del comportamiento humano a través de desarrollos de instituciones de salud, las cuales se encargan de aplicar sistemas preventivos, atención médica curativa, procesos de rehabilitación, una carga genética, el estado nutricional y las enfermedades. Por otro lado, son determinantes el sexo, la edad, la condición física y la personalidad del individuo.

Dentro de los factores ambientales que es lo que nos ocupa esta mañana, existen factores psicológicos, biológicos, químicos, físicos y factores accidentales.

Dentro de los más importantes, vamos a mencionar a los factores químicos como carga corporal, dentro de ellos se encuentran básicamente productos químicos, tales como los polvos, interacciones por uso de medicamentos, de irritantes dérmicos o bien aditivos de alimentos.

Dentro de los factores físicos tenemos ruido, clima, la carga de trabajo, la iluminación y las radiaciones, como factores determinantes del estado de salud o de enfermedad.

Existen factores que inciden en la exposición de efectos adversos por exposición a sustancias químicas. Éstos son características propias del factor de agente químico como es la característica o la construcción física o química del componente, la capacidad tóxica o el potente tóxico del efecto, la dosis.

Dentro de los factores del organismo es conveniente que conozcamos las vías de exposición, la susceptibilidad propia del organismo y los patrones de actividad, de conducta y hábitos básicamente de un trabajo.

Dentro de los factores ambientales tenemos que determinar los que afectan la susceptibilidad o la resistencia del individuo en el organismo, los que afectan las características, las dosis, las rutas ambientales de la gente.

Los factores de exposición, tales como la ruta ambiental de la exposición, la vía corporal de exposición, las concentraciones o dosis de la gente, la duración y la frecuencia de la exposición y las presencias de otras sustancias que pueden obrar como aditivos o potencializadores del riesgo.

Dentro de la amplitud de los efectos en cambios pre-patológicos funcionales u orgánicos, alteraciones en la susceptibilidad del organismo, alteraciones de la resistencia del organismo, alteraciones del desarrollo y del crecimiento, cambios conductuales, alteraciones patológicas a diferentes órganos o bien, la muerte.

Cuando existe el contacto humano, hay una serie de eventos o sucesos que determinan la peligrosidad de la exposición. En cuanto existe el contacto humano hay un proceso de absorción el cual va a trasmitir al torrente sanguíneo el contaminante para ser excretado en forma directa o bien sufrir un proceso de biotransformación, en la biotransformación, que generalmente se realiza a nivel del hígado pueden existir dos rutas metabólicas, hacer que el tóxico sea más tóxico o menos tóxico, posterior a la biotransformación vuelve a circular como tal o un metabolito al corriente sanguíneo para generar los efectos a diferentes órganos del cuerpo llamados efectos tóxicos, que pueden ser alteraciones genéticas, teratogénicas, carcenígenas o inmunotóxicas.

Después de efectuar la exposición puede seguir dos rutas que exista o no exista el riesgo de efecto tóxico. Si no hay una respuesta inmediata ante la exposición estamos en la oportunidad de hacer aplicación de programas de fomento a la salud. Cuando existe una respuesta patológica es el momento de hacer la aplicación de los programas preventivos para evitar la aparición de la enfermedad.

El aspecto esquemático de la respuesta biológica ante cualquier contaminante es parte de una carga corporal del contaminante seguida por cambios fisiológicos y de otro tipo de significado propio a cada agente contaminante y posteriormente aparece lo que es el umbral para ser manifiesta la enfermedad a través de efectos iniciales de daños por exposición. Si no actuamos a este nivel es manifiesta la enfermedad y puede llegar a generar la muerte. Esta es la evolución natural del proceso de exposición a efectos adversos a la salud.

Cuando hablamos de exposición es frecuente que usemos los términos de toxicidad, de peligro y de riesgo.

La toxicidad es la propiedad intrínseca de una sustancia para dañar a los órganos vivos y el peligro es la posibilidad de que un factor, un agente o una condición ambiental de riesgo, bajo condiciones específicas cause un efecto adverso en la salud humana.

El riesgo es la frecuencia esperada de efectos indeseables que aparecen por una exposición dada a un contaminante, el riesgo es un concepto matemático relacionado con la gravedad esperada y/o la frecuencia de respuestas adversas que aparecen por una exposición dada a una sustancia química. De tal forma, que el riesgo va a ser la multiplicación de la toxicidad por la exposición, a esto lo conocemos como agente químico.

El riesgo dentro de la probabilidad estadística de que ocurran efectos adversos a la salud va a depender de: primero que el agente esté presente en el ambiente, que ocurran concentraciones suficientes de exposición, que los individuos se expongan al agente y que las personas expuestas sean susceptibles a una concentración tóxica.

Un agente químico de alta toxicidad puede ser de bajo riesgo en virtud de la baja exposición, así un agente químico de baja toxicidad puede ser de mayor riesgo por la elevada exposición individual o comunitaria.

Todos factores tienen tres dependientes. La primera es dependiente del compuesto, que nos interesa conocer las características químicas de este compuesto, la biotransformación, la asociación a macrocélulas, la bioconcentración, la forma de cómo se excreta y qué interacciones va a manifestar en el organismo. Los dependientes del receptor va a ser la especie, la edad, el sexo, la susceptibilidad individual, el estado nutricional del humano, las características o cargas genéticas y el estado de integridad del órgano blanco o del órgano agresor.

Por último tenemos la dependiente de la exposición, dentro de ello nos interesa conocer cuáles son las rutas ambientales donde se encuentra el compuesto químico, cuál es la vía de exposición del humano, qué cantidad de dosis está absorbiendo y con qué frecuencia se genera la exposición.

Cuando hablamos de exposición es frecuente que utilicemos el término dosis y la dosis es la cantidad de una sustancia que se administra, expresada generalmente en peso de la sustancia por unidad de peso corporal.

Es preferible dentro de la salud ocupacional mencionar exposición en vez de dosis, y esto es, por la facilidad de hacer la evaluación.

¿Cómo vamos a hacer la evaluación de la exposición de un agente químico? El individuo no podemos separarlo del ambiente laboral, de su hábitat natural" Es difícil precisar con exactitud las cargas de exposición corporal. Hablamos de fuentes emisoras en el exterior del área laboral y de fuentes emisoras dentro del área laboral, enfocado más hacia el aspecto del trabajo nos interesa conocer los factores de dispersión de los contaminantes. Esto incluye los sistemas de ventilación que se encuentren en las factorías.

Dentro de las fuentes emisoras en el exterior, vamos a evaluar la concentración de carga corporal sumada a la concentración en el interior del establecimiento. Esto nos va a dar lo que es la exposición total de la carga.

Después de tener la exposición total evaluada vamos a calcular la dosis interna de acumulación del contaminante. Esta dosis interna va a ser biológicamente efectiva en los tejidos blancos o en los tejidos agredidos por el contaminante antes de dar la manifestación médica o la manifestación clínica de daño corporal.

La intoxicación va a ser un conjunto de efectos nocivos producidos por un agente químico derivado de una exposición, estos efectos pueden ser efectos inmediatos o efectos retardados, cuando existe una única exposición hablamos de una intoxicación aguda y cuando la exposición es repetitiva hablamos de factores de hipersensibilidad, en los efectos inmediatos en la exposición única podemos generar o recabar información de efectos retardados a determinados órganos y cuando la exposición es crónica o en forma repetida hablamos de intoxicación crónica. En este concepto entrarían lo que son las bronconemopatías y dentro de ellas la silicosis.

Existen cinco fases de exposición para efecto tóxico. En la laminilla podemos observar en el extremo izquierdo las fases de evolución de la intoxicación y ntos (sp). En ese momento podemos precisar el posible daño corporal a través de la evaluación ambiental del contaminante en estudio y posterior a la exposición viene una fase de toxicocinética para hacer la transformación absorberse o eliminarse el contaminante y posteriormente tenemos la fase de la toxicodinamia donde la biotransformación va a generar un daño a nivel de las moléculas o de las células o bien de la membrana celular y antes de que aparezca un efecto nocivo que es la fase clínica podemos hacer una evaluación biológica para ver la carga total corporal del contaminante y poder aplicar las medidas preventivas oportunamente.

Dentro de la fase clínica que es la manifestación en si de la enfermedad vamos a generar efectos adversos, lesiones preclínicas antes de ser manifiestas y finalmente tenemos la manifestación clínica por un daño reversible o irreversible, en esta sección entra lo que es la vigilancia de la salud.

Hablamos de mecanismos de toxicidad, estos mecanismos de toxicidad básicamente van a ser alteraciones en la estructura de la célula o acción sobre la función de la célula. Cuando hablamos de alteraciones de la estructura de la célula puede ser que exista una destrucción celular total, que existan alteraciones en la membrana de la célula o bien alteraciones en los órganos celulares. Cuando hablamos de una acción sobre la función celular esta puede ser que se modifique la permeabilidad de la membrana celular, que se modifiquen las actividades enzimáticas o bien que exista modificación de la reproducción celular que es lo que va a generar alteraciones mutagénicas carcinígenas o teratogénicas.

En resumen podemos decir que el riesgo es la evaluación de la exposición multiplicada por la toxicidad. En los datos de exposición es de importancia conocer las concentraciones ambientales a las cuales está sujeto el trabajador expuesto y evaluando dos acciones nos va a dar la probabilidad real de que ocurran efectos adversos a la salud.

Dentro del marco de la vigilancia médica ocupacional existen etapas para aplicar un estudio de vigilancia epidemiológica, éste parte de la sospecha del riesgo en determinada labor, en determinada área. Cuando tenemos la sospecha del riesgo formulamos una hipótesis de estudio qué es lo que queremos buscar, qué queremos solucionar y de ahí hacemos el diseño del estudio a través de la recopilación de datos estadísticos, un análisis previo y el momento de la intervención de las conclusiones del estudio, es muy importante considerar la validez de los estudios epidemiológicos a través de validez interna o validez externa.

Las áreas de información van a ser obtenidas a través de sistemas de vigilancia o encuestas o en estudios de corte y casos y controles.

El objetivo de la vigilancia epidemiológica es describir la frecuencia con que ocurre la enfermedad en una población dada, la descripción cuantitativa de este posible riesgo va a dar la característica de la persona en riesgo, las características del medio del lugar en que se está aplicando el estudio y la evolución temporal de la frecuencia de alteraciones o afecciones biológicas.

Mediante el conocimiento causal del posible descubrimos las causas o los factores de riesgo de la enfermedad o bien establecemos la fuerza de asociación entre las variables independientes y la variables dependientes y a través de diseños apropiados de investigación y una metodología estadística de análisis.

Descrito el problema y conocidos los factores causales proponemos medidas de prevención y control cuantificando el impacto de las medidas de prevención y control ambiental.

Existe un sin número de estudios epidemiológicos. En la plática que nos ocupa nos interesa conocer los estudios de asignación no controlada dacer (sp) estudios observacionales, selección a partir del sujeto del efecto, o bien de la exposición, a través de estudios descriptivos y analíticos, de series de casos y controles de estudios ecológicos, de estudios transversales.

Dentro de la selección de sujetos a partir de la exposición que es la evaluación preventiva de riesgo nos interesan básicamente dos estudios, los estudios de corte o los estudios transversales.

¿Cómo vamos a elaborar el cálculo de la exposición humana? Partimos de un estudio epidemiológico de evaluación de riesgos y de efectos a la salud a través de información de exposición, de información ambiental existente, de información de efectos, de información rutinaria, información casual de asociación y diagnósticos básales de riesgo.

Dentro de la serie de información, la información de efectos vamos a lograrla a través de los registros de las estadísticas de mortalidad, de los registros especializados tales como frecuencia de cáncer de malformaciones congénitas y de los sistemas generales de vigilancia epidemiológica.

Los diagnósticos básales iniciales parten de la evaluación de la exposición por estudios ambientales de higiene industrial y estudios demográficos, en las dos corrientes vamos a obtener servicios clínicos especializados que nos van a evaluar la exposición del efecto y del riesgo y estudios ecológicos de prevalencia y encuestas directas de riesgo.

Los elementos de la evaluación de la exposición parten de las fuentes como está distribuida, qué número y qué lugar, en qué descargas tenemos la mayor afluencia de contaminantes, cómo se transforman y cuál es el destino ambiental de los diferentes medios a través de las rutas ambientales de exposición, las concentraciones medidas o estimadas a través de monitoreos ambientales, las características de la población expuesta a travral (sp) o extralaborales, las vías de exposición a través de las tasas de absorbción, la magnitud, duración y frecuencia de la exposición y el análisis integrado de la exposición.

Medición de concentraciones ambientales de la sustancia, identificación de la ruta ambiental de exposición, establecer duración y frecuencia del contacto humano con el medio contaminado, conocer la tasa de absorbción para cada vía de exposición, identificar por cuáles vías de exposición está ocurriendo el ingreso de la sustancia y asumir los valores estándares para estimar el contacto de ingreso del medio contaminador del organismo.

Existen estándares mundiales que nos hablan de las tasas de absorbción de los diferentes contaminantes. Por ejemplo sabemos que el humano debe de consumir dos litros de agua al día, tiene que estar respirando aproximadamente 23 metros cúbicos de aire por día, etc. Esto se logra a través de la aplicación de fórmulas establecidas para calcular la dosis total de exposición.

En la dosis total de exposición, vamos a conocer la concentración del contaminante en el medio expresada en miligramos por metro cúbico, en miligramos por litro, en miligramos por kilogramo, etc. multiplicado por la tasa de ingreso al organismo del medio contaminado en metros cúbicos de aire por día, en litros por día, en gramos de alimento por día, en gramos de tierra por día, etc. Multiplicado por la tasa de absorbción expresada en porcentajes, multiplicado por la duración de la exposición en horas o días, meses, años, etc. todo esto dividido entre el peso corporal total del individuo.

La dosis exacta de exposición se va a calcular multiplicando la concentración del contaminante por la tasa de ingreso, por la tasa de absorbción de dicho contaminante dividido entre el peso corporal y multiplicado por el número de días en que realmente ocurrió la exposición. El monitoreo es la ejecución y el análisis de mediciones de rutina con el propósito de detectar cambios en el ambiente o en el estado de salud de las poblaciones y existe un sin número de monitoreos y la relación directa de éstos es con la fuente o la ruta de exposición.

Tenemos el monitoreo de emisiones para hacer la caracterización de las fuentes a través de emulsión de las sustancias esto es la generación de fuentes, la frecuencia y la modalidad de la emisión, dentro del monitoreo ambiental nos interesa evaluar la exposición directa a través de las diferentes fuentes como es: aire, agua, sol o alimentos, el monitoreo biológico va a ser el indicador de la dosis interna de la carga corporal del contaminante a través de dosis absorbida, carga corporal, concentración en los tejidos blancos y por último tenemos los efectos biológicos a través del monitoreo médico que nos va a detectar los bioindicadores de efecto, los efectos precoces, el deterioro manifiesto en la salud humana.

Dentro del monitoreo biológico este se van a hacer las siguientes determinaciones. Podemos determinar en forma directa la sustancia original a través de su vía de absorbción, podemos ver o medir las alteraciones iniciales de la exposición, los marcadores de la enfermedad a través de la célula como alteraciones bioquímicas o alteraciones moleculares y el medio biológico humano en los fluidos corporales, en las células y en los tejidos.

El indicador básico de estos indicadores biológicos de exposición nos va a dar los efectos posibles y la dosis biológicamente efectiva para responder ante cualquier agresión de contaminante. Lo más usual es tener predictores antes de evaluar la carga corporal. Esto se logra a través de los monitoreos ambientales.

En el monitoreo ambiental nos interesa conocer cuáles son primero los contaminantes a estudiar, durante cuánto tiempo instrumentos o técnicas analíticas serán utilizadas. Con todo esto vamos nosotros a calcular la vulnerabilidad biológica del riesgo.

En la laminilla podemos observar conforme pasa la edad la carga corporal se ve más agredida tanto por aspectos de disposición ocupacional como no ocupacional a generarnos un riesgo.

Todo esto que acabamos de comentar en México lo tenemos reglamentado a través de un marco legal que debemos de cumplir toda la industria, la publicación de las diferentes normas oficiales mexicanas emitidas por las autoridades gubernamentales encargadas de la vigilancia de la exposición a riesgo, básicamente aquí vamos a enfocar tres normas, la norma técnica 79 emitida por la Secretaría de Salud y publicada en 1987, la norma oficial mexicana 010 de la Secretaría de Trabajo y Previsión Social publicada en 1993 y la más reciente que es la norma oficial mexicana 048 de la Secretaría de Salud publicada en 1996.

La norma 79 nos habla de la vigilancia epidemiológica de los factores de riesgo de las enfermedades y de los accidentes de trabajo a través de informaciones epidemiológicas, de estudios de campo, de diagnósticos epidemiológicos, de investigación epidemiológica y de estudios especiales.

Esta norma nos ubica a la población en riesgo, nos clasifica al personal en caso sospechoso, probable o comprobado. Esto es, el caso sospechoso es cuando no existe manifestación de riesgo, el caso probable es cuando es compatible a la manifestación expresada clínicamente del riesgo y el comprobado es cuando hacemos uso de los monitoreos biológicos o de estudios de vigilancia médica con manifestación comprobada de daño, estudios de defunción en los casos de fallecimientos por exposición a riesgo y los estudios de campo que básicamente van a ser cuatro.

Estudios de campo observacionales o instrumentales clasificándolos en cuatro grupos. El grupo uno es ica (sp) 79. Clasifica y agrupa a las enfermedades de trabajo en tres grandes grupos: la vigilancia epidemiológica de las neumoconiosis incluyendo la silicosis y la asbestosis, la vigilancia epidemiológica de las sorderas y de la hipoacucia y la vigilancia epidemiológica del dolor de espalda bajo.

En 1996 entra en vigor lo que es la norma oficial mexicana 048 de la Secretaría de Salud que establece el método normalizado para la evaluación de los riesgos a la salud como consecuencia de agentes ambientales.

La norma oficial mexicana sobre la metodología normalizada para la evaluación de los riesgos a la salud es producto de la necesidad de contar con un instrumento útil que permita valorar el grado de riesgo de una población determinada, ya sea la expuesta laboralmente a los agentes como la que por diversos motivos permanece un tiempo prolongado en la vecindad donde se generan los factores de riesgo y que por ello pueden verse afectados en su salud.

A partir de la evaluación de este riesgo se espera la implementación de medidas correctivas y programas de vigilancia de la salud que las poblaciones expuestas permitan disminuir el daño a la salud humana. Esta norma tiene un sinnúmero de especificaciones.

Dentro de las especificaciones de la norma 48 tenemos primero la identificación precisa del establecimiento, la ubicación del mapa regional, la autorización de uso del suelo, estudios geográficos e hidrológicos, históricos y poblacionales, características de construcción, de ventilación y eliminación, tanto naturales como artificiales del establecimiento, descripción precisa de las operaciones de actividades que se realizan en el establecimiento asociadas a un factor de riesgo, identificación de agentes que pueden dañar la salud del hombre, determinación de los medios por los que puede propagarse los agentes identificados, identificación de poblaciones expuestas dentro y fuera del esta-económicas (sp) y étnicas que influyen en el riesgo y evaluaciones clínicas de la población laboralmente expuesta según la norma oficial mexicana correspondiente vigente y registro de salud de la población relacionados con el riesgo a través de estadísticas de movilidad y mortalidad o encuestas directas, registro de salud en centros de atención cercanos y estudios epidemiológicos realizados, identificación de los patrones epidemiológicos sobre un patrón de salud, enfermedad de la población, ya sea en comparación con sus antecedentes o con otras poblaciones de características similares, identificación de agentes físicos, químicos y biológicos en los diferentes medios, determinación de facilitadores e inhibidores de los agentes identificados, evaluación de los agentes físicos, químicos y biológicos de acuerdo con la norma oficial mexicana correspondiente vigente, registro periódico de monitoreo de efectos a la salud, la periodicidad de que pueden ser semanales, quincenales, mensuales, semestrales o anuales dependiendo del agente investigado, el sistema de indicador biológico de efectos a la salud identificado de acuerdo a la norma oficial correspondiente.

De acuerdo a las especificaciones vamos a clasificar y vamos a ubicar a la población en riesgo en tres grandes grupos, tenemos el grupo de riesgo superior medio inferior ese está relacionado básicamente en tres aspectos: en las concentraciones ambientales de exposición mediante monitoreo ambiental, siete muestras sobre el nivel máximo permisible en un período de un año ubicados en el grado superior.

En el de condiciones biológicas dos monitoreos sobre el nivel máximo biológico permisible se ubican en grado superior, en grado medio es cuando el 50% de las muestras ambientales cursan sobre el nivel máximo permisible, el grado inferior es cuando menos del 50% de las muestras ambientales se encuentren por debajo del nivel máximo permisible.

Esto va a generar una serie de medidas sanitarias a cumplir y va a dar dos recomendaciones: primero es proponer recomendaciones específicas de acuerdo al resultado de elaboración de riesgo y elaborar convenios con las autoridades gubernamentales tanto de la Secretaría de Salud como de la Secretaría de Trabajo.

Question Period - Période de questions - Período de Preguntas

MR. TRABANT: Thank you, Dr. Valverde. Are there any questions?

MS. MORPAW: Thank you for the presentation, Dr. Valverde.

I wonder if you could talk, and maybe someone from the Canadian and American side would like to make comments afterwards, about particular health risks in the mining sector in Mexico, what are your principal challenges in Mexico in the mining sector in terms of health, and what prevention activities are being advocated or adopted to change or to improve any situations that you could tell us about, and that anyone else might like to. Thank you.

DR. VALVERDE DURÁN: Bueno en cuanto a la relación estadística de la ocurrencia de riesgos va a ser una ponencia por el Dr. Aguilar Salinas donde vamos a hablar básicamente de números, en cuanto a lo que se hace en la industria minera. Me voy a permitir hablar del grupo en que trabajamos que es el grupo México, de Industrial Minera México, básicamente en la prevención de riesgos nosotros manejamos lo que acabamos de ver de la norma 048, tenemos que identificar a nuestra población en cuanto a ocurrencia y probabilidades de riesgo. Aquí tenemos programas específicos de análisis previo para determinar el punto exacto de la exposición de los trabajadores.

Nuestros dos riesgos más importantes son la silicosis y las sorderas o hipocusis.

MR. TRABANT: Any other questions?

MR. STEPHEN HUNT (United Steelworkers, Canada): Just a question about medical monitoring. Who pays for the monitoring if a worker exhibits signs of illness?

DR. VALVERDE DURÁN: Bueno en México, nosotros estamos afiliados a la seguridad social y dentro de lo que se paga la empresa se encarga de hacer todo lo que es aspecto preventivo de evaluación de riesgo o de daño. Tenemos en metalúrgicas, en fundiciones o refinerías tenemos sistemas de seguimiento biológico donde comparamos los monitoreos ambientales para ver la carga posible del daño a través de determinación, en el caso de fundiciones vemos metales pesados y evaluamos el daño bioquímico previo al efecto de evaluación médica y en esto determinamos metabolitos o el metal en sangre o en orina y todo esto es pagado por la empresa. Cuando los indicadores de daño son manifiestos de acuerdo a la clasificación del riesgo que mencionamos antes, en riesgo superior, nosotros transferimos al sistema de seguridad social al trabajador el cual se encarga de aplicar el tratamiento correspondiente.

MR. HUNT: Thank you. In Canada, we have a program called WHMIS, which is the Workplace Hazardous Materials Information System. It is not perfect, but it allows workers to identify what toxic substances they may be exposed to. Do you have anything similar to that in Mexico?

DR. VALVERDE DURÁN: Sí, de hecho lo que acabamos de mencionar ahorita, lo que es la vigilancia epidemiológica tras de la norma 048 y de la norma 79 tenemos implantado tanto en unidades mineras, en plantas de beneficio, en refinerías y en fundiciones sistema-50 chance (sp).

MR. HUNT: You identify your risk groups and if you are on the high side of the 50 percentile, you would be monitored more closely.

If I took an example of lead, if workers were being overexposed to lead, is there a program in Mexico, which we have in some jurisdictions in Canada, not all, because we do not have uniform standards in Canada, but if a worker was overexposed to lead in some jurisdictions, he would be placed in another work area, not under social assistance or to the medical program, but in another work area, where his lead levels would hopefully drop, the exposure would be reduced.

DR. VALVERDE DURÁN: Sí, de hecho ahora en México se está trabajando con una norma, una norma oficial mexicana para establecer el límite biológico máximo de exposición laboral al plomo. A pesar de que no tenemos reglamentado aún en México el manejo seguro del plomo, en la industria mexicana se manejan dos condicionantes: el retiro de la exposición y la limitación de la exposición, de acuerdo a los exámenes tanto ambientales como biológicos aplicamos el programa de retiro y de limitación. Nosotros manejamos el retiro a la exposición cuando la evaluación sobrepasa el nivel máximo permisible establecido en la norma 10 de la Secretaría del Trabajo en México y limitamos la exposición a pesar de que el monitoreo ambiental esté dentro de los niveles permisibles y encontramos un indicador de efecto, de bloqueo del ácido del metabolito o la sintoporfirina (sp)? de la LAU lo retiramos temporalmente de la exposición al trabajador. Esto es en períodos de acuerdo a la vida media biológica del plomo que van desde 120 días hasta 6 meses y le damos un seguimiento mensual biológico para ver la concentración de tanto del metabolito como del metal en sangre.

MR. HUNT: Thank you, Doctor.

MR. TRABANT: Any other questions? Thank you very much.

Concurrent Session - Respiratory Disease - Séance simultanée - Maladies respiratoires - Sesión Simultánea - Las Enfermedades Respiratorias

MR. LARRY MACKEN (Industrial hygienist, Mine Safety and Health Administration, U.S. Department of Labor): Continuing with the theme of preventing adverse human consequences this morning, we are going to start a session on Respiratory Diseases.

Our first speaker is Ing. Manuel Guillermo Landa Piedra. He has degrees in metallurgy, mining engineering, and a Master's in Administration. He is currently the Head of Occupational Safety for the Mexican Social Security Institute.

ING. MANUEL GUILLERMO LANDA PIEDRA (Titular de la División de Seguridad en el Trabajo, Instituto Mexicano del Seguro Social): Muchas gracias por la invitación al Instituto Mexicano del Seguro Social y quisiera empezar con el tema, parte del tema que es la prevención de consecuencias humanas adversas en enfermedades respiratorias. El Instituto Mexicano del Seguro Social a través de la coordinación de salud en el trabajo de México, tiene un programa el cual dentro de su estructura llega a atender la salud del trabajador con la vigilancia epidemiológica y la vigilancia del ambiente de trabajo en la parte preventiva.

Vamos a hablar exclusivamente de la parte preventiva porque hoy por la tarde el Dr. Aguilar también del Instituto Mexicano del Seguro Social va a hablar sobre la parte correspondiente a los subsidios y pensiones y el costo que se tiene de estos problemas de salud que afectan al trabajador desde el punto de vista médico.

Este programa de salud en el trabajo tiene dos vertientes: decíamos, el programa de salud de los trabajadores que propiamente es la promoción y la prevención de los riesgos de trabajo a toda la industria en México y el programa de prestaciones por riesgos de trabajo e invalidez. En el primero de ellos el objetivo que tenemos es mejorar la atención a la salud de los trabajadores de las empresas afiliadas y del propio Instituto y de alguna manera proporcionar esa protección a los medios de subsistencia de los casos de riesgos que se presentan, tanto de enfermedad general como de invalidez.

Es importante también que esta primera vertiente de los objetivos son de fortalecer la cultura del autocuidado de la salud, entonces el proteger a los trabajadores, el prevenir los accidentes y la enfermedades y el promover una cultura de protección ambiental.

Tenemos aquí en este esquema la forma como se trabaja en un sólo programa, nuestra misión lógicamente que acabamos de mencionarla que es la atención a la salud del trabajador y la protección de los medios de subsistencia a través de estas dos vertientes y con el apoyo de las normas, la investigación, la educación, la comunicación y las reuniones.

Con este programa nosotros tenemos que atender 11,447.000 trabajadores, aproximadamente un total de 407,000 riesgos que ocurrieron en el año pasado en toda la industria y la tasa de riesgos de trabajo que nosotros tenemos es de 3.6 hasta 1998.

Los días de incapacidad son del orden de más de 9,000.000 casi 10,000.000 en el 1997 y 9,000.500 en el 1998. Días de incapacidad por trabajador 0.9 y 0.8. Aquí vemos alguna gráfica en que se ve la tasa de incidencia en riesgos de trabajo como ha evolucionado a través del tiempo y la labor que se ha hecho conjuntamente con la Secretaría del Trabajo y Previsión Social de México y el Instituto Mexicano del Seguro Social, principalmente a la disminución a través de este programa en los últimos 4 años en esa tasa de incidencia de riesgos de trabajo.

Tenemos también la oportunidad de ver en esta lámina allá en la parte minera, cuál ha sido el comportamiento de estos riesgos de trabajo durante los últimos años y podríamos mencionar que se tienen dos tipos de minas, las minas no metálicas que están en la parte superior y las minas metálicas, hay diferencias en cuanto a las características de los problemas que se tienen, por ejemplo las empresas son 1410, no han variado mucho, los trabajadores son del orden de 30,0 y lógicamente que van a tener tasas bastante altas y también las minas metálicas.

También en la industria minera las enfermedades de trabajo que nosotros tenemos registradas son del orden de 703 en las minas no metálicas y han disminuido a través del tiempo precisamente por las modificaciones y la mecanización que en los últimos años se tiene en las empresas, sobre todo en las minas de carbón. En el caso de la extracción de minerales metálicos no ha sido así el caso, dado que a pesar de la mecanización y de los nuevos sistemas que se tienen de explotación en las minas, no ha variado gran cosa.

También podemos ver que esas incapacidades permanentes por enfermedad de trabajo pues lógicamente que a raíz de las modificaciones en la industria minera del carbón sí, han dado resultado y vemos una disminución de las incapacidades permanentes por enfermedad de trabajo, es decir, que se han mejorado los sistemas de ventilación, se han mejorado los sistemas para los problemas de higiene industrial que se puedan presentar en el ambiente y las incapacidades permanentes. En las minas metálicas no ha sido también el caso, ahí vemos que en muchas de las minas no se están aplicando la normatividad correspondiente.

En el caso de las defunciones tenemos pocas defunciones registradas, precisamente porque la evolución de estos padecimientos pues lógicamente a veces se pueden confundir con enfermedades generales y no se tiene a la fecha gran cantidad de investigación al respecto de saber realmente cuáles corresponden a enfermedades de trabajo y cuáles corresponden a enfermedades generales.

Les quería mostrar esto porque uno de los principales problemas que tenemos en cuanto al riesgo físico o a la condición peligrosa son los peligros del medio ambiente, forman parte importante y se tiene que ver que estos peligros del medio ambiente son los que nos están provocando esta situación de ausentismo, de accidentes y problemas de enfermedades de trabajo en las minas y ocupa el segundo lugar, tanto en la minas metálicas como en las no metálicas.

Vemos que también en las minas no metálicas el antrasilicosis pues lógicamente que es la enfermedad de trabajo de los mineros del carbón y se presenta con menor frecuencia en los últimos años debido a estas modificaciones.

Aquí podemos ver que en las minas metálicas los problemas de neumoconiosis debido al polvo de sílice ha ido disminuyendo no en la medida en que debiera.

Esto tiene mucho sentido puesto que lógicamente faltaría inv (sp) por los problemas de la trituración en la mina tiene que ver precisamente con el manejo de explosivos, con el tipo de roca que existe in situ y por las características mismas del proceso de barrenación y de detonación con explosivos en las minas, entonces no se han hecho estudios precisamente para controlar los tamaños de partícula.

En el programa estratégico de salud en el trabajo nosotros estamos realizando visitas promocionales a todos los centros de trabajo. Aquí se incluyen las minas. Este número que ustedes ven aquí no es exclusivamente de las minas, es de todas las empresas que nosotros visitamos en el año y hacemos capacitación a las comisiones mixtas del orden de 4,723 cursos el año pasado. Este año vamos a rebasar esto probablemente. Ya llevemos 6,000 hasta este momento.

Realizamos también estudios especializados del orden de 3,000 que precisamente llevamos a cabo año con año, estos estudios tienen que ver con seguridad y con higiene industrial aunque si en menor escala para la higiene industrial. Los programas preventivos que nosotros establecemos conjuntamente con las empresas a raíz de los estudios que estamos realizando.

Otro tipo de estudios que realizamos, son los estudios epidemiológicos, estos estudios conjuntamente con las empresas para llevar la vigilancia epidemiológica de estas empresas.

Es importante hacer notar que las empresas mineras últimamente tienen, sobre todo las empresas grandes, cuentan con ingenieros, médicos especialistas que están trabajando muy decididamente a modificar estos ambientes laborales. Desgraciadamente no son todas las empresas mineras. Entonces el Instituto Mexicano del Seguro Social adonde va realmente con mayor frecuencia es a las empresas mineras pequeñas o medianas donde no cuentan con los recursos humanos especializados y que tendríamos nosotros en muchas ocasiones, inclusive monitorear el ambiente de trabajo de esos trabajadores.

Cuáles son las áreas donde precisamente se están presentando los problemas y nosotros podemos decir que los principales problemas uno es el ruido, el ruido provocado por las barrenadoras o por los equipos que ahora se utilizan, como los scoop-drums, los jumbos etc.

Otro aspecto es la contaminación del ambiente que les mencionaba por los polvos en el cual nosotros vemos que cada día el polvo no solamente es el polvo sino son también los humos que se producen por estos equipos principalmente equipos diesel que están presentes en el ambiente de trabajo y nos dan la idea de que el trabajador se está enfrentando a nuevos problemas de los cuales no están perfectamente protegidos.

Es importante también tomar en cuenta que hay otros problemas que no hemos todavía investigado como son los problemas ostiomusculares producidos por el calor y la humedad relativa que existe en los ambientes de trabajo.

En un estudio que hicimos hace aproximadamente 10 años, nos encontramos en una mina con una población trabajadora de aproximadamente 850 trabajadores en una mina subterránea en la que los problemas del 15% de los trabajadores que tenían aproximadamente más de 15 años trabajando, ya tenían algunas lesiones referentes a problemas auditivos, problemas en los pulmones y problemas ostiomuscaleres sensibles porque el trabajador minero en ocasiones por la falta de ventilación, el área se calienta muchísimo y otro problema característico de esta mina teníamos un mineral que es la pirita y que hacía una reacción exotérmica y producía mucho calor. Casi todas las minas en México tienen este material, sobre todo las minas en donde se explota plomo, zinc, cobre, oro y plata. Entonces este material produce una reacción exotérmica y calienta el ambiente de trabajo.

Estos aspectos generales que nosotros vemos aquí de control que se han establecido pues no tienen nada de extraordinario. Sin embargo, lo único que estamos aplicando es la metodología del reconocimiento de evaluación y control que manejamos en la higiene industrial y el Instituto Mexicano del Seguro Social cuenta con 4 laboratorios de higiene industrial de salud en el trabajo en empresas. Para ello nosotros tenemos un marco normativo que nos rige que inicia con la constitución política de los Estados Unidos Mexicanos, la Ley Federal del Trabajo, la Ley del Seguro Social, el Reglamento Federal de Seguridad e Higiene y Medio Ambiente de Trabajo y las Normas Oficiales Mexicanas. Estas Normas Oficiales Mexicanas que de acuerdo al programa que nosotros establecemos tiene que ver precisamente con ese reglamento, con la norma oficial mexicana 10 de 1994, la norma oficial mexicana 114 que se refiere al sistema para la identificación y comunicación de riesgos por sustancias químicas y la norma oficial 116 de seguridad en los respiradores, purificadores de áreas contra partículas nocivas.

La norma oficial 121 que es específicamente para los trabajos de las minas tiene que ver con todas con ellas y con otras más. Sin embargo, en la parte correspondiente a la vigilancia del ambiente de trabajo, nosotros estamos aplicando estas normas.

Nosotros trabajamos en base a procesos, decíamos la promoción importantísima a través del acuerdo de acciones vinculadas, es decir, la participación de varias instancias, varias áreas del Instituto para promover la salud del trabajador. La prevención en donde se llevan a cabo los estudios y programas que hemos mencionado en las empresas mineras y la higiene industrial y la higiene industrial y protección al ambiente en donde se hace la evaluación propiamente de ese ambiente de trabajo y que de alguna manera nosotros estamos ya obteniendo algunos resultados y ya se han hecho investigaciones que se promueven en eventos que nosotros realizamos en México como son el caso de la Reunión Nacional de Investigación de Salud en el Trabajo que se lleva a cabo año con año desde hace 4 años y a iniciativa del Instituto Mexicano del Seguro Social.

Las líneas de apoyo que es la investigación decíamos en donde se hace propiamente todo lo relacionado con accidenteros de capacitación regionales y que colabora para capacitar a diferentes niveles de las empresas a trabajadores, supervisores y técnicos especialistas de las empresas en diferentes tipos de cursos. Este año llevamos aproximadamente 8,000 cursos ya establecidos.

Por último la comunicación que nos permite a través de folletos y de reuniones como éstas en las que podemos promover y dar a conocer de alguna manera los resultados que se obtienen en estos estudios y programas.

Quiero agradecer como les decía y espero que haya sido interesante esta corta plática y que no da oportunidad muchas veces a expresar todo lo que se tiene y todo lo que se hace, realmente el Instituto Mexicano del Seguro Social ha hecho un gran esfuerzo durante muchos años, al menos desde hace 23 años que yo trabajo en él y que hemos visto muchas empresas, trabajado con muchos empresarios y gracias a la promoción que ha hecho el Instituto Mexicano del Seguro Social al respecto las empresas se han preocupado por tener especialistas tanto desde el punto de vista médico como desde el punto de vista técnico mediante especialistas, o ingenieros que se dedican a la seguridad y a la higiene industrial. Muchas gracias.

MR. MACKEN: Thank you. Are there any questions?

Question Period - Période de questions - Período de Preguntas

MR. GEORGE BOTIC (National Representative, Canadian Auto Workers Union): I have a couple of questions, if I may. Thank you very much for your speech. It was very informative.

You had a chart out there that talked about 18,600 visits, or something like that. Was that by the inspectors? How was that conducted, the workplace visits on your chart?

ING. LANDA PIEDRA: Bueno, esas 8,000 visitas son de promoción, promoción que tiene que ver con el ofrecer a los empresarios los servicios que tiene el Instituto en el ramo de salud y seguridad en el trabajo. Es la investigación, la capacitación, la asesoría tanto desde el punto de vista técnico como la asesoría desde el punto de vista médico y técnico así como de ingeniería.

También otros aspectos importantes del cuidado de la salud del trabajador en cuanto a diversas enfermedades y que manejan otras áreas del Instituto Mexicano del Seguro Social como son medicina preventiva y algunos aspectos que tienen que ver con el cuidado que debe tener el trabajador en cuanto a su salud personal, aspectos sociales, aspectos de manejo del tiempo libre y sobre todo, de las características importantes de la salud propia del trabajador.

Las visitas a los centros con relación a los estudios es otro aspecto que es preventivo, quiere decir que vamos a hacer estudios de investigación a las empresas, pequeños estudios de investigación que nos permite conocer cómo está funcionando la empresa desde el punto de vista de seguridad y de salud, equipos médicos e ingenieros asisten a las empresas para proporcionarles esa asesoría a ellas y estudiar conjuntamente con ellos el ambiente de trabajo de determinadas áreas.

Vamos a las minas, por ejemplo vamos a los rebajes, a las áreas de explotación y medimos los polvos, medimos la temperatura, el ruido y por la parte del médico observamos y en base al análisis de puesto vemos cuáles son los esfuerzos que realiza el trabajador, cuáles son las características de trabajo y sobre todo el médico puede a partir de la observación de los problemas de ambiente que se tienen hacer un estudio más cercano a la realidad de lo que le pasa al trabajador o desde el punto de vista médico-clínico.

Una vez que nosotros determinamos en estos estudios cuáles son los problemas, conjuntamente con el empresario establecemos medidas y recomendaciones para que se mejore ese ambiente de trabajo y esto está basado precisamente en el programa preventivo, que se menciona ahí, es decir, que estos programas preventivos abarcan aquellos lugares de trabajo donde se está ocasionando el problema.

Nosotros ya no podemos gastar dinero en visitar la empresa y dejar olvidado el problema, tenemos que controlarlo y a través de estos programas que se pueden controlar los problemas.

MR. BOTIC: Just on that, when you say "preventive programs", does that mean the orders that are issued at the end of the day? In Canada, be it under the federal jurisdiction or be it in provincial jurisdictions, we have specific inspectors that may go into the mine or into the workplace as companies. If they see a violation of the Act or regulations, they will then issue orders.

I am asking you, under the Program, do your inspectors issue orders, and how many inspectors are there that work for your department?

ING. LANDA PIEDRA: Nosotros tenemos 450 ingenieros y técnicos, pero nuestra labor no es de tipo coercitivo. Nuestra labor es de colaboración con las empresas. Es en toda la extensión de la palabra es asesoría a las empresas para que mejoren las condiciones de trabajo. Hay una instancia federal que es la Secretaría del Trabajo que de alguna manera nosotros colaboramos con ella porque al realizar este tipo de estudios hay el antecedente de que el Instituto Mexicano del Seguro Social ya visitó la empresa y ya dio algunas recomendaciones para mejorar la situación. Cuando llega el inspector de la Secretaría del Trabajo, lógicamente se basa en muchas ocasiones en este tipo de estudios y en cierta manera, estamos colaborando para que se lleve a cabo.

La labor del Instituto con las empresas, porque el Instituto en su formación es tripartita, trabajadores, empresas y gobierno, nosotros no podemos ir contra ellos, tenemos que ayudarlos y esa es la labor del Seguro Social.

MR. BOTIC: Thank you.

INTERLOCUTEUR: Très rapidement, quels sont les horaires des travailleurs miniers chez vous? Est-ce que ce sont des horaires de 12 heures ou de 8 heures, ou moins ou plus?

Est-ce qu'il y existe aussi un droit de refus, où un travailleur exposé à des produits toxiques ou à des poussières qui dépassent les normes, est-ce qu'il y a un pouvoir de refus?

Lic. José Víctor Mejía Domínguez (Director de Normas de Trabajo, Secretaría del Trabajo y Previsión Social): Yo le voy a contestar lo que me corresponde. No somos autoridad como mencionaba. Los turnos son el matutino de 8 horas, el vespertino de 7.5 horas y el nocturno de 7 horas. Normalmente en todas las minas.

La otra cuestión es que si el problema es tan grave, si la presencia o la exposición del trabajador debido a la concentración del contaminante amerita salir del lugar de trabajo, lo pueden hacer. Tienen el derecho. Sin embargo, esto es importantísimo, se debe de negociar dentro de la empresa y con el trabajador, la representación empresarial con el trabajador, pero sí tiene dentro de sus derechos, la reglamentación, sí le permite al trabajador salir del lugar del trabajo siempre y cuando amerite la peligrosidad de ese ambiente laboral. Sin embargo, en 28 años que tengo como ingeniero de minas, y que conozco más o menos las minas, nunca se ha dado el caso de que un trabajador salga de su lugar de trabajo aun cuando tiene las posibilidades desde el punto de vista legal.

Soy Victor Mejía, de la Dirección General de Inspección Federal del Trabajo de México, quiero comentarle a la persona que preguntaba sobre las visitas de inspección que el día mañana en la participación del Lic. Joaquín Blanes Casas se les darán muchos pormenores relacionados con el procedimiento de inspección en las minas así como las medidas que habitualmente se dictan para la prevención de riesgos de trabajo. Gracias.

MR. MACKEN: Again, thank you.

The next speaker is Dr. David Muir. He is a professor at McMaster University Medical School. He is a clinician, but he also is interested in epidemiology of pneumoconiosis.

DR. DAVID MUIR (Professor of Medicine, McMaster University): Thank you very much, and thank you for giving me the honour of speaking today.

I am going to be fairly brief, and I am going to speak from slides. Could we have the first slide please. On silicosis as an example to raise some of the issues which you, as workers and government and industry, have to decide.

I put up co-workers pneumoconiosis because in my previous work in Britain, I was much involved with the epidemiology of that.

Lung cancer, again I am just putting up for completeness. In Ontario, we did have a big uranium mining industry. And chronic obstructive pulmonary disease, at the bottom, is an extremely controversial subject, particularly those of you from the coal mining industry will know of the events in Britain during the last year or so.

I happen to be one of those who think that coal mining dust exposure is associated with chronic obstructive pulmonary disease, but I am well aware that it is a controversial subject so I am not going to present this today.

I am not going to mention asbestos at all. I come from Ontario, where we do not have any asbestos. I am well aware that in Canada this is a very politically sensitive subject, so I am going to move rapidly on to show you some real occupational lung disease that I meet.

To start with, I am going to show you a normal chest X-ray. For those of you who are not physicians in the audience, this is the heart, which is normal in this case in size and in shape and position. This is the patient's right lung, and this is the patient's left lung, with the normal blood vessels going out. That is a normal chest X-ray.

To be contrasted with a film which regrettably does not show in this light, but you will have to take my word for it, that there are small round opacities visible throughout the lung field. I saw this patient not long ago and was able to tell him that he has the early stages of silicosis. I saw him in my clinic at McMaster. For those of you who are familiar, this is on the ILO scale of about 2/1 or 2/2. In other words, he has small round opacities which are visible upon looking at his X-ray, and this is early silicosis.

The question that this worker asked me is, what advice could I give him. I am a clinician. I have worked in the mining industry all my life, both in coal mining and hard rock mining. The only comment that I could make to this patient was that he should have been exposed to lower dust levels some 10 or 15 years before. I have no treatment to offer him. I have no evidence that either taking him out of work or putting him back in work will make any difference, and I will show you some evidence on that at the moment.

The only comment I can say to this worker, who has established silicosis, even though you cannot see it, is that he should not have been exposed to dust in the past. This leads me on to my major conclusion, that I hope you will ask questions about.

In my view, the only way to prevent silicosis is to ensure low dust levels. The problem is, what is an appropriate dust level, and how do you guarantee or ensure that a worker should not be exposed to excessive dust.

This is a political issue, to be resolved in different jurisdictions, but I have to tell you that as a practicing physician I do not believe that X-ray surveillance is a reliable method of preventing the disease that you just saw. The reason I say that is based on the following evidence.

This is a study which I published with my colleagues from McMaster in the hard rock mining industry of Ontario. We were looking at the risk of developing silicosis against cumulative dust exposure during the life of the working miner.

There were three problems with this study. The first of these I would draw your attention to is that these are all different X-ray readings by five different physicians, all of whom are quite well known in this area, all of whom are very experienced. You can see immediately that they all know produced different risk estimates.

The first comment is to say that despite what you may read or learn or hear, the diagnosis of silicosis is not nearly so easy as you may think. You have to decide what level of abnormality you will take before you make a diagnosis, you have to decide how experienced the physician may be, you have to decide how many physicians to read that X-ray you will take, because here are three quite well known -- I will not identify who is who, I am one of them. The others are quite well known across North America. You can see immediately that we all read different levels of pneumoconiosis.

The second issue is that the risk estimates go back to zero point. From the evidence that we obtained in this study, we were not able to demonstrate a zero risk point at any level of cumulative dust exposure, or cumulative respirable silica exposure.

If you accept this sort of evidence, it makes no realistic sense to demand that all levels of silicosis are the only acceptable risk in industry. It is not a practical proposition, if you accept this sort of evidence.

The third problem is more serious. We now know, from the South African data, that 50 per cent of their silicotic cases were recognized long after the miners had retired. They retired at the age of 65, and 50 per cent of their cases occurred when the miners were reaching 65, 70, whatever it might be. So you can immediately see, without any science at all, that X-ray screening does not provide guarantee to a worker of not developing silicosis. If that is your only method of control, you will miss at least half the cases.

Only long term follow-up can detect such cases. In other words, if you have a screening program, the study that I did, this one here, was limited by the fact that the only X-rays I had available were because the law in Ontario required a minor to have an X-ray while he was at work. No provision was made for subsequent screening afterwards. So I had no X-rays, I have no idea what happened to these miners after they left my study.

If we followed the South African data, then I was missing at least half of the cases. That is what will happen to you if you have a screening program limited to while the worker is still employed.

I suspect that it depends on the silica levels, the quartz levels, in the respirable dust.

The South African data, about 30 per cent of the respirable dust is composed of silica. We know that in the coal mining industry of UK the same progression does not occur. There have been studies done, looking at coal miners, to see whether they developed pneumoconiosis after leaving the industry. At present, there is no evidence that that happens. I suspect that it is because the fractional content, the percentage content, of silica in the coal mine dust is low, whereas in South Africa we know that the percentage concentration of dust is very high.

So the most important thing for industry in North America and in Mexico to my mind at the moment is to find out whether this progression of cases occurs when the content of silica in the respirable dust is fairly low. I think this is a major, major problem the industry faces.

The only way to do it is to follow up groups of miners after they have left. In Ontario in the respirable dust is only about 8 or 9 per cent silica. It may well be that my study, which I used here, is not as bad as it seems. It may well be that we did not miss cases, but at the moment I have no mechanism of proving it, nor in Ontario at the moment do I have the opportunity to follow up these miners. The reasons are complex, and I will not go into them now.

If I were a miner, to protect me from silicosis I would want to know that I was working in low dust levels. How I would achieve that is an issue which there are representatives present, how they are to achieve that is a political issue which, as a physician, I will not go into.

If you are going to employ workers, then you must ensure that they have long term follow-up after leaving work.

The miners themselves must consider what is an appropriate health target. At the moment, I do not believe that minor degrees of silicosis in an 80-year-old man is a really clinically health hazard. But I am well aware that the law in the United States might say otherwise. As a clinician, I know what I am doing. I am not a lawyer. I will leave that to be sorted out, but I think that the idea of no evidence of silicosis at all is totally unrealistic.

If possible, the miners must identify dust levels that cause ill health, for obvious reasons. That is to be contrasted with industry. For their best protection to run an operation on a long-term basis, they need to maintain reliable dust measures, with adequate quality control, they need to maintain reliable employment records, and they need to ensure reliable X-ray programs with long-term follow-up. The reason being that then people like me can come along, look at the data and try to identify dust levels which do not cause ill health.

The vested interest is separate. The miner needs to know what level of dust will harm him. Industry needs to know what level of dust can be regarded as without significant health hazards. They are slightly different.

A choice has to be made by both sides, both miners and industry. Is it better to enforce a moderate dust standard or to advise a rigid epidemiological standard which is not maintained in practice?

If I were a miner, I want to know what dust I have been exposed to, and I want to enforce and ensure the levels. The actual levels are possibly a secondary issue. In other words, legislation, lawyers and industry and miners have to make a decision at some time whether to go for a moderate dust standard, but to make absolutely sure that it is 90 per cent complied with -- because I do not believe on the whole across North America that standards are 90 per cent complied with -- or to recommend a theoretical very low standard which is not complied with, which is extremely difficult to measure, very low standards, the lower you go, the more difficult it is to maintain it.

Mr. Chairman, I am deliberately going to stop at that stage. I hope that I can stimulate some discussion, particularly stimulate discussion amongst those of you who think that having an X-ray prevents silicosis. I have seen a lot of silicosis and I do not believe that I have ever prevented a single case. If I really want to prevent it, I would get rid of all the doctors like me and hire more engineers. Thank you.

MR. MACKEN: Any questions? That was a very stimulating and thought-provoking commentary.

Question Period - Période de questions - Período de Preguntas

INTERLOCUTEUR: Docteur Muir, vous avez mentionné que le Rayon-X comme tel n'était peut-être pas la meilleure façon de détecter ou de voir la silicose. Qu'est-ce que vous voyez qui serait une bonne méthode vis-à-vis la détection, pour un, et de deux, savoir si le travailleur minier a une silicose?

DR. MUIR: I can only answer the first question, because the second one got lost.

The X-ray is the only method of detecting it. The problem arises that once the X-ray shows significant abnormality, it is already too late. Because we now know that silicosis can occur 50 per cent -- half the cases will occur after they leave the industry. Therefore, surveillance during work is only half of what is necessary.

I missed the second question. What was your second question?

INTERLOCUTEUR: Ma deuxième question est, qu'est-ce qui serait la meilleure méthode pour détecter?

DR. MUIR: An X-ray. A chest X-ray is the only method of detecting it. There are, in theory, other methods, but they are not practical.

INTERLOCUTEUR: Mon autre question, vis-à-vis l'exposition: Est-ce que les années d'exposition... on sait que pour ce qui est de l'asbestose c'est un nombre d'années. Pour ce qui est de la silice, est-ce que c'est à peu près le même nombre d'années, avec une exposition assez forte? Est-ce que c'est 15 ans, 10 ans, ou 5 ans?

DR. MUIR: It entirely depends on the level of dust exposure. I have seen silicosis occurring within three years of first starting work. I saw a patient two weeks ago who left the mining industry of Ontario, having spent 40 years as an underground miner. His X-ray at the time that he left was normal. He developed silicosis for the first time when he was aged 75. That was why he came to me.

Duration of exposure is only relevant if I know the concentration of dust.

INTERLOCUTEUR: Merci.

MR. STEPHEN HUNT: Thank you for your talk, Doctor.

(Off-microphone) -- could have been a better system. Today, we have retired miners that read the obituary pages. When we know a miner passes away, we ask a widow or a surviving member to submit the body to autopsy to determine whether or not he was silicotic when he died. So we are aware of that program, which is very interesting.

I am going to applaud your honesty here on this, but I am going to ask this. We are in a forum that is supposed to discuss labour cooperation on a side agreement to NAFTA. If this is an agreement that talked about trade or something, I think this room would be packed, but because it is health and safety, it is not.

I just heard the speaker from Mexico talk about the studies they are doing on workers to reduce exposure to silicosis. Let me just tell you this. From my experience in the mining industry, and I oftentimes have the opportunity to see some pretty ugly places, and I have traveled not to Mexico but to other countries in Latin America and have seen some horror stories with respect to how mining is conducted.

I was in Peru and I saw a mine where the life expectancy in that mine amongst miners is 38 years old. Every single worker is silicotic.

My position is, in 1999 silicosis should be eradicated, and it is by controls of what you suggested: You ventilate, you reduce dust exposures to the lowest possible levels. And we do not know what that is.

When you heard the speakers from Mexico, if there is anything that could come out of this conference as a good recommendation is the free exchange of information, the honest and brutal exchange of information. It seems to me, after listening to the Mexican speaker, they are just reinventing the wheel in Mexico. They are doing the same studies that were conducted in Canada and probably the United States, probably 10, 15, 20 or 30 years ago in Great Britain.

It seems to me a terrible injustice to workers that the same phenomenon is happening now in Mexico and other Latin American countries and they will do studies on the deaths, and then come to recommendations on how to improve it.

I will just ask you a long winded question, a long-winded preface to the question: Do you think a good recommendation of this conference is that they use the skills from yourself and other people who have studied these diseases for years and years and years, and get in on the ground floor right now and make concrete suggestions and solutions to the problems that we know exist, and are easily eradicated with some common sense?

DR. MUIR: We do not need to do any more research about silicosis except the question of the necessity of long term follow-up, and except the question of does the percentage of quartz in the silica matter? I think it does, but I cannot prove it.

For practical purposes, we know how to prevent this disease. In Ontario, it is now a very uncommon disorder, not only because the mining industry is getting less but because silica standards have been enforced. I use the word "enforced" deliberately.

I think that to cure this problem, it is a question of enforcement rather than further research.

NEW SPEAKER: Una pregunta, presentaba en su estudio de la lámina la diferencia en cuanto a la lectura de imagen radiológica, ¿ustedes utilizan algún método específico como patrón para la lectura radiológica de las etapas de la silicosis?.

DR. MUIR: I use the ILO system, the International Labour Office system, for looking at X-rays. It is a matter of great regret to me that in Ontario we do not have a system for doing that now.

The Ontario system has now been privatized, so these films are going out to private radiologists, and I think it is a great pity. I would suggest that all these films should be seen and evaluated by the International Labour Office system. At the moment, we do not have any better method in doing that. It really is a very good practical method.

NEW SPEAKER: Otra pregunta, en cuanto a la aparición inicial de las imágenes radiológicas ¿ustedes tienen la experiencia de llevar seguimiento en cuanto a las concentraciones de sílice libre y en qué período detectan las primeras manifestaciones en la radiografía?

DR. MUIR: Again, it depends on the level of exposure. It so happens that in Ontario we did not see any changes with less than 15 years of exposure. In some countries it is much less than that. In other countries it is much longer.

The first signs depend on the guaranteed level of exposure. If it is really 0.1 milligram per cubic metre in the respirable dust, I would not expect changes to occur between 30 or 40 years. If it is higher than that, then I suspect it will occur before then.

NEW SPEAKER: En la experiencia que tiene de los estudios realizados ¿qué porcentaje de cuarzo o de sílice libre se tiene en la concentración de exposición?

DR. MUIR: In Ontario, the average silica level, percentage level of silica in the respirable dust is about 8 or 9 per cent. The absolute level I do not know, because this was a selected population and I know what it was for those workers, but I do not know the overall silica levels in the hard rock mines of Ontario, and I think I should not speak on behalf of the mining industry and give any data.

I have a reasonable idea, but I do not think it would be proper for me, as an academic, to say what the current dust levels in Ontario presently are. I don't know if anyone from the mining industry is present, but I don't think I should respond to that.

Perhaps from the Steelworkers. Do you know what they are?

NEW SPEAKER: The dust levels for the...?

DR. MUIR: In the hard rock mines of Ontario, do you happen to know what the silica levels on average are?

NEW SPEAKER: It would vary.

DR. MUIR: It is very uncommon in Ontario now. I have seen some cases of progressive massive fibrosis from those who got silicosis 30 years ago, but as a disease now I do not see this. So it is very uncommon.

I have only seen one true progressive massive fibrosis in the last two years I think, and that had gotten his exposure many years before.

MR. MACKEN: Thank you. If we could, I would like to hold questions for Dr. Muir to the end, and present Kenneth Vorpahl. I want to attempt to keep this as close to schedule as I can at this point.

Kenneth Vorpahl is the corporate industrial hygienist for Unimin. He has responsibility for plants in the United States and Canada. Unimin has plants in Canada, Mexico and the United States, and about 33 of the plants under Ken's oversight produce or utilize silica.

MR. KENNETH W. VORPAHL (General Manager, Safety and Health, Unimin Corporation): Thank you. I should have borrowed some of Dr. Muir's slides, because I think we have the same ideas.

Unimin has been in business for 29 years. We are an industrial minerals company. My area of responsibility includes the United States and Canada. Within those two countries we have 33 plants that mine and process quartz-containing materials, and where we have a silicosis prevention program.

My talk really describes Unimin's silicosis prevention program. It works for Unimin, and hopefully you will find some aspects useful to your operations.

As an introduction and a summary, preventing silicosis is theoretically rather simple: just control the amount of quartz-containing dust people inhale. Technically, there can be some real challenges. Again, you do not prevent silicosis by taking X-rays or even collecting dust samples. You prevent it by controlling quartz dust. X-ray and dust sampling, however, are very necessary ingredients in a silicosis prevention program, as they tell you how well you are controlling dust. I will discuss these in more detail later.

First, a little about our experience with silicosis. Unimin has not created a case of silicosis in its 29-year history. We have eight people with silicosis working at our plants, determined by X-ray evaluations. These people came to Unimin with silicosis through acquisition at plants at which they worked. These employees are closely monitored and they occupy positions with minimum risk to dust, usually control room type.

Unimin's silicosis prevention starts at the top, with the President of the Corporation and the Board of Directors. Their commitment is essential, and in fact they are committed to the prevention of silicosis. Unimin has a total of five board approved corporate business objectives. One of these addresses the reduction of dust, the sole purpose being prevention of silicosis.

The corporate objectives are continually evaluated. This objective is quite specific in terms of applicable job descriptions and maximum level of dust permitted, as determined by personal dust sampling.

Our corporate head of operations and his regional managers are also committed to prevention of silicosis. Each of their periodic meetings begins with safety and health, where dust issues are discussed. Also, individual plan managers' performance evaluation addresses safety and health, and dust control is an item of that evaluation. All of these actions and interactions stem from the corporate objective, and we do have top down commitment.

In addition, each year we have what we call a dust summit. Here, safety and health operations, engineers and technical support people meet and discuss dust issues. All dust sample results from each plant, each job, each operation, are presented and are evaluated against projected plant capital projects. Project priorities are adjusted based on these dust sample results, and often new projects are established on the results.

So far I have discussed management's commitment to the prevention of silicosis. Now I will talk about our actual program.

The program follows that of the National Industrial Sand Association, or NISA Occupational Health Program Document. NISA has also established basic tenets for a silicosis prevention program, to which Unimin subscribes and is committed to. The specific tenets a …-smoking company. I will discuss the other cited elements as they pertain to Unimin's program.

Medical surveillance: Our plant personnel have chest X-rays every two years. X-ray interpretation, read in accordance with ILO procedure by qualified persons, is currently the only standardized screening methods for determining the presence of silicosis in individuals.

Because there are numerous plant locations, Unimin utilizes a contracted mobile van service to obtain X-rays and conduct other medical surveillance, such as pulmonary function tests, audiograms, and so forth.

The quality of the X-ray picture is extremely important to the person who reads the film. Most small local clinics take X-rays for broken bones and other easily identifiable markings. They are not used to obtaining the uniform high quality films required for pneumoconiosis determination. We insisted on an X-ray provider that produced consistently uniform and high quality pictures.

Our films are read by a physician who is a NIOSH certified reader. Reader certification means that that person has demonstrated a high degree of proficiency in evaluating X-rays for dust disease, again using the ILO classification system for pneumoconiosis.

The reader used by Unimin basically reads X-rays for dust disease -- such as silicosis, asbestosis, black lung, as well as TB and related diseases -- on a full time basis. We therefore obtain high quality X-rays, to be read by an expert in the field of dust disease.

Having said that, again X-ray results in fact provide historical information concerning dust exposures. The dust exposures necessary for readable lung markings on an X-ray film take years to develop. That is why we also obtain dust samples representing what employees breathe and what is in the general workplace environment.

Breathing zone dust samples represent what an individual was breathing at the time that sample was obtained. Analytical results for filter samples are obtained within days of sampling. By maintaining breathing zone concentrations below regulated permissible exposure limits, we believe that we can prevent those lung markings that take years to develop and are eventually read on X-ray film. So, why take X-rays? Well, they do provide biological proof of what is happening in the lungs as a result of dust exposure.

We collect around 1,500 samples a year, with about two-thirds being personal or breathing zone and one-third being area samples. Trained Safety and Health supervisors collect the samples. The filter samples are analyzed by an accredited laboratory, using X-ray to fraction.

An annual sampling schedule is developed at the beginning of each year for each plant, and no two schedules are the same. They are based primarily on the type of activities occurring at the plant, and their sampling history. For example, we do not expect dust levels at a dredging operation, so only a few samples are taken there for documentation purposes, whereas there is a higher potential for dust exposure at a screening operation, we take more samples.

Area samples are collected at the same location, at each plant, each year. Their primary purpose is to document and provide trend data concerning overall dust in the facility over time -- in this case, years.

We also make extensive use of direct reading dust meters. These do not distinguish quartz from non-quartz materials, however they are great as detective devices. They are used to detect sources of dust and to evaluate dust levels during changes in process controls, where you have real time values.

Filter dust sample results are entered into our database electronically by the laboratory. If an elevated sample occurs and the plant cannot explain it, root cause analysis takes place and continues until the problem is identified and corrected.

All dust sample results are available to plants, our office, regional managers and other Unimin personnel via the Internet. A monthly Safety and Health Report is also published, and dust levels are listed. That report is distributed to all plants and operational managers.

Dust control: As I mentioned at the outset, preventing silicosis is theoretically simple, just control the amount of quartz-containing dust that people breathe.

Dust levels in most indoor plant environments can be reduced if you want to do it. Doing it depends on the culture of your organization. Also, the degree of dust reduction does become more difficult as levels are progressively reduced.

In terms of company culture, you may, for example, have a great idea for a local exhaust system at a material transfer point or a dust collector at a strategic location. However, if the upstream decision makers or the writer of the cheque is not interested in dust control, your idea is not going to be realized.

Commitment is essential. That is why I spent time at the beginning of this session talking about top down management commitment. Without it, your efforts to control dust will be difficult at best.

I now want to briefly discuss some general categories for dust control. For simplicity, I have designated two groups, engineering process control being one group, and work practices the other.

Ideally, an industrial minerals plant would be equipped with process equipment having no moving parts, no required maintenance, totally enclosed, abrasion proof, exhausted transport systems, and be a wet plant or at least one cleanable with water. We are not there yet, but some of these items are actually becoming a reality.

Some examples of engineering and process controls: Coarse materials are very abrasive, and wear in transport systems is a continuing problem. Metal ducts require frequent patching of holes and/or replacement. In addition to dust leaks, the process of repair and replacement increases the potential for employee dust exposure. So where feasible, Unimin utilizes low velocity transporter-containing systems.

The conventional rule of thumb for transport velocity for dust is 4,000 feet per minute. Dust will be moved at this velocity, and duct wear will be severe. We have installed systems at plants using velocity at 1,000 feet per minute or less. The duct configuration is a vertical zigzag pattern, with product falling to collection points, and only the fine is actually moving to dust or other collectors.

We retain more product wear and tear on the ducts and dust collectors. We do dust leaks, and the frequency of repair and reduce the potential for dust exposure.

In other areas we try to provide dust exhaust ventilation as close to the source of dust as feasible, using maximum enclosure.

Material transfer points: We try to minimize vertical drop; the shorter the fall distance, the less potential for dust coming into the environment.

We have enclosed transport systems and added water truss in the conveyor systems. We try to provide easy access to routine maintenance sites on process equipment to actually lessen the potential for dust exposure due to climbing in, under and around equipment.

For water sensitive processes having multi floor structures, we try to have solid floors to facilitate wet clean-up. With expanded metal floors, water entered at the top goes to the bottom and wets everything in-between. In water sensitive areas with open floors, we have used hard piped central vacuum systems for clean-up.

In another area, the use of cartridge type dust collectors lessens the exposure for dust when compared to replacing bags in the bag house system. Also, control rooms or other safe havens are widely used to provide a dust free work environment.

We are continually adding automatic and remote sampling samplers in otherwise automatic processes, all of which reduce the time an employee has to spend outside of a controlled environment.

In another area, and this is a simple one, environmental or yard dust can become plant dust due to the open nature of process buildings. To reduce this source of dust, we restrict truck traffic on our property and provide either pavement (inaudible) dust suppress services for their movement, and areas surrounding buildings are planted to reduce wind blown dust.

These are just some examples of engineering and process control. Again, the object is to reduce the potential for dust exposure.

Work practices: The use of good work practices can dramatically lessen exposure to dust. This is an area where employee involvement becomes very important. Employees have to buy into the concept of dust control and understand how they are a major part of the control process. Education, training, reinforcement of training and quality supervision are key elements in this process.

Implementing good work practices is not necessarily an easy task. Old habits are hard to break. It is the old story of "I've done it this way for years". The list of good work practices is very long, and I will just mention a few primarily by category: Maintaining distance from the source of dust in the person's nose, that is a category. Just distancing one's self from the source of dust can be significant in terms of exposure.

For example, use long handle brushes to clean screens as opposed to brushes with short handles. Add a long handle to a sampling container so that instead of, for example, kneeling on the floor to obtain a sample, the equipment should conform to the size of the collecting container. For example, if the container is the size of a cup, it should not be necessary to open a two foot square panel to collect the sample. The larger the opening, the more potential for dust exposure.

Provide a clean work area is another category. For example, cleaning the work area prior to performing maintenance. In water sensitive areas, we use HEPA vacuums. In general, the work area should be cleaned on a routine basis, not after major accumulations of material. (Inaudible) sweeping. Of prime importance concerning the accumulation of material is why is it there?

Address the source of the leak. Perpetual cleaning does not eliminate the cause of accumulated material. Also, regularly clean warehouse floors to reduce dust re-entering the air by just forklift traffic.

Handling material is another category. How material is handled directly affects potential for dust exposure. Again, for example, if a bag of material fill to the floor and broke open and you picked it up in a bear hug position, you are almost guaranteed of a dust exposure just by the proximity of the material to your nose. Also during bagging operations don't throw the bags in the pelt, place them there. The impact from throwing does generate measurable dust. We have documented that.

I only mentioned the use of respirators in passing. If they are used correctly, they will provide protection in accordance with their stated protection factors. Respirators are only as good as they are maintained and used.

So, work practices like engineering and process controls require commitment on the part of management and all employees. If you establish work practices as work procedures, do employees understand what they are and why? Do you enforce them, and will your management assist in enforcement? Are they committed to these as well as the other methods to control dust?

In summary, I have discussed Unimin's program to prevent silicosis. I discussed various methods to control dust and exposure to dust, and the fact that top down management commitment is required.

Dust control is not an overnight process. It takes thought, time, and often money. We continually work at improving our facilities, but you have to start someplace. The bottom line is that silicosis is preventable. Thank you.

MR. MACKEN: Are there any questions for Mr. Vorpahl?

Question Period - Période de questions - Período de Preguntas

NEW SPEAKER: My experience with dust sampling is that dust tends to be really non uniform, so actually measuring the actual exposure to the workers can really be pretty tricky. Do you have any comments on that?

MR. VORPAHL: You are absolutely right. We have trouble, for example, keeping the sampler in the person's breathing zone. If a worker goes to work and wears a T-shirt and you strap it to his collar, by the time he is hot and sweaty, what used to be by his breathing zone ends up in his belly button and you are sampling down there, which is not really what we are interested in.

We have problems concerning people taking their samplers off while they have a break and so forth, throwing them on the floor, and we get elevated readings just because of the fact that it is now at a different place, and collecting dust does not represent what he is breathing.

When we get good samples, and every time a sample is obtained on a person for a normal work day we require that an activity log is prepared. By hour, that individual is to describe exactly what he or she was doing during that sampling period. So at least when we have excessive exposure, we have a clue as to where to go and try and find out what it was about.

Our claim to fame is that we have enough samples enough and over a long period of time that even by individual people, we can pretty well figure out what they are doing.

MR. MACKEN: Any additional questions?

M. GÉRARD LACHANCE (Responsable santé, sécurité et environnement, Syndicat des Métallos, District 5, Montréal): Je voudrais poser la question à M. Vorpahl: Est-ce que vos échantillons sont en continu sur le travailleur lorsque vous faites les inspections, ou s'ils sont par période? Est-ce que l'échantillonnage se fait en continu ou par période?

MR. VORPAHL: When a sampler is put on an individual, it is for his work shift, whatever time that might be. It starts at the beginning of the shift and concludes at the end of the shift.

Our sampling schedule for each plant goes not so much by person but by job category, then we rotate that. So at the end of the year, hopefully we have sampled every person in that job category. But all samples cover an entire work shift.

M. LACHANCE: C'est par période. Merci.

MR. VORPAHL: Right. It is total work shift.

MR. MACKEN: I would like to thank Ing. Manuel Landa, Dr. Muir and Mr. Vorpahl. If there are any other questions, I think we still have a few minutes before lunch. If you would come to the front, perhaps you could address your questions to them directly.

I noticed, in listening, that there may be some differences in terminology. Perhaps there are areas that we could clarify. Possibly the studies that were done in Manuel Landa's group may be closer to what we would call a health hazard evaluation than an actual enforcement or a pure research study. So possibly some dialogue in this area might be beneficial to all parties. Thank you.

Concurrent Session - Ergonomics / Human Factors / Musculoskeletal Injuries - Séance simultanée - Ergonomie / Facteurs humains / Blessures musculosquelettiques - Sesión Simultánea - La Ergonomía / Factores Humanos / Lesiones Musculoesqueléticas

MR. BERNIE DECK (A/Provincial Coordinator, Mining, Ontario Ministry of Labour): Good morning, ladies and gentlemen. I would like to welcome you to the session on Ergonomics, Human Factors and Musculoskeletal Injuries. My name is Bernie Deck. I am with the Ontario Ministry of Labour, and I will be your chairman for this session.

The area of musculoskeletal injuries is a very large area to the industry. Work has been done in this area, but much work remains to be done. We have three very interesting speakers this morning. I am sure you will find their presentations informative. You will have the opportunity to ask questions after each presentation.

Our first speaker is Dr. Larry Grayson. Larry is the Associate Director of Mining at the National Institute for Occupational Safety and Health. Larry received a B.A. in mathematics in 1974 from California University of Pennsylvania. Early in his career, he worked in all manner of jobs underground and has had in excess of 25 years experience. He worked his way up from laborer, right to mine superintendent. He is a certified mine examiner and mine foreman in Pennsylvania, and is a registered professional engineer in Missouri and Pennsylvania.

He received a Ph.D. in mining engineering from West Virginia University in 1986, and was with that faculty until 1996. He then joined the faculty of the University of Missouri-Rolla and was there between 1996 and 1997. He has published in excess of 114 technical papers, and papers dealing with health, respirable dust, mine management, and computer applications in mining.

Please welcome Dr. Larry Grayson.

DR. LARRY GRAYSON (Associate Director, Mining, National Institute for Occupational Safety and Health): Thank you very much, Mr. Chairman. It is a very great pleasure to be here.

I will talk about ergonomics and human factors and musculoskeletal injuries and give the guidelines for sort of identifying and assessing the level of potential problems in mine operations. I will sort of focus on my institute, the National Institute for Occupational Safety and Health, as a primer that outlines all of what I am about to talk about, and I will give you the address for that at the end of the presentation, and along with the web site where you could indeed order it or download.

I will focus on ergonomics at work. I am going to bring my own personal mining experience to the presentation as well, having tried to do a few tasks, sometimes unsuccessfully. I will sort of get into that, but I will focus mostly on mining.

Let's talk a little bit about the points I will be covering. First of all, defining what musculoskeletal injuries are. I will get into recognizing cumulative and acute trauma resulting from work activity, I will talk about elements of an effective ergonomics program, I will talk about ergonomic successes in mining. We do have a few already that have been achieved primarily over the last 10-15 years.

With respect to defining musculoskeletal injuries, first of all, they are disorders of muscles, nerves, tendons, ligaments, joints, cartilage, spinal disks, etc. in a human body. What you can see is that the disorders are typically not the result of an instantaneous or an acute event but rather, they are more likely a general, gradual or chronic development over time. Sometimes there are exceptions, like low-back pain.

I will also say that they range in severity. Sometimes they do not seem to be too severe, they are mild but chronic, and they are intermittent at times. They can also, however, be debilitating in the workplace for the worker, as well as chronic.

A disorder may have several distinct features that define it or may be defined primarily by the location of pain, and this can be a clinical determination as well. Some of the common ones that you are familiar with, of course, are carpal tunnel syndrome, low-back pain, especially in mining, tendinitis, bursitis, neck disorders, and other joint-type disorders.

Some of the activities in mining which are really prone to musculoskeletal disorders are handling supply materials especially in awkward positions, in large loads, reaching overhead or extending yourself -- maintenance and construction work is replete with these kinds of injuries -- using jack-legged drills or hand tools with a lot of vibration, in particular, roof (inaudible) task. Very repetitive kinds of tasks are prone to MSDs.

Work in mud or slippery surfaces, when you are trying to handle materials in particular; dragging and lifting cables, sort of taking those cables overhead especially can be very distressing; and finally, production support activities of various types.

Now, why are MSDs or musculoskeletal disorders a problem? They cost us money, number one, and there is pain and suffering on the individual's part. So among the most prevalent lost time injuries are these and illnesses in most industries, not just in mining. They are also among the most costly occupational problems, especially when you get into Workers' Compensation and temporary disabilities.

They cause workers much pain and suffering, quite frankly. I am sure that some of you have been like me, at some point in time in your mining career, you have gone through some of this for a while, at least until it went away, maybe a month or two later. It decreases productivity, and also the quality of the work.

Now, what is ergonomics? Good question. It is the science of fitting the workplace conditions and the demands of the job to the capabilities of the working population -- in our case, miners. That is really what we are trying to do: Make it work.

We are assessing the work related factors that may pose a risk of musculoskeletal injury, or disorder, and we make recommendations from these observations and studies that are on-going -- sometimes measurements of forces or things like that on the individual -- to eliminate or reduce these injuries.

The benefits of the program are quite big actually, and its effective and successful interventions enhance productivity, they reduce your cost, increase the workers' satisfaction at the same time, and it reduces the injuries and illnesses themselves.

In injury prevention, there is a general research philosophy that most of us use and we do look at the whole system, the person working in the entire system, the whole demand, if you will, on the person in that system.

We look at failures. Failures basically end up giving us losses that we do not want, whether it is a personal loss or whether it is an organizational loss. So, we want to remove the failures that give those losses, you know, the general approach to loss control.

We also at the same time know that it is a host of factors -- physical factors and conditions in which people are working -- organizational factors -- the way you design work, the way people work on those particular tasks in the job -- work practices, and other human factors that are involved. What we want to do is get the prevention side of things, and that is through effective interventions. So it needs to be studied.

Recognizing work-related musculoskeletal disorders, there are some things that you can do. This primer that I mentioned earlier and that I will show you later on, spells all this out quite well. The Mine Safety and Health Administration, MSHA, that you are all familiar with now has accident records, and usually they do need some interpretation.

There are some narratives that are contained in those that are very helpful in interpreting what the injury really was. Workers Compensation claims, they are written out; Company Accident Records, they do a good job of investigating the accidents as well, and they have a separate accident report. And then, finally, Medical Diagnosis in treatments of the individuals who go to the clinics.

Also there is Worker Complaints. We can listen to these as well, of undue strain, localized fatigue or discomfort, or pain, that just does not go away, like overnight of maybe in over a week, and especially for certain jobs and certain conditions, that we can pinpoint those jobs and conditions that need the observations.

Worker visits to a clinic with frequent references to physical aches and pains. That is the reason they are going, for instance. There is some documented information there. Identifying job tasks that require activities with repetitive forceful exertions by the individual, and then taking a look at those tasks.

Identifying job tasks that require frequent heavy or overhead lifting of various types. Identifying tasks that require awkward work positions -- sometimes it can be a light load and because of the work position, and the extension to put it somewhere else, it can involve a disorder. Identifying tasks that involve vibrating equipment or tools. So we can easily do that.

Finally, reading about MSDs, and this is the Health and Safety Professionals at the operation and/or safety organizations, like ours. You can read about those and see the connectivity, if you will, to certain jobs and tasks. They will appear in trade publications, insurance communications, popular literature of various types.

Learning about MSD cases that were found among other businesses or other nearby operations, and they want to get a hold on their problem and that gives us an impetus to look at it in our operation as well. Anticipating the potential for MSDs when we start looking at increasing worker productivity or modifying work procedures, or practices.

Now that we have identified these, let's talk a little bit about elements of an effective ergonomics program. First of all, it is identifying or looking for the signs that you indeed have a problem, and we have covered that already.

Next, in order to have an effective program, of course you have to set up the environment so that indeed it will happen well for effectiveness. So, make an ergonomics program basically part of the company's Safety and Health Program. Obviously that requires a commitment that you want to solve the problem. Demonstrate that management commitment and then, the best way it works is to have worker involvement all along the way, because they know what they are doing, they have a better idea of exactly what the problems are and how they might be able to address them.

Who should participate? We kind of leave this all inclusive because really it is a safety and industrial hygiene person at the sites; workers and management need to work together for it to be most effective; healthcare providers would have to be involved at some point in time -- sometimes nurses may come in to Operations and even give presentations during training sessions: Human resource personnel; engineering personnel, because there may be engineering answers besides administrative answers; maintenance personnel, because of the nature and complication of all the tasks and parts that need to be carried and things of this nature; and finally, ergonomics specialists would be very important.

There are different ways of gaining participation among all these parties. Of course the joint Labour-Management Committee approach is a very effective one, where you indeed take advantage of good relationships that have been set up, and focus on problems through that committee -- maybe sub-committees of that committee; the work group approach -- sort of brainstorming among workers and possibly supervision enters first with them and of course, the professionals; and then finally an individual input approach can also work, where you identify the problems and then go after those problems based upon the input you have.

The third element for an effective program is building in-house expertise with training if indeed you are going to do it in-house. Sometimes contractors may be used to come in and help with the problem. There are a lot of consultants out there that can help out.

Ergonomics awareness, building that awareness among the workforce, that again reinforces the commitment side effects. A job analysis and what control majors may be able to be used effectively to stem the problem. Problem-solving techniques. Besides the brain-storming, there are certain perspectives that are needed on what we may be able to do. We brainstorm the ideas and then implement techniques to take care of those problems.

Target different groups with specific materials, because not everybody will be doing the same function, so a little bit different orientation for those who will be handling different aspects of the overall program.

Finally, materials are available. NIOSH has some of that, I am sure that MSHA has some of that, and your agencies in your own countries will have some very useful materials to help.

The next element would be gathering and examining evidence. We talked about some ways about that earlier, but medical and health indicators, worker report follow-ups, reviewing MSHA and company records, that we mentioned earlier, conducting symptom surveys of the employees, periodic medical exams possibly to take care of that more systematically than the worker showing up to the doctor.

Identifying risk factors so that there are checklists that can be used. I think that in the presentation right after mine, Jean Paul will be talking about some specific risk factors in Mexico. But screening jobs for these risk factors and then performing job analyses in detail through observation and pinpointing them.

Evaluating and prioritizing finally, once you have all these risks factors -- you cannot focus on everything all at one time so you do some sort of prioritization and go after certain risk factors first.

The next one is developing and implementing controls of what seems to be the best controls. So engineering versus administrative control options are there, possibly some personal protective equipment or some devices that may be able to be used -- some glove protection, something like that. Evaluating the effectiveness is also an important part of this, no matter which type of intervention it is.

The next one is setting up a healthcare management program. There, we are talking about job familiarity, job placement, evaluations of people, early reporting. So access for the workers to an effective healthcare provider and then finally treatment as the disorders do show up, and quicker rather than later.

Basically, pro-active approaches work best. So prevention orientation is sort of given as the philosophy of the way we are going to approach the program; establishing employer/ employee responsibilities and the commitment, again part of that being pro-active; planning and designing would include ergonomic considerations from again the system's perspective so that the whole chain if you will, of handling the supplies and materials from outside all the way - if it is an underground thing, all the way to the use site. Considering modifications of work practices, procedures to reflect worker capabilities and the limitations of the workers under those situations.

Some successes in mining that we have seen over the years have been redesigning on packaging of supplies and materials, palletizing if you will some of them so that they are not as bad a load, if you will, on the workers; handling devices on equipment, little cranes on certain utility vehicles, things of this nature, even something simple like a small utility vehicle that can be used; new seat designs.

Some of the research has gone and interacted back and forth, different type of seat cushions and things of this nature to protect the spine better; redesign a roof bulling machine so that bending bolts and handling the bolts in the steel and stuff like this, if it is underground-type setting; very repetitive types of tasks that can be helped sometimes by some redesigning, maybe the controls themselves, being able to differentiate between the controls better and not hit the wrong lever at the wrong time while you are extended doing your work, for instance.

Numerous company efforts. There has been some very, very good pro-active ergonomics programs in a number of companies in the United States, and I am sure it is the same in Canada and Mexico.

In short, what I have done is just sort of outline as a lead-in to Jean Paul's presentation next, and you will get a little more specifics I believe, and then later on Tammy will get even more specific on a particular study, but I sort of summarized in a general way the guidelines. Define musculoskeletal injuries. I have talked about how to recognize MSDs resulting from work activities and tasks in mining, I have talked about the elements of effective ergonomics programs and finally, ergonomics successes in mining.

I brought a publication with me, if you are interested in looking at it. It sets out all of these things that I had to say, and we can get it to you if you want one. So just give me a card or something like that and we will be happy to get you one.

Question Period - Période de questions - Período de Preguntas

MR. DECK: We have time for some questions. ¿Hay algunas preguntas?

NEW SPEAKER: I have a question, and perhaps you could comment on what you see as the challenges in this area -- in the area of musculoskeletal disorders, as the technology is changing in the workplace.

Why I ask that is, one of our summer students came in, I believe it was last year after a weekend and he had his hand wrapped in a tenser bandage, and I asked him what happened. He said, "I spent the weekend playing a video game, my hand is screwed up". Is this what we are in for now?

DR. GRAYSON: As technology has been changing, we certainly have been seeing some different types of disorders like that. For instance, with a remote control device and having to manipulate that device for an entire shift, that kind of strains and things like that, manipulative kinds of strains, it is not uncommon.

As technology changes and we get into more and more intense cognitive demands on people looking after conditions, looking after the instruments that they need to use with the new technology, and at the same time maybe interrupting from time to time to do non-routine tasks, all of these demands are still going to be there, and if anything, the conditions are going to get worse.

The physical conditions under which the workers are working. In the United States in particular, the number of work hours have been increasing quite a bit and the number of consecutive days they are working. If you couple that with all these other demands of technology and the fatigue factor and the interactions of the materials and supplies you are handling or the regular task or the non-routine task with that extra demand of time, it is all going to certainly accumulate and probably cause more distress in the future. That is my perspective anyway.

MR. DECK: Thank you. Thank you for an interesting presentation.

Our next speaker, as Dr. Grayson mentioned, is Jean Paul Becker. Jean Paul is a professional engineer. He is President of the Board of Certified Professionals in Risk Management. He is also a member of the Board of the Mexican Association for Safety and Health. He is founder and director of the consulting firm Certificados en Administración de Riesgos, A.C., which provides services related to workplace safety and health in ergonomics.

Mr. Becker is also a technical advisor for Quest Technologies in Latin America. He holds a bachelor degree in Industrial Engineering from the Universidad Autónoma Metropolitana.

Jean Paul resides in Mexico City and is going to talk to us today about ergonomics in the Mexican mining industry.

MR. JEAN PAUL BECKER MEYER (Presidente del Consejo Mexicano de Profesionales): Buenos días, Good morning. Bonjour.

Es un placer para mí estar aquí este día para platicarles qué es lo que se está haciendo en ergonomía en la industria mexicana y en la industria minera.

Principalmente vamos a dividir la plática en tres secciones, la primera son antecedentes legales, qué es lo que tenemos dentro de nuestro marco legal que nos hable de ergonomía, dónde podemos atacar este punto es una base, es un principio de referencia para los patrones y para los profesionales que se pueden dedicar a esta materia.

En segundo lugar, hablaremos del área de oportunidad que tiene la ergonomía dentro de la industria minera y específicamente dentro de lo que es las zonas de explotación ya sea a cielo abierto o subterráneo principalmente.

En tercer lugar, un pequeño programa de ergonomía.

El reglamento federal de Seguridad e Higiene y Medio Ambiente de Trabajo, que fue publicado recientemente el año pasado, incluye dentro de sus referencias un capítulo exclusivo a la ergonomía que nos dice: que las empresas deberán de tener o desarrollar un programa de ergonomía donde se tenga la existencia de factores de riesgo.

Si hacemos referencia a esto que nosotros tenemos en el reglamento vemos que viene buscando tener un estandard desde hace tres o cuatro años y a lo que van ahora en el proyecto estandard, es justamente el establecimiento de este programa con ciertos principios.

Dentro de la normativa específica de la industria minera que es la norma 121, tenemos ciertas tareas que se están especificando, por ejemplo, los requerimientos, requerimientos que toda una unidad minera de explotación o beneficio que cuente con 25 o más trabajadores deberán de incluir estudios técnicos en los cuales se analicen los tipos y grados de riesgo, que sea aprobado por el Director de la mina, que se establezca un plan de seguridad e higiene y procedimientos generales específicos.

¿Qué son estos tipos y grados de riesgo en ergonomía? En ergonomía son los factores de riesgo que nos llevan a las lesiones musculoesqueléticas, también hay requerimientos en cuanto a lo que es el personal de seguridad.

El personal de seguridad debe de colaborar con el responsable de seguridad de la mina y estar capacitado para realizar actividades entre las cuales vigilar que todos los trabajadores cumplan con las medidas de seguridad y que lleven controles de los riesgos de mayor impacto.

Volvemos a hablar de factores de riesgo, requerimientos en los cuales se deban de establecer sistemas de capacitación o medios de capacitación a los trabajadores, ¿enfocados hacia qué principalmente? La norma los especifica como sistemas de transporte de materiales, manejo de materiales, donde podemos tener uno de los mayores problemas en cuanto a lesiones musculoesqueléticas que no se definen, que son las lesiones en la espalda baja o algún otro tipo de situación.

También hablamos dentro de esta misma norma de lo que son las medidas y servicios de higiene, recientemente en la mañana teníamos una conferencia en la cual se estaba presentando los programas de salud e higiene desde el punto de vista de enfoque médico y aquí otra vez, estamos estableciendo que la frecuencia del tipo de los exámenes médicos periódicos se establece en base al tipo de riesgo al que están expuestos los trabajadores.

Si se dan cuenta cada uno de estos párrafos contenidos dentro de la norma, nos habla de los factores de riesgo.

Los exámenes médicos dependerán de los niveles de exposición a los riesgos y de las características de los agentes de riesgo, factores de riesgo otra vez.

¿Cuáles son las enfermedades que pueden estar clasificadas? Y esto ya me estoy pasando a lo que es la Ley Federal del Trabajo, el documento que rige todas las actividades laborales en nuestro país.

Tenemos dentro de este documento dos artículos importantes, uno que describe lo que son las enfermedades de trabajo, las cuales podemos encontrar dentro de ese listado, son aproximadamente 400 enfermedades las que están registradas, dentro de ello vemos algunas que son enfermedades de trabajo que están íntimamente relacionadas con lo que son lesiones musculoesqueléticas o enfermedades de trabajo derivadas por exposición a factores de riesgo ergonómico, tenemos bursitis, egromas, tenemos osteoartritis, trastornos angioneuróticos que esto lo podríamos definir como entre alguno de ellos la enfermedad de Querbán (sp), vibraciones, en enfermedades, deformaciones.

Tenemos enfermedades endógenas que una de ellas es específica por la cuestión de fatiga, como es el nixtagma (sp) de los mineros, que es un problema de fatiga ocular.

El siguiente artículo nos habla acerca de la tasación o valuación de las incapacidades permanentes, a cuánto debe ascender en un momento dado la indemnización al trabajador por sufrir un tipo de enfermedad, está dividido en miembro superior, miembro inferior, cabeza, torax, abdomen, aparato genitourinario, columna vertebral y clasificaciones diversas.

¿Dónde entramos en la cuestión de ergonomía principalmente? Miembro superior, miembro inferior, abdomen y columna vertebral.

Veamos cada uno de ellos: miembro superior está una enfermedad tipificada como parálisis del nervio mediano en la muñeca y se tasa dentro de un 15 a 25%, ¿qué puede ser esto? Un síndrome del túnel carpal.

Cuando hablamos del 15 al 25% equivale aproximadamente a lo que sería la cuarta parte, lo que se paga al trabajador, la cuarta parte de su salario diario durante tres años, eso es lo que se le pagaría al trabajador lesionado, pero lo que se le cobraría al patrón, viene a ser el equivalente aproximadamente de la cuarta parte de 28 años, entonces el impacto económico es bastante importante.

Seguimos adelante, miembro inferior parálisis del nervio ciático, mayor popitlo externo, popitlo interno de 20 a 40%. Esto podríamos referirlo como un dolor en la espalda baja y esto equivale a 40% lo que viene a ser casi la mitad, casi el equivalente a 14 años.

Hernias inguinales, crual o epigástrica, aquí la cuestión importante es, que es inoperable, ayer comentábamos y me decían: bueno, esto puede derivarse de un accidente de trabajo, de un movimiento instantáneo, etc., pero tenemos que considerar que puede no ser así y está contemplado.

Secuelas en la columna vertebral, secuelas de traumatismo sin lesión medular y esto son golpes, pero que padece de reacciones persistentes de la cabeza o del tronco con acentuado entorpecimiento de los movimientos y aquí manejamos el equivalente de lo que se llama una lordosis y en la parte de abajo lo que es la sifosis o una escoliosis son las desviaciones que puede tener la columna vertebral, a través del tiempo.

Secuelas de traumatismo en la columna con lesión medular y esto ya es parapecia en los miembros inferiores, cuando la marcha está entorpecida o cuando la marcha es imposible o cuando es posible con la ayuda de muletas, de 70 a 90% y de 50 a 70%, o sea tenemos tasadas este tipo de enfermedades que podríamos relacionarlas como lesiones musculoesqueléticas, entre una lista de aproximadamente 700 valores para la indemnización, valuación de incapacidades permanentes.

La cuestión es, ¿existe esto en el marco legal? ¿Cómo podemos evitar este tipo de situaciones? Y aquí es donde entramos a algo muy importante que es la ergonomía hoy en día, una área de oportunidad para poder desarrollar y mejorar nuestros sistemas laborales en cualquier tipo de industria, no solamente en la industria minera.

Aquí quise enfocar este ejemplo única y exclusivamente en lo que son los métodos de explotación, estamos hablando de lo que es el método de explotación superficial a cielo abierto que tiene una serie de tareas pero principalmente donde vemos o sea en que la parte importante es la perforación, voladora, carga y transporte o enfocarlo hacia lo que es el método de explotación subterráneo donde se hacen trabajos para llegar hasta el mineral a través de galerías, chimeneas, rampas, pozos y trabajos de preparación para extraer este mineral.

Las tareas principales que tenemos en este tipo de situación es similar a la de cielo abierto con la excepción de perforación voladora, aquí no hay carga, aquí hay acarreo y transporte.

Analizando este tipo de situación pasamos primero a la explotación superficial, ¿qué tenemos como factores de riesgo? Todo está en función de qué tan mecanizada o manual sea el tipo de trabajo, hay algunas minas donde todavía se están haciendo trabajos a mano y en otras donde ya se está llegando a la sofisticación de la automatización, pero esto no me exime de los factores de riesgo, lo único que va a hacer es que va cambiar el tipo de factor de riesgo.

Donde hay trabajo manual tenemos factores de riesgo que son los típicos ergonómicos que se conocen como repetición, fuerza, postura, pero vamos sofisticando y haciendo cada vez más automatizado el proceso y vamos a tener otro tipo de factor de riesgo que es exposición a agentes físicos, no estoy hablando de enfermedades de trabajo, per se, la cuestión es que estos agentes físicos, ¿qué pueden causar? Carga mental, tensión mental, la gente va fatigándose y nos va causando un riesgo que muchas veces no contemplamos, la fatiga del trabajador.

Si queremos que siga siendo eficiente trabajando igual durante 8 horas, pues realmente es difícil, por ejemplo en factores de ruido, se dice que no se debe exponer a un trabajador a 85 decibeles por más de 8 horas, por el riesgo de pérdida de la capacidad de la audición.

Hablando ergómicamente, decimos que a partir de 70 decibeles el incremento en la fatiga del trabajador aumenta y ese es el concepto que debemos tomar cuando hablamos de factores de riesgo.

Cada uno de estos está dividido, por ejemplo tenemos perforación a cielo abierto, obviamente de todos los factores de riesgo que es repetición, fuerza, postura, contactos tensionantes, directos, desapoyo contra superficies, iluminación, condiciones climáticas como es: temperatura, humedad, ventilación, etc., vibraciones, ya que sean de cuerpo entero o en extremidades superiores, ruido y finalmente lo que es la demanda metabólica que está incrementando los riesgos a nivel muscular.

Obviamente a cielo abierto no vamos a tener problemas de iluminación, a menos que queramos trabajar en el norte, cerca del polo norte durante seis meses no va a haber sol, pero en esencia no tenemos problemas de iluminación, el riesgo más grande de todo esto es en perforación donde puede haber mucho trabajo tanto manual como mecanizado.

En el proceso de voladora pues pueden ser las posturas que se adopten en un momento dado y cuando se hace la detonación, las condiciones climáticas definitivamente, y el ruido.

En carga tenemos riesgos específicos de fuerza y postura, las condiciones climáticas van a estar afectándonos mucho por ejemplo hay una norma que habla acerca de los niveles naturales de temperatura a los que debe uno estar expuesto y normalmente en nuestro país, donde se encuentran las minas pues es seco y muy caluroso. Cuando hablamos de temperaturas, estamos hablando de temperaturas de 40 a 50 grados centígrados y automáticamente se sale de los estandares establecidos o de los parámetros establecidos en la norma.

Existen otros lugares en donde se hace, donde se procesa el material donde nos encontramos a temperaturas de 40 grados centígrados pero con el 80% de humedad y esos son extremos en los cuales no podemos utilizar los estandares o los parámetros establecidos en estas normas, automáticamente se está fuera y es adonde debemos considerar lo que es la demanda metabólica del trabajador porque la gente se habitúa y la gente que vive en ese lugar, probablemente no tenga problemas con los cambios de temperatura y esas afectaciones.

Por el otro lado, tenemos la explotación subterránea y entonces aquí la iluminación sí se considera un factor importante en todos los efectos, la visualización, el hecho de poder ver lo que estamos haciendo.

Obviamente en perforación viene siendo la situación más crítica, no quiere decir que una persona que está trabajando con una perforadora mecanizada tenga riesgos de repetición o fuerza, no, lo hace la máquina, pero volvemos a que puede tener exposición a condiciones climáticas, a ruido definitivamente, vibraciones si está sentado sobre la máquina, pueden ser vibraciones de cuerpo entero, o si lo está manejando con la mano, son vibraciones en extremidades superiores, y ahí es donde entramos a qué se debe de hacer, cómo debemos de prevenir estos factores de riesgo.

Estos factores de riesgo los podemos esquematizar en un programa muy simple, lo acabamos de ver, cuál es el mensaje que nos traen ellos, en el sentido de que tenemos que integrar un programa de ergonomía en el cual se contemplen estas situaciones, pero más simple para nosotros.

El programa de ergonomía debe incluir el análisis del lugar de trabajo y el análisis del lugar de trabajo para nosotros en México esto es cumplimiento de un mandato legal, es analizar y determinar cuáles son los factores de riesgo a los cuales estamos exponiendo a los trabajadores para poder prevenir la lesión.

No vamos a hacer una corrección, más bien estamos en la fase de prevención, estos análisis de factores de riesgo pueden ser hechos de acuerdo con los factores de los análisis manejados en ergonomía comúnmente o análisis de seguridad en el trabajo incluyendo factores ergonómicos, cosas que ya manejamos en el pasado y lo único que tenemos que hacer es entender cuáles son los factores de riesgo ergonómico e incluirlos en el proceso y determinar las soluciones para prevenir este tipo de factor.

Una vez que determinamos cuáles son los factores de riesgo, debemos incluir lo que son los controles de los factores de riesgo. Algunas veces, tenemos efectos de repetición y fuerza, metemos una máquina, solucionamos el problema y ya no trabaja el hombre, trabaja la máquina, pero por el otro lado creamos otro tipo de factor de riesgo, las soluciones tienen que ser integrales, tienen que ser globales. Hay veces que tratamos de solucionar un problema de ventilación, ponemos unas campanas muy bonitas, con motor, todo el sistema bien calculado, pero la sujeción de todo se hace directamente al techo, un motor colgando, y en qué transformamos, resolvimos nuestro problema de ventilación, pero creamos un problema de ruido.

Tenemos que considerar ese tipo de sistemas, quitamos fuerza de repetición, pero podemos entrar a factores que van a causar una tensión mental en el trabajador y esto fatiga, menor productividad y costo para la empresa.

Después o al mismo tiempo mejor dicho, debemos de llevar a cabo lo que es la vigilancia de la salud y administración del servicio médico, definitivamente, los ergónomos pensamos, estamos convencidos y creemos de que esto es una tarea multidisciplinaria en la cual debemos de trabajar todos juntos. Ayer nuestra amiga que subió y bajó 8 veces del Everest antes de llegar a la cima, hablaba mucho de lo que era el compromiso del trabajo en equipo, pero si los ingenieros nos dedicamos a una tarea, los médicos se dedican a otra tarea, los administradores a otra tarea y ninguno de nosotros nos ponemos a trabajar en conjunto, no vamos a lograr el objetivo principal que es la prevención del riesgo y del daño a la salud de los trabajadores. Esto hablando en seguridad e higiene, hablando globalmente, es en la mejora de la situación económica tanto de la empresa como del país en general.

Para lograr todo esto, obviamente tendremos que tener unos programas de capacitación y adiestramiento pro-activos, continuos, y no nada más el sistema de manejo de materiales, sino en qué son los factores de riesgo, qué son las lesiones musculoesqueléticas, cómo se previenen éstos, cómo pueden trabajar las personas o los trabajadores dentro de los sistemas de mejora continua y entramos a sistemas de calidad entonces.

Definitivamente la capacitación y adiestramiento debe de incluir algo que muchas veces aunque está establecido tanto en las leyes de México, Estados Unidos y supongo que también en Canadá, que es el derecho a saber, "a right to know", muchas veces no les decimos qué es lo que está sucediendo y ahí es donde debemos atacar esto.

Definitivamente, considero que la ergonomía es un área de oportunidad muy grande, no nada más para la industria minera, sino para todo tipo de actividades en nuestra vida diaria. Muchas gracias.

Question Period - Période de questions - Período de Preguntas

MR. DECK: Are there any questions for Jean Paul?

Jean Paul, you spoke of this requiring a multi-disciplinary effort.

MR. BECKER MEYER: Yes.

MR. DECK: How can we or the industry or the regulatory bodies make that happen?

MR. BECKER MEYER: Okay.

Primero estamos estableciendo una serie de parámetros dentro de las normas y estándares que se escriben. Esto no está bajo una sola persona, o de una sola actividad o un solo grupo. Yo creo que debemos de trabajar dentro de estas actividades todos los involucrados, porque eso es lo que nos va a decir cómo hacer las cosas. Después tratar de establecer dentro de las industrias una formación de la cultura de ergonomía, esta formación de la cultura de ergonomía inicialmente es involucrando a la gente, capacitando, dando cursos, pláticas, mostrando mejoras, pero involucrando a todo el mundo.

Podemos dar una plática de prevención de lesiones musculoesqueléticas y quien debe intervenir es el médico de la empresa diciendo qué es la lesión musculoesquelética, el de seguridad o el responsable, el ergónomo describiendo cuáles son los factores de riesgo, el de ingeniería explicando cómo son las instalaciones, cómo se hicieron, el de mantenimiento involucrándose dentro de lo que es cómo cuidar el equipo y de esta manera estamos hablando de un involucramiento de todo el mundo.

Llegar a la formación de una cultura de ergonomía en una industria no es fácil, y no se hace de la noche a la mañana. Aproximadamente se requieren cuatro o cinco años para lograrlo, entonces ¿qué se necesita? Algo que todos los que estamos en seguridad conocemos muy bien, alguna vez lo dijo Frank Bird, se llama "commitment", y ¿qué es "commitment"? Es compromiso, debemos estar metidos en esto y creer en ello para poder trabajar juntos.

Does that answer your question?

MR. DECK: Thank you very much.

Our third speaker is Tammy Eger. Tammy is an ergonomist with the Mines and Aggregates Safety and Health Association, (MASHA), and an adjunct professor with Laurentian University in Sudbury, Ontario. Tammy's responsibilities with MASHA include conducting audits and identifying problems, and providing services to the mining industry.

As a professor, she teaches classes in human kinetics and oversees 4th year kinesiology students completing their ergonomic internships.

Tammy was born in Manitoba, received her Bachelor's of Science degree at Queen's University in Kingston in Biology, a Bachelor degree in Physical and Health Education and a Masters of Science degree in Biomechanics, with a specialization in Ergonomics.

Tammy joined the Mines and Aggregates Safety and Health Association in 1998. Previously, she worked as an ergonomist with the Occupational Health and Safety Clinic in Sudbury and was involved in ergonomic research with the Canadian Military and with DuPont Canada.

Please welcome Tammy Eger.

MS. TAMMY EGER (Ergonomist, Mines and Aggregates Safety and Health Association (MASHA)): Thank you very much for having me today. For all of you that have showed up to listen to our presentations, and I would like to thank my two colleagues for their interesting talk this morning.

We have had a general overview of musculoskeletal disorders and then we got a little bit more specific with Jean Paul's presentation, and I am going to now talk about one particular human factors issue that we have identified already earlier in the Conference and that is to do with visibility. In particular, I am going to talk about visibility from load hall dump vehicles.

What I am going to talk about - you will see there are some handouts on the tables. I have more slides in that print-out than what I am going to speak to today, but that will give you an opportunity to see the complete overview of the study and where we are going to be going in the future. You can always corner me later on and ask me questions if we don't have time to cover the details you are looking for today.

In particular, I am going to talk about the testing that we have done to date; that is a simple line of sight method to help us identify what some of the design areas are in the LHDs that are causing blockages and restricted visibility; and I will leave with some recommendations, "What can we do right now with what we know so far?", and let you know what we are going to do in the future.

First of all, I am sure most of the people in this room know what LHD is, but we are talking about a load hall dump vehicle and you can see with the design, if we have an operator sitting in the cab in a bucket loaded, you are not going to be able to see a whole lot and that is the problem. We have those restricted sight lines, so we will focus on that in my presentation today.

We know that poor visibility has been identified as the causal factor in a number of incidents involving load hall dump vehicles. In particular, this is for the period of 1984 to 1996, from our statistics for Ontario, that are given to us by our customers: 37 medical claims, 25 lost time claims and 6 fatalities; and this is where we are very concerned.

When we look into the statistical analysis in a little bit more detail, what we find is if there is an accident or incident involving a load hall dump vehicle and visibility is a contributing factor, it is often quite severe. So we end up with a severe injury and in some cases a fatality, and we want to try to get that number down to zero.

What are we talking about? This picture illustrates the problem. As you see, we have an operator sitting in the compartment and you have a person -- in this case it is a 5'5 pedestrian standing in front of that LHD. That sight line, you can see where you are restricted. You cannot see that person in front of the bucket, and there have been cases where individuals have been struck and killed because the operators of the vehicle have not been able to see them.

I am just going to give you a few accidents, this is what we are talking about, and these are quotes right from accident records that we have received. While cleaning up, he was run over by a scoop tram. The injured worker was operating a scoop tram. He entered a barricade area leading to an open stope. The worker and the scoop tram fell 30 metres to the lower level. The injured was standing beside a tractor when he was hit by a scoop tram. And these are just a few.

So what we did with MASHA, the Mines and Aggregates Safety and Health Association, that serves mining customers of Ontario, is that we got together with two partners -- Underground Committee, which is made up of representatives from mining companies throughout Ontario, and Laurentian University, which is located in Sudbury -- to research this problem.

We have a number of phases that we are looking at. Today I am going to talk about the line of sight testing that we are currently doing and the administration of a questionnaire to operators to get their perceptions: What are the problems? What would they do if they were given the opportunity to change the design of their machines?

We are also in the process of tracking accident and incident records and we want to compare those with our scores for visibility ratings on the machine and determine, are there more incidents or accidents occurring with the machines that have lower visibility scores? I will show what I mean as we go on.

In the last stage I am not going to talk about today, but we are going to be moving into testing design modifications in a simulation environment. So how can we improve the design? Those are our two goals.

First of all, we want to be able to recommend changes that can result in improved visibility; recommend design changes to the LHDs. We want to use this information and share it with people out there, share it with the workplace.

Can we improve our training programs for people operating LHD vehicles and other people working in the mines? Can we improve working practices to eliminate some of the other hazards that result from operating these vehicles?

First of all, line of sight testing. Basically, the purpose of this -- we just wanted a simple method, something that we could use both underground and on surface to compare line of sight distances. What I mean here is the distance that you can see around that vehicle to ground -- to a person standing and to a person kneeling.

We know that there are a number of different LHD models in use, and this is just in Ontario mines alone. Each vehicle has different sight line blockages, so we wanted to identify where were the primary causes. The ones in red are the ones I will talk about today.

I am not going to focus a lot on the methodology, as we do not have time for that in today's Conference. I will give you a brief overview, and if anyone would like more details, they can come and speak to me after.

We start with all this equipment which can be purchased from a local hardware store, taken down underground and people can be trained to do a basic site line evaluation in a very short period of time. What you need is listed here. The key component is this index point locator, and it has a light filament attached to the top. That light filament, when you set a battery right here in the operator's position, it lights that light up so in a dark environment underground you can see that light and that would represent the operator's eye position. That is what we have used.

What we do is we mark off an area around the LHD underground and we make measurements basically in a rectangle and we go around the machines and we record the distance that you can see on an adjustable rod, similar to a survey rod, and it is a graded stick. From that, we can locate where we can see the light filament on that rod and we can then extrapolate by doing mathematical calculations to the distance you could see the ground and the distance you could see through a standing person.

If we had unlimited space we would be able to know exactly how far we could see the ground, but those of you that have been underground in mines, you know the drift width is narrow and we do not have 6 metres on either side or often the space around the machine so we needed to come up with a method that allowed us to work in a restricted space environment.

These are two students that I had helping me test. You can see it is cold in Sudbury in the winter, and they are recording as we go around the machine on surface where the cause of the blockages were. Pictures are also taken at each area, so you have a visual record of what is causing the line of sight blockage from the operator's position.

And as I have mentioned, we then get values for three positions: The distance you can see in front of the machine to ground; the distance you can see if a person was kneeling; and the distance to see a person standing.

I am just going to summarize the tests we have done so far. What are the primary causes of visibility? And these are listed here and I will give you an example of the more common ones.

Bucket. Obviously, if the bucket is up you have more of a restriction to the front depending on the load in the bucket and the sides of the bucket, your visibility restrictions are greater. The other thing is some of the designs have a lip of the front. This one is actually smaller. Some of the models we saw would come straight up in a cross and that lip restricts your visibility to the front even greater.

Light brackets are another big problem. Comparing these two designs, the width of the post and in this case here, having a bracket that comes straight across and the light hanging down caused even a greater amount of visibility impairment just to show you one example from underground.

Circled in yellow here we can see a pedestrian walking. The reflective gear helps us identify them a little bit clearer. As they move across the path of the scoop, you can see we have now lost sight of that person and they are completely invisible. Those are situations where we can have a potential for a fatality if the operator was not aware that person was in their path.

Remote Box: Placement of add-on features like the remote box are a problem. Typically some of the problems we saw, they are placed right in front of the operator's vision, and they are placed up higher than the operator's eye height. In this case, this remote box causes impairment to the whole back corner of the machine, and I will show you that in a second in a picture.

Engine Design, depending on whether it is a D-deck or a Deutch (sp) engine. Some engine heights sit up higher, the profile is not flat, so we actually step up. This design here, we have one, the engine sometimes is cut back on the side or by the radiator which will help improve visibility. If we have a square design, we have more limitation around the corners.

And Cabs. The thickness of the post and at the back, if there is no window or no opening, you have restricted visibility behind the machine.

So, from our measurements, we are able to produce this shadow graph. I am going to show you one for an eight-yard scoop with no cab. The red represents the distance you cannot see someone if you are looking to site to ground. Okay? Blue, you cannot see somebody if they are kneeling, and yellow, are the areas you cannot see someone around that scoop if they were standing.

The cause of that restriction then, we can see the bucket, the lip on the bucket, the lights, okay, so now we are talking about the light brackets. The bucket in the boom here, in this particular model, the hoses were not secured down to the boom very well so they were up and caused more restriction. If they were flatter, we would not have had as much of a blockage here.

Lights, and the placement of the fire extinguisher: The fire extinguisher was placed directly in front of the operator's line of sight to the front right-hand corner and caused impairment. And this was the machine I showed you the remote box on earlier. You can see that we have cut off our visibility to our whole back right-hand corner. This would be a problem if this operator was backing up, perhaps a situation where someone has parked their carrier, a personnel carrier vehicle behind, the LHD, the operator did not do a check, was not aware, and backed up and would run right over that vehicle.

So, some simple recommendations. Things like the remote box and the fire extinguisher could be repositioned. The hoses could be flattened down, and looking at redesigning the lights, and in this particular model, the seat height could have been higher to allow that operator to sit a little bit higher.

We look at one with the cab, then. You can see our visibility impairment is completely different. Now, the operator has to contend with the fact that his cab post causes restrictions. Okay? So the thickness of those posts are an important consideration in the design because there was no window or opening at the back of the cab; we restricted our visibility completely -- a complete blockage to the back side.

Overall, though, the rest of the machine does fairly well. You do not see any jutting out blind areas to the front corners that we saw with that other model.

In this one, look at changes to the cab canopy, particularly an opening or a window at the back so you can see out the back-end; reposition the light coverings, and the thing I did not show you on the picture but this one, the wheel wells had a mud flap that came up higher than the profile of this scoop itself and that causes restrictions to the visibility as well. Those could be lowered.

So you can see with the line of sight method, this was our original test, we have shown that the distances that you can see around a vehicle vary by model. Okay? So not every model is the same and when we are talking about 15 to 20 different models in use, you need to identify the design features on each that are causing a problem.

We also know that when people put things like remotes and fire extinguishers and make changes to the vehicle, they should consider the placement because they can cause further visibility impairment.

And with this method, it is simple but it does allow us to identify some design features that we might want to look at, testing later in a simulation environment. Here is just one example. In this particular machine, instead of having the radiator engineering come out square, they have angled down and cut it back. If I look at my distances to ground here, I can see if I was standing here from the operator's position. There is the light filament, you can see the ground.

Here, you can see the ground 10 metres out from the machine, you can see the ground 15 metres out from the machine, 29, and now we cut that off. Other models though, if you came out square, immediately here you would no longer be able to see until you are about 29 metres out in front of that, or out behind the back end.

Some cabs have the operator's cab just angled out a little bit from the side, it improves your visibility again to the back end, so now we can see the ground even further. What we like to do in tests in our simulation studies is combine the two features. How much improvement can we then have in visibility? We can take good features we identify in one model and bring them all together to create, I guess, if you like, the ultimate LHD in terms of reducing our restrictions in visibility.

I will just touch briefly on the questionnaire that is being conducted. What we have done so far, we have done the line of sight testing and we have done pilot tests with our questionnaire. The reason for the questionnaires, we need to get the operators' opinion. They drive these machines everyday. They know which models are better than others, they know what features cause more visibility impairments and we want to get their ideas.

To give you an example from a few questions that we have asked, "For LHD models you have driven, what characteristics allow for better visibility?" Here is what some of the operators have said: Smaller buckets. So obviously, if you are talking an eight-yard versus a nine-yard bucket, we are going to have more restrictions. Seat replacements and better light placements. So the lights are causing a problem. Lower the fire extinguishers; lower the radiator in the air cooled intake; have the cab open.

Another question: "Check, on the table,, what characteristics interfere the most with good driver visibility". Here, we see the position of the remote box, lights and the radiator were the three most common answers. Those are all things that we can do some work on right now.

"Can you suggest any changes to improve visibility?" I will not go through them all, but here are a few: "They can sit higher in the cab." "As soon as we increase our sitting height, it allows us to see more, especially to your far right-hand corner of the machine".

Again, we have a mention of the engine, the radiator on the D-deck engine being too high; it cuts up higher than some of the operators' direct sight.

So what we are doing now, we pilot test the questionnaire, we have made some changes and we are now going to distribute this to operators throughout Ontario and we are hoping to get over a hundred questionnaires back, and then we will have an idea of what features they really can identify that we can look at in our simulation studies that are upcoming.

I am just going to take a couple of minutes to tell you what we have learned and what we can do with this information that we have now: What can you take home or take back to your mines, and what can we do to start to address this problem immediately?

First of all, we know that line of sight distances are what you can see on an LHD - varies between models. So when you are looking at purchasing, consider different model types; ask for your line of sight diagrams; consider the placement of add-on features. When you are doing retrofit changes, maybe speak with the operator, find out where would be the best place to put this where we would not restrict your visibility.

What can operators do? The first thing I encourage operators, you have been driving the machines for a long time, sometimes we forget to respect the hazard and I am going to call it a hazard in this case. Take the time to go walk around your machine and understand what you can and cannot see. Have a friend or a colleague walk around and just identify where your blind spots are so you will know before you enter a new area that maybe you really do not see what is out in front of your right-hand corner. Take a little bit more time.

Before entering those new work areas and before starting up your vehicle, it is a good idea to just walk around, take 30 seconds. We have seen a number of incidents where people have driven personnel carriers, or left equipment around or behind, scoots and operators just gone for a break, he comes back, starts up his machine and carries on, and we end up having a vehicle crushed or equipment damaged. The person that left the equipment there in the first place should not have, but the operator can help out by taking time to go around the machine. All new work areas should be inspected on foot.

Do not enter a work area without knowing what is there. There has been a case, a fatality happened where an area was cordoned off, an operator prior to going on holidays knew the area was safe, he entered the area, it was no longer safe. That is why it was cordoned off. He could not see an open hole, fell to his death, unfortunately. That was an incident that could have been prevented.

And if there are hazards, it is your responsibility to make sure those are clearly marked. What can pedestrians do? Well, we are underground, it is our responsibility to make sure the operators can see us. Do not assume just because we are 30 feet or 40 feet out in front of that machine that, that operator can see us. There are big visibilities, especially to the right-hand side and to the back right-hand corner. Make yourself visible.

Signal and communicate before we cross an open path, and again, do not leave vehicles or equipment unattended in an area where LHDs are going to be using.

What else? Well, people that are in the engineering side are looking at purchasing of equipment. Ask for a line of sight diagram; look at where your biggest restrictions are. Can you request some modifications before you purchase that machine? And that is where we really want to go. You spend hundreds of thousands of dollars on these machines and there are little changes that we can ask the manufacturers to make to improve the visibility.

I am just going to highlight a couple of those design features here.

We talked about lights and light brackets. If you can decrease the thickness of the brackets, you are going to improve your visibility. If we are looking at the engine profile, the lower the profile, the better. We want the operators to be above that engine: The higher they sit, the better they are going to be able to see.

Lips on the front of the buckets cause more of an impairment. So if you do not need the lip, it is better not to have it present. If we can have the seats in the cabs so that the operators can adjust their height and sit up at a point that still allows them to operate the machine safely but at a higher position.

Cab design. We have seen some indication that if it is pulled out slightly from the side, you improve your visibility along the operator's position, the left-hand side, and operators do use that area for sighting primarily.

Mud Guards. You can make sure that they do not stick up over the wheels too high; and the remote box positioned in an area where it is not directly blocking the line of sight. Preferably on the top, right in front of the operator's vision, particularly to the right-hand corner. And again, with the fire extinguishers, avoid obstructing your sight lines to your front corners.

To conclude then, we know visibility is restricted when operating LHD vehicles. We know that operators should be encouraged in training programs work procedures to take their time to understand where are the restrictions with the machine they are driving. We want to make sure everybody is following the procedures to work safely around those vehicles and where possible, consider modifications for improvement.

Today I just touched on two things. We know there is lots to do in this area, and I do not have any of the answers right now. We have funding for two years and what we are moving into is simulation studies and we are considering things like cameras, where they should be positioned, but there are problems with those. To place a camera on a machine when the bucket is up and loaded, where are you going to have the camera so you can see to the front?

The other problem with cameras, we do not want to take away the visual attention from the operators, so if they now have to focus on several different cameras to see the four corners around their machine, are they going to be able to pay attention to what they need in a particular time?

I think some of the answers still focus on the fact that we need to improve the original design and then consider these things as well.

I just want to acknowledge the three students that helped me with the pilot testing of our methodology. One day we were doing some testing on surface and a little blizzard came up in Sudbury and we were not able to work our equipment and function - our batteries died, our lights were not working, but our three students were very helpful in this.

If you have any questions now, I can take those. Thank you.

Question Period - Période de questions - Período de Preguntas

MR. DECK: Questions? Could you go to the microphone please?

DR. ARNOLD R. MILLER: I am Arnold Miller of the Fuelcell Propulsion Institute. (Inaudible) Laboratories is a member of our consortium. They are interested in the idea of using FLIR technology -- this is forward looking infrared. You can see a person or you can see any heat emitting source in total darkness.

They also have the capability of analysis of a thermo-image, sort of like the software can determine whether it would be a person or an engine, you can make that distinction. This would seem to overcome this problem you indicated, the operator being too busy if he had a bunch of cameras to look at. Do you think this would be useful?

MS EGER: Yes, I think something like that would cover two of our problems: it would help identify situations where persons have been run over so from what you said, it would help identify if equipment was in the area so if an engineer was operating. Now, I would have to ask you, the other fatality situation we have had is in terms of the train, if you are not able to identify through the shadows an opened hole or hazard that machines have falling into. So, with that system though, we would cover two of the three, and it is something to consider.

DR. MILLER: Yes. We should talk about it.

MS. EGER: Yes, good idea. Thank you.

DR. MILLER: Thank you.

DR. GRAYSON: Just wondering and I am thinking along the lines of comparative standards and if you have been thinking about comparative standards, for instance, at a certain horizon, in the complete field of vision, if you will, and coming out with measures, from one piece of equipment to another at particular distances, like 25, 50, 75 feet. Have you been thinking along those lines?

MS. EGER: Yes. From the site lines, what we will do is we will, once we finish on the top twelve machines in Ontario, we are going to categorize them in terms of ranking. One will be with the distances, you can see the four corners have been identified as the primary areas. The operators have told us so far, "We want to be able to see our corners and we want to be able to see out in front from the corners". So we will give a ranking in terms of how far you can see out with each of these machines to the corner.

The other thing we are going to do is with the questionnaire, we have asked the operators to identify key features that they feel they have to be able to see to operate that machine safely. And a colleague of yours has identified those things as visual attention locations, or key areas around the machine that you need to have visual attention to, or hazard or an injury situation can happen.

So once we get the results from the questionnaires, I want at least six key areas around the machine that we need to be able to see and then, we will rank the machines: Does their current design allow you to see that area one? Can you see four of the six areas? Can you see three of them? So that will help us to give a ranking to start with.

Does that answer your question?

DR. GRAYSON: Yes, it certainly does. Thank you. What I see is, work like this and other safety-type features being sort of designed into equipment on demand, if you will, by operators.

MS. EGER: Yes, definitely. I mean, we would want to then share these results. The manufacturers have been helpful to date to allow us to do testing on their property of their equipment and our responsibility is to then share our results with them. So we will make what we find available and tell them, hey, your machine ranks maybe 3rd, you can see 4 of the 6 key areas, and here are some things you can do to improve it.

NEW SPEAKER: Good work, Tammy, and good presentation.

Mr. Chairman, I have a blanket question to any other speakers.

We all recognize that it is a wonderful science. I wonder whether any other speakers will care to comment on one or two success stories that might have made a major impact.

MS. EGER: Larry, do you want to start with one success story that you can share with the group? So you have one?

DR. GRAYSON: We can talk to a number of them in our country and one was the seat design that I was talking about earlier, about coming up with a better cushion, if you will, to protect the spine in different places and there was a researcher at the Pittsburgh Research Lab who had been working on that particular aspect in mines during research and making it amenable to production activities as well; and now, Joy Manufacturing is looking at incorporating that design so that it will be part of the safety features of that particular equipment.

Another one was a roof bolting study that had been done in the midst of contract work out in the field was also there at the laboratory where they indeed were working with manufacturers to make changes in the controls where they would be distinguishable without having to look at them directly and they would be logical so that up means up, you know, and stuff like that, and it would be square versus triangle or versus round, and prevent the kinds of injuries that were occurring because of the (inaudible) that flowed in the workplace, changing conditions and stuff. That has worked out really well too.

That's a couple of them but there are others.

NEW SPEAKER: As far as they know, in the mining industry there is not very much, but I can tell you that most of the industries that are running into the automatic mode, that is, cement industry, petroleum, some chemicals, and they are working a lot on the control rooms. They are working with these places and controls and they put computers altogether and try to define the men and control all of that.

I can tell you that our subway system in Mexico City is 25 to 30 years old, and it has had only two accidents -- two big accidents. One convoy hit the one that was in front of it, and there was one human factor error on the first one. But it was mostly, not on the design of the control room, but it was on the selection of the guy that was taking care of this.

So we have to take care also on the profile of the work, not only to describe the work and all that stuff, but to do a profile to hire the right guy for that place. They realized that, and they changed it. So they are using some stuff, including psychology, including-- okay?

MS. EGER: Do we have time for another one here?

MR. DECK: We will find time.

MS. EGER:  I will show something that has happened that is good out there.

The first picture is me down underground. I am loading a hole, so we are talking about loading powder up in a hole. I am not very good at it, I did a couple and the guy said to redo the holes because I was getting tired, my arms were sore, my back was sore. It is a very repetitive task.

So what this one particular mine was looking at was automating the task. Why do we need to do these manually, and I will show you a machine. So it is not perfect, there is still modifications that are needed. What they have is basically a hose pusher attached to a boom and the guy will sit in a bucket and it allows him - right now he is just guiding the hose into the hole. Once he has the hose pushed up into the hole, the pusher will now push that hose up and it will load the powder automatically so he no longer has to push it up by hand.

There are still a few problems with where the controls are positioned and getting the right pressure to make sure the hose is being pushed up at the right speed so that the powder does not all fall back down, but it is a start, that there are some good ideas out there, and the guys came up with this one on their own. I just stepped in to help them with the positioning of the controls and those things.

NEW SPEAKER: Tammy, congratulations on a very practical project you are working on which is going to benefit miners throughout the world, I am sure of that, and it is a project near and dear to my heart, but what about the manufacturers? Have you been in touch with the manufacturers? What is their attitude towards this? Are they willing to modify their machines in line with what you are finding?

MS. EGER: It is a good question now. In terms of being in touch, we have contacted three of the major manufacturers in the Sudbury area, and they have been accommodating. We have gotten access to their property, they have given us -- only one of the three has actually ever done a sight line measurement on their machine and it is their new model that has come out, and that have given us a copy of that.

In terms of where we want to go, some of the responsibilities lie with everybody in this room, as we need to come up with, I guess, the ability to demand a little bit better equipment from the manufacturers, and it is difficult right now because there is not a lot of people buying the machines. So in terms of the force, the pressure to cause the manufacturers to make the change, they are still selling the equipment the way it exists and we are still buying it. So they are not going to make the changes until we, as a community, say, no, we are not going to buy what you have, and we will be able to do that a little bit better once we have some standards, or once we say, these are the things that we want on a machine.

Right now we do not really have the answers for them, so that is what I am hoping to get with this study. If we can get some of the answers, we are then going to share those and arm the people buying the equipment share with the manufacturers and say: Now, you have the information, it is time to make the changes. So it is a valid point and we have a lot of work to do there.

NEW SPEAKER: Well, I had sort of a statement also along with the question but I applaud what you people are doing.

As a Safety Director of a mine for a lot of years, we felt sort of helpless. Fortunately we have Larry and some of his people come up and look at some of our problems, our seats and what-have-you. And I know what it is to get manufacturers to change - Southwest Engineers called in several truck manufacturers and just wanted to change a seatbelt, and put a light; a $2.98 light that says the darn thing was connected, and they refused to do so. We put it on ourselves actually.

Now it is all said and done but it is aggravating for you when you know there is a problem out there, just like the cameras. They are not perfect -- and people are not going to use them until they are perfect, so it is people like you who will make the difference on whether it is corrected.

I really liked what you showed what people could not see. We did it on a Caterpillar 789, 190, the 240, the 793B and 930E Kamatsu, and I will tell you what, it is scary. We lost a guy, a contractor, that worked on trucks who told people not to do what he did. So it is not total education people. We still lose people that lose line of sight of what they are doing, and what have you.

So, I think it is up to all of us to talk to these people and talk to the manufacturers and say, hey, the studies are out there, please do something because our people are paying the price for it. And I thank you very much, I really appreciate what you are all doing. It is making a difference.

MR. DECK: We have time for one more question.

NEW SPEAKER: Quiero felicitarla por su presentación, los accidentes en equipo en la mayoría de nuestras empresas son fuertes, las pérdidas son costosas, lo primero es obviamente la vida humana para lo que estamos y debemos tratar, enseguida los costos de las empresas, son costos altísimos, que en un momento determinado por la falta de capacitación, de visibilidad, de diseño, de ingeniería, o de diseño de obra o de diseño de construcción no da lo que en algunas ocasiones nosotros queremos, yo quiero también compartir que en una de nuestras minas en México, en Peñoles tuvimos un accidente fatal igual en una zona de visibilidad en el crucero de un rebaje hacia el nivel estaba una persona haciendo limpieza, iba saliendo el scrub de 5 yardas con el cucharón lleno de rezaga y en la perspectiva en el punto ciego, no lo vio y pasó sobre él, no vio ni la luz, no vio nada, ¿por qué? Porque iba sin visibilidad al frente del cucharón lleno de rezaga. Gracias.

MS. EGER: Yes, thanks for sharing your situation with us. Unfortunately, those stories are all still too common. I am sure we could go around the room and talk about situations where a fatality has happened or where there has been a near miss and I will just share one more with you that really brought home the importance of this study to us.

Not to long ago, maybe six months, in a local mine in Sudbury, an LHD was driving down a ramp and a pick-up truck was coming up the ramp. Now, the truck had stopped, he thought that the scoop had turned off and then he continued. And the scoop had not turned off and the LHD struck the pick-up truck and pushed it over 48 feet before realizing he had even struck the vehicle.

There were three people in the cab, and luckily for an Act of God or "who-have-you", no one was seriously injured. And one of those people happens to be on the MASHA Board of Directors. Since then, not only has the study received good attention before, but it has even received more attention as of late.

I think our time is up, but I am glad we are aware that ergonomics can do good things for mining and we have just touched on it, and if any of you have any situations, I am sure anyone of the speakers would be happy to give you some ideas and share stories with you.

MR. DECK: Thank you, Tammy, for a very interesting presentation.

I think we have run out of time. Please join me in thanking our three presenters for a very interesting morning. Thank you.

Luncheon Address - Allocution du midi - Discurso del Almuerzo

MR. GEOFF BAWDEN (Co-Chair): This morning's session was quite successful. There was a lot of debate and discussion, which is a positive sign.

It gives me great pleasure, today at lunch, to have a distinguished speaker, who will be introduced in a moment by a good friend of the mining industry. I would like to introduce Mr. Ed Huebert. He is the Executive Vice-President of the Mining Association of Manitoba, which represents all the employers in the province of Manitoba in the mining industry. He has held this post for a number of years in a most distinguished fashion. I would like to call upon Ed.

MR. ED HUEBERT (Executive Vice- President, Mining Association of Manitoba): Thank you very much for your kind comments, Geoff.

It gives me great pleasure to introduce our distinguished speaker for today's luncheon, Professor Fox-Decent. He is currently Chairperson of the Workers' Compensation Board of Manitoba since 1982, and has served as Chief Executive Officer of the WCB from 1995 to 1998.

He is a former professor of political studies at the University of Manitoba. He has chaired a number of province-wide committees, such as the Commission on Pay, Pension and Allowance for members of the legislature, and the Workplace Safety and Health Advisory Council. He has also chaired three recent Manitoba constitution task forces addressing the future of Canada.

Wally Fox-Decent has been a member of the Canadian Forces Reserve for 40 years, retiring in the rank of Admiral.

In addition to all the above, he finds time to chair the Labour Management Review Committee for the Province of Manitoba.

With that, I would like to introduce Professor Fox-Decent.

PROFESSOR WALLY FOX-DECENT (Chairperson, Workers' Compensation Board of Manitoba): Good afternoon, ladies and gentlemen. Bonne journée.

C'est pour moi un grand plaisir d'être ici pour discuter avec vous du sujet de la santé et de la sécurité du travail. I am delighted to be with you today to talk a little bit about workers compensation, or the provision of security for workers where they unfortunately have a situation of an injury or accident at work.

Buenas tardes, bienvenidos a todos y a todas. Es un gusto para mi estar en esta reunión con ustedes.

I believe that if you are privileged to be asked to address a group at the noon hour over lunch, you have a special obligation to be very brief.

If you are an inspirational speaker or a comedian, you may be able to speak longer, but I am neither, and I will therefore be brief.

Ladies and gentlemen, it is always a pleasure to be with a group of people who are concerned about workplace safety, not to speak of workplace health.

If we take a look at workplaces as houses and we talk about the rooms in the house, it is clear that there is the most significant room, which relates to wages and workplace conditions.

Or, for the employer in the same house, the house of the workplace, a decent production, which is efficient and effective, and of course if it is a private sector workplace, a decent return on investment.

But, in this workplace house there must be a significant room, a room that really sets the atmosphere for the workplace, which we would describe as the room of safety.

Regrettably, there must also be a room that provides for restoration in various forms if the worker is injured. In Canada, we would call this the Workers' Compensation Room. Workers' Compensation, however, is of course a provision in each of our three countries: Mexico, the United States, and Canada. There are some reasonably significant differences among the three systems.

The American system might be described as essentially a private delivery system, although there are some states where there are state compensation systems at work. The prevalent process in the United States is private delivery under regulation of the 50 states.

In Mexico, which of course is not a federal state in the same sense as Canada or the United States, the system is, as my Mexican friends know much better than I do, a system essentially under the auspices of the national government. It is part of the health, labour and social security system, which is essentially provided by institutions of the national government in Mexico.

In Canada, the program is provided by the 13 governments at the provincial and territorial level. There are, in effect, 12 monopoly agencies which deliver services to the 13 entities. There is no agency at the moment in our new territory of Nunavut.

There is federal compensation law which applies to workers under federal jurisdiction, but typical of intergovernmental activity in this country, the federal law is administered by the 12 agencies and commissions at the provincial and territorial level.

The Canadian system is now about 90 years old, and was begun in Ontario. I am sure there are some Ontarians with us today. We do of course acknowledge, those of us in the nether regions, that Ontario is the mother of us all. So the Ontario system was really adopted in the other states and territories of Canada about 90 to 80 years ago.

I think it is interesting to note that our Canadian Workers' Compensation system emerges, as I see it, from what is a very strong characteristic of Canada, and that is the characteristic of cooperative endeavour, collective activity as opposed to individualism and individual activity, which of course is, I think, one of the hallmarks of our sister to the south, the United States.

So the Canadian system brings together employers and workers in a mutually responsible and cooperative endeavour. At the heart of this endeavour is what is sometimes described as the historic trade-off. This trade-off is quite simple: The employers pay for the system through law provided by the Government. The workers receive benefits according to the law provided by the Government. In return for the benefits received, the workers surrender their right to sue the employer. It is essentially, therefore, this trade-off that is fundamental to our Canadian system, which has been sustained essentially in its present form for some 80 to 90 years. It was originally a system which provided partial wage replacement and medical service of a limited variety to injured workers.

As the system has evolved, it has become much more. Now, in addition to wage replacement and medical service, the objective of returning the employee to the workplace, wherever possible, has become as important as wage replacement and medical service.

Therefore, such vital issues as disability management toward restoration of ability to work and sometimes described by the term not disability management, but vocational rehabilitation, has become one of the most significant activities of the modern Canadian system. We believe, those of us who are privileged to be part of running the Canadian systems in their 13 locations, we believe that the employers are as interested in return to work as are the employees.

And thus, the original contact between employers and employees, which involved this concept of mutual responsibility and collective will being exercised through an agency created for that purpose, thus this original intent is revived and continued by the process of common interest in returning the worker to health, and thus returning the worker, wherever possible, to the ability to return to the workplace.

Because the Canadian delivery systems, the 12 systems for the 13 state and territorial entities, are monopolies, there is no competition. I believe we in this country who are in these agencies have a special responsibility and obligation.

Whether you are a public monopoly or a private one, and we have some private monopolies in this country, particularly in the utility field, be it private or public, if you are a monopoly you must listen with special care and consideration to your stakeholders. Therefore, in the Canadian systems you will find special efforts being made to reach out to and communicate with and listen to our stakeholders.

Our principal stakeholders are of course employers and workers, but there are many others, including a variety of medical providers, and including a variety of those who have special skills in disability management or vocational rehabilitation.

So, ladies and gentlemen, in each of our countries we find different systems. But in each of our countries we have a driving need -- to work together as providers, as facilitators, as educators, as trainers, as government legislators in the provision of safety and in the provision of workers compensation.

Regrettably, workers compensation or whatever it may be called in the next millennium, will always exist, because workplace injury will always be with us. But the more successful you are in the field of safety and health in the workplace, the less workers compensation will obviously be necessary. May you be very successful, and may we, in the Workers' Compensation arena, be your faithful partners.

Thank you for listening. Muchas gracias por su atención.

MR. BAWDEN: Thank you very much. Ladies and gentlemen, that is Professor Fox-Decent.

Edward had gone through a list of Wally's impressive accomplishments over his lifetime. One thing I would like to add to it is the fact that our Chairman of the Workers' Compensation Board is amongst a very elite club in Canada, a club that its only members are the most accomplished Canadians, and that is that he is a Member of the Order of Canada, for his distinguished work in constitutional and other issues.

I can say that Wally has always been a good friend and partner of Safety and Health. He has always been motivating employers, workers and the Department of Labour to struggle ever better toward the elimination of accidents.

Wally, on behalf of the organizing committee and the delegates here, I do have a small package for you. We have a name tag for you, not nearly as distinguished as your Order of Canada, and a delegation package.

Concurrent Session - Long Term Health Effects - Séance simultanée - Effets à long terme sur la santé - Sesión Simultánea - Efectos a Largo Plazo sobre la Salud

DR. ALBERTO AGUILAR SALINAS (Titular de la Coordinación de Salud en el Trabajo, Instituto Mexicano del Seguro Social): Vamos a dar inicio a esta sesión simultánea agradeciendo a todos ustedes su presencia y especialmente a los expositores, el tema "Efectos a largo plazo sobre la salud" nos invita a comentar en torno al uso de la epidemiología como una ciencia que a través de conocer sus causas y factores que determinan el proceso de salud-enfermedad en un grupo, el conocimiento que aportan para estimular la prevención de los daños a la salud, para proteger la salud de los trabajadores, contaremos con la participación del Sr. Jean Marc Mackenzie, él es vicepresidente principal de asuntos corporativos y legales de MEDACAM Health Management Inc. Destacado proveedor canadiense de servicios de gestión en el campo de minusvalías, y de medicina del trabajo, el Sr. Mackenzie es licenciado en derecho y en administración de la salud por la Universidad de Dalhousie, es miembro también del Colegio de Abogados de Ontario y ha trabajado en un destacado bufete de abogados canadienses y en un importante hospital docente, así como en la Comisión de Accidentes de Trabajo de Ontario. El Sr. Mackenzie también es jugador de profesional de Hockey, deporte muy común en estos ambientes con los balleneros de Hartford, profesor invitado en la Escuela de Derecho de Osgoode en un curso de negociación para abogados.

Hace más de 10 años que MEDCAN provee servicios en el campo de la medicina del trabajo en la industria minera del Canadá y en el extranjero. Muchas gracias por su participación Sr. Mackenzie y es de usted el micrófono.

MR. JEAN-MARC MACKENZIE (Senior Vice-President Corporate & Legal Affairs, MEDCAN Health Management Inc.): Thank you very much for the introduction. I guarantee the translators that I grew up in Cape Breton, Nova Scotia, where they teach us to speak in paragraphs and not in sentences. So, I will try to go very slow so we can go through with this.

Just a quick introduction to MEDCAN. We are a private health management company here in Canada who provides a array of services to corporations and governments, primarily involved in occupational health, disability management, awareness and a product which we are introducing through a partner, Access Health, which is in the US. It is telephone health for citizens, to help them coordinate through the health care system.

So what we do for employees to coordinate them, we are now looking at with citizens. We manage approximately, I guess it is growing close to 300,000 employees in corporations across the country; we have provided services as indicated in the bio to the mining sector for approximately a decade.

An interesting thing in our business, providing health management services to hundreds of thousands of employees that we are seeing more and more the same types of predictions of illness, no matter if it is in the mining sector or with a bank, or whatever, we are seeing commonality which I will speak about today.

Our role, when we go in to work with a corporation, we have heard various topics addressed, which I will not go into detail about, hazard control with health and safety and industrial hygienists. Our role is to provide support to the corporations from a medical expertise area. We are doctors, lawyers, nurses, kinesiologists, physiotherapists, and yes indeed, even lawyers, because there is often contention involved in this business that we do and we are a support function to the companies, to achieve what they have to do.

Health and safety, to achieve their mandates, and human resources, to achieve what they have to do with productivity and scheduling, and we are the support-function of what they do.

One of the big areas that we work with in the mining sector is, for instance, the rail or the air traffic controllers of the air sector - is legislative compliance, making sure that the company is doing the biological monitoring or the auto-metrical - whatever we are required to do as a corporation.

So we ensure that we meet the legislative standard in that regard, a major focus as well as financial management. The cost and exposure of employee absenteeism continues to rise and recent studies have indicated that it can be 10% of payroll. So companies hire us for basically two elements of risk-management: financial and legislative.

Over the last couple of days, the three first checks, the engineering controls that we dialogued about yesterday, as a worker in administrative practices that we are addressing this morning in the kinesiologist lecture as well as ergonomics lecture about the body movements within the workplace and the site lines equipment, where we go, as well as the area that I am going to talk about is how health management is all viewed at the end of the spectrum, we do not focus in on the workplace per say, we are focusing in looking at the health in each and everyone, as you sit here, what risk is associated with your health-related condition, your history and your working in the environment.

So we start back at the individual level versus the work site level and it is our role to coordinate back with the workplace people in order to achieve some synergy and work into programming that makes sense.

I guess health management: some of the areas and services that we look at for employees is the medical history and assessment which I will talk about more with the pre-placement, the periodic as well as the biological monitoring.

More and more, lifestyle is impacting on what is going on in the workplace, whether it is through EAP programming or in some cases, substance abuse programming that we are involved with, but lifestyle is a significant factor with workplace activities.

Environment: not only specifically talking about the workplace issues that we are addressing here but more importantly, the health environment that the individual operates within. Genetics: lifestyle appears twice, I guess, it was supposed to really highlight that, the lifestyle area.

Disability management: a big component of what we do once you become sick or injured; how do we get you back to the workplace and safely.

Fitness: we offer an array of programming for our clients if we do identify health risk. With a lot of our corporations, we have the authority to enroll in fitness programs to address health risk concerns that can potentially be financial or health hazards for the organization, rehabilitate, therapy and kinesiology.

As you look at the tools, we will go on in the workplace with the exposure of radiation or how we breakdown or what we do for processes. We look at the same thing from the medical side with people. We are seeing changing environment, not only the way we do the mining business with advancements in technology, with advancements in smelting, we are also seeing advancements in stress put on individuals that we are concerned with.

We are seeing change in the types of illnesses. More and more, if we look at the snapshot of our history with our mining clients back ten years ago, that the type of injuries that they were with, musculoskeletal and the other type of exposures that you can predict, now if I showed statistics from two companies, and one being a bank and one being a mining industry, they are getting more similar.

We are seeing more repetitive strains with the changes in technology; we are seeing stress, we are seeing psychosocial, we are seeing these chronic pains, chronic fatigues, it is beginning to address more and more hazards that are similar to other organizations that we work in. Our employees are being challenged as demographic are challenged in society.

So it is our role to look at the changes of what is impacting on our demographics, the changes that are impacting on our workforce and come up with programming for a corporate client that reduces legislative risk and reduces financial risk. And that is our role and mandate.

It is with the prediction obviously, the cause of connection, and then hopefully the introduction of prevention programs.

Health Management Programming: I have to thank my colleagues in the legal profession. They help keep us in business by legislating what we have to do and not have to do. They introduce base line compliance levels. From province to province, it varies obviously with, for instance, auto-metric testing. The level of testing in Ontario is different than the level of testing in Manitoba or Newfoundland for that case.

Exposure levels, exposure levels for fitness to work, whether you are in a mine rescue team or you are a conductor of a train or landing a plane. It can vary from jurisdiction to jurisdiction, of your ability to get a card to work; and we are involved in ensuring the legislative compliance from the individual in that medical sense.

Risk Management is where, once we identify some of these legislative issues, we begin to work with the workplace people, to hopefully alleviate some hazards that may be identified, as well as financial risk for the corporation. The cost of employee disability and absenteeism is significant, not only to the individual who may suffer pain, but for the corporation financially. With the global economy which is evidenced by this conference, we all have to be competitive with cost and every array; and then finally and most importantly, it is a promotion of health status for the workers.

Basic elements of a medical surveillance program which we probably all have in place at various levels, the question becomes, where do you go with this? You have this skeleton and shape of a program where you probably do pre-employment; you do some periodic; you do some biological monitoring; and then perhaps, some health screening.

The issue becomes for us, for a company trusting in us, to tell them what is the best risk management that we can do. We want to meet legislative standards but if we can do more, we want to make sure that we are doing more in a sensible fashion, that we are investing the company's money in a good way with a return on investment. So we explore for corporations what we can be doing in these areas and as demographics change and as disease states change, we change what we do in these areas.

For instance, with the pre-employment screening, we now have screening techniques that we can look at as someone prone to develop, you know, rapid movement injuries in the wrist or hand, if they are working with technology. Stress resilient questionnaires so we understand if an individual being pressured with cognitive skills for eight or ten hours a day, will they be able to meet the demands of the job? We continue to work and change our methodology testing for a client as the demographics change and dictate.

I will walk through this quickly, some of the services that we provide in these areas. Depending on your program and depending on your province, or country for that matter, and in speaking with Margie even in the auto-metric varies obviously in the US and perhaps in Mexico - in looking at our president is over in Indonesia right now, looking at these testing procedures of what is going on for a client over in that area from a mine perspective, as well as from a hospital perspective.

It varies from province to province and the testing of what we do, with some of our clients, we will do auto-metric primary function, the blood work, pressure and vision, we do that on a regular basis yearly. All the workers will come in and we will do baseline testing on them every year.

What we are looking at doing is obviously identifying pro-active health risk identification so we can see and predict what is going on in the workplace, what is being impacted.

There are statistical data and evidence on, for instance, diabetes and cardiovascular programs. Ernst & Young has done studies with our partner, Access Health, in this area that once we identify a worker that may be prone to different types of illnesses or conditions, by enrolment into a program, a health management program, it helps to reduce their absenteeism rate, goes up a hundredfold.

We have cases of diabetics missing 20 days of work prior to engagement in the program, and they go to missing no days of work, similar with cardiovascular and other types and conditions.

So what we look to do here is meet legislative compliance, first and foremost, and then work with the company to see what else we can develop, standards that are acceptable to them and to the workers. It is a cost-benefit analysis of where we can go with this and measure the return on investment.

Specifically, with the biological monitoring, as I indicated, first and foremost it is the compliance. The second thing, it is the cost-benefit analysis. More does not necessarily mean better. If the corporation that we are testing for various things and we identify, the question becomes, what do we do with that information? So we want to ensure that we are testing in areas that we can impact, make a change, and do not expose the company.

There is a health care system that takes care of our workers. We engage workers in the economic sense for the means of production and work together for economic gains. We are not there to supply doctors and nurses and people to deal with pure health care things. We are there to do risk analysis of the workplace and our employees, in connection with the risk that the company may have legislatively, legally or financially. And so, it becomes an analysis of doing something smart.

You go in sometimes and talk to companies here in Canada. They put nurses and doctors on site, and they get them doing more advanced first-aid. They are basically running a mini-hospital there. I would never counsel someone to do that because you are not a health care system. You do not want to expose that risk. You should not be touched and that is not in your business.

Your business is in showing you are doing what the government needs you to do, you are doing it responsibly and you are also working on the financial side of it in taking good care of your people. That is your job, end of story. Well, it seems some companies get out of that business but there are still some out there wanting to do more and more for providing pure medical services which exposes risk.

So we have been assessing data, within the Canadian structure, for probably about 12 years on employee health status. Everything from psychosocial data to pulmonary data to auto-metric data, to things that go on, and we are now starting to get to a point where we can give some causal connections to what is taking place in the workforce. And that becomes our job. Not from the environment prospective of the safety of the workplace but from the individual working within the company safely.

We all know people that the individuals themselves present hazards; I played hockey with people that you knew that they were going to get hurt, it was not because the game was dangerous but the individual himself was dangerous; you knew that he was just an accident waiting to happen, you could always say, when is this guy going to go down with something because it is the individual. We all play in the rules. The same thing once we get to know workers' health history, we can do predictions for safety to ensure that we are doing it sensibly, whether they are exposed to different types of workplaces or not.

So it becomes a predicting of looking at this health data. We can collect more health information because we are independent. We are not the company doctors, we are not the company nurses, we are an independent objective medical company that is engaged by the corporation to provide services.

We gain the trust of the workers, we gain the trust of the union and try to gain the trust of management that this is our role, it is independent. We can respect confidentiality but we can do good across the board by collecting and assessing more health information, and by looking at how this health information can be used to predict risk factors within the company to try to prevent injuries or illness.

Just a couple of quick examples of where health data can be beneficial, we had one case of - we called it the broken arm. We had individuals break their arm three times. The company began looking at ergonomic assessment: what was this person doing right and wrong with lifting? what did the job demand?

We got involved after basically the second broken arm and tried to deal with the family physician. The family physician kept treating for broken arm. The problem was with this individual, he had a bone density problem. He was always going to break his arm. It had nothing to do with the ergonomic assessment that the company was engaging in doing. The problem was a pure medical problem. And we have to, with the medical company, we can look at that, we work with the family physician and the individual got appropriate treatment to deal with that in a pro-active way.

We could not deal with that through ergonomics or change in the workplace or looking at the way we do, we had to do a medical change in that instance.

Similar, we see lots of cases where individuals get clearance to work, from the family physician or specialist or someone, whoever. We often joke sometimes that we think the physician always took journalism as an under-graduate because they are getting more creative with their return to work notes at times.

This individual showed up at the workplace with the note saying, he was clear to work. The company calls us back to deal with this issue. This individual had -- I would not call it episodic but more occurrence of seizures. His job was a delivery truck with a company, a well-known national company with a cross aside of the truck. The real kicker was, he had a driver's license taken away four months ago because he was prone to seizures. He showed up at the management door and said, I have clearance to go back to work, and in those cases, unless you had someone to delve back into it, he could have got clearance to go. That is a health hazard for the company, because of the medical problem, that this guy's doctor shopped until we got a note to go back, and so we cleared the medical side of it.

There are lots of cases where we work with medication. With an air traffic controller, depending on the medication we give for migraines or deal with disease states, the individual can work and not work. Depending on whether they treat episodic, every time a guy goes off with the depression, or they go off with stress, or do we treat it pro-actively with a stronger medication they take once a week, then they will not be prone to this.

We look at these types of illnesses and conditions to prevent workplace occurrences and as well to help the individual to remain and stay at work. There are lots of examples of back care programming. Diabetes and cardiovascular programs which I have talked about, there are a lot of document studies of people getting involved with these programs and moving through it for identification.

Critical incident stress is a big thing we do for the financial services. Bank robberies are increasing in this country and they are more violent, and trying to manage them back.

I guess, just to conclude on the health management support of collecting data and tools. We have occupational health programs in place. What is the objective of it? Are we doing it just because we have to do it? Or do we view it as a critical support element of a health and safety program or human resource program?

I think what the message is, is that there is more you can do with looking at health data than just being in compliance with things. There are more things that we can look at, patterns and trends of what is going on, to help us to hopefully prevent an incident from occurring, or if it does occur, to shorten the duration.

We can look more to the health management side of what we do in our business to enhance our health and safety and hazard control side of it, as well as the financial side, as well as the legislative side. The tools and programming are in place.

To facilitate lost light before some eyes - we just created and finalized last week a new program where we can take the baseline biological monitoring data, your auto-metric data, and all the data we are doing as well as any history of disability that the individual has, and we can meld then into a system. We call it a disability management (inaudible) system, where we can begin to track and provide support information to help in safety or to human resource people that you can understand what is going on in an area.

We can do it by disease state, we can do it by supervisor, we can do it by department, we can do it by union code, we can do it by whatever we want. It is a tool now for people to start saying, what is going on in the refinery? I know we had 40 injuries but what are they? And if you pull it up and it is 38 of respiratory, it gives us information then to hone in and look at what is going on.

Or if they are back, we can begin to look at it. But to begin the introduction of tools that we begin to mirror the two of them together to give information and that will be what the corporation wants to do to act on this information to help with the incident level.

I guess my final slot is that health management is a tool; Margie will talk more specifically on epidemiology, on what the specifics of data and trend can do in an area. Health management can support your health and safety and your industrial hygiene programs. It gives the baseline of the individuals' health, where they have been going, what has been happening, and where they are going.

Particularly now that we are seeing the emergence of the psychosocial or the stress-related, this is our new hazard emerging into the 21st century. It is not so much the exposure of the chemicals, the way we are processing. Our people right now are hazards in themselves, particularly as we spoke even in the earlier presentation this morning, with the cognitive demands we are putting on people and all that, we have to make sure that we are managing those sides of it is effectively as well.

Health screening programs, to look at the array of what can be done. Legislation gives you an idea of what can be done but to look beyond what makes sense for your company and where we can explore and what we can do with it. You do not want to expose risk in any way with that way, but what can we do to collect better information to mitigate hazards.

Tracking information is the key, which Margie will be speaking about, the data to hopefully get to a prevention stage.

My concluding remarks is that there is information, there are tools and data out there to support, and I think we are making good progress in this area and I hope we continue to make progress. Thank you.

DR. AGUILAR SALINAS: Muchas gracias por su presentación Sr. Mackenzie, e invitamos al auditorio por si desean hacer alguna pregunta o comentario a la presentación del Sr. Mackenzie.

Question Period - Période de questions - Período de Preguntas

MS. MARGIE E. ZALESAK: Often in the United States what we found is operators going to use biological monitoring, especially for medical, for chemicals in lieu of engineering controls. How do you handle that in your company?

MR. MACKENZIE: I guess the answer is that it has to be an integrated process, as I talked about it, we look at it from the health side, the biological monitoring from legislative as well as from other health exposures.

The Corporation with their health and safety and industrial hygiene, people will continue to work in these areas and it is up to us to share information back and forth and to get better information back and forth, respecting confidentiality of what can be done in this area.

So it is basically, we are supporting what they are doing and hopefully giving better information for further testing or exploring what may be going on.

DR. AGUILAR SALINAS: ¿Otra participación?

NEW SPEAKER: I was curious to hear you saying that stress is getting to be an increasing incidence. Can you give me some idea of the primary cause?

MR. MACKENZIE: I would be a millionaire if I could say what is going on. We trend and track our cases that we have for hundreds of thousands of employees. We are up to 38 % of disability cases across the spectrum, including in the mining sector. The primary diagnosis of stress or secondary diagnosis related to stress of psychosocial type of illness.

I guess usually the responses, it is demographic, it is the job change, it is more doing less, it is different demands put on workers, it is lack of, I guess, of knowing where they are going in this area. But we are seeing more and more of it put on the notes from doctors and put on illness-types of reports.

What we see is that our biggest thing is trying to manage that component of what is going on in the workplace and what potential risk can these, if we do have 40% of that type of condition occurring with absenteeism, what is that doing for risk in the workplace if at all anything, or particularly in the mining sector or in our rail sector or in the air traffic control sector, what are we doing with that? That is why we are trying to collect data and synthesize what is a (inaudible).

DR. AGUILAR SALINAS: ¿Alguna otra intervención?, bueno de no ser así, vamos a invitar a darle la bienvenida a Margie Zalesak quien es asistente especial de administración de la seguridad y salud en la sección minas metales y no metales. Con anterioridad, fue jefe de servicios de salud en la sección de metal y no metales, es higienista industrial acreditada por la Junta Americana de Higiene Industrial y también es agente profesional en seguridad de minas, certificada por la Sociedad Internacional de Profesionales de la Seguridad Minera.

Margie fue galardonada con el Premio John Blumfield de la Conferencia Americana de Higienistas Industriales del gobierno, fue becaria del Consejo para la Excelencia en el programa gubernamental.

Durante sus 21 años como higienista industrial ha trabajado para la administración de la higiene laboral y de la salud del Departamento de Trabajo de Estados Unidos y para la compañía de Petróleo Shell. Bienvenida Margie, usted tiene la palabra.

MS. MARGIE E. ZALESAK (Special Assistant to the Administrator of Metal and Nonmetal Mine Safety and Health Administration (M/NM)): Thank you. Good afternoon. I am very pleased to be here at the meeting to discuss our topic, the role of epidemiology and the causation in association of long-term health effects with workplace activities as a hazard control.

As health and safety professionals, we are often used to using epidemiology to set exposure limits. We are familiar with this research study often generated from especially academia to initiate changes in our perception of injury and illnesses.

The question I want to present to you is, how can a government agency such as MSHA use and develop epidemiology data or other similar health data to control hazards? MSHA is extremely concerned that many small operations, there is no medical surveillance or health programs done by the operator. This way, they do not know the health status of their workers, nor do they recognize the risk that their employees take.

We think epidemiologic studies can be used effectively by increasing the knowledge and the hazard awareness of both the operators and the employees in government as to the occurrence of illness.

I would like to present to you two projects that MSHA has done in order to generate that kind of data. One project dealt with ground silica operations and the other involved surface coal miners. Both of these projects required MSHA to get their support and help from the National Institute of Occupational Safety and Health and they have been our partners in these endeavours.

We also have had to have open and frank discussions with both labour and industry to discuss their concerns and to ask for their help and suggestions. Trade associations have been an effective partner with us on the ground silica studies.

In July 1991, MSHA sent a letter requesting technical oversight to NIOSH to estimate the prevalence of silicosis in ground silica operations by conducting a medical evaluation of active and retired miners. A protocol and a methodology were developed during 1992, and actual data collection was started in 1993. The agency has two goals: To eliminate silicosis, and to eliminate black lung.

For those of you who are unfamiliar with ground silica operations, ground silica operations process sandstone, other high silica content stone, into the consistency of flour. The product is nearly pure silica and because of its fine size, is a severe inhalation hazard. It makes it difficult to control, it is very abrasive and you can have operations that look extremely clean by anyone's standards and still be overexposed to the silica.

MSHA expertise lies in the environmental measurement and so, we conducted that part of the study. NIOSH are recognized for their medical expertise, and they conducted that part of the study.

We also work with the National Industrial Sand Association and the individual operators in the labour locals to get participation and address any concerns of confidentiality and purpose and scope, so that we would get as much participation as we could.

At the time, there were 16 ground silica operations in the United States. Nine sites were selected. The sites were selected based on whether they had outstanding violations of MSHA Respirable Silica Study standard, whether they had a history of overexposure, the size of the mill, we wanted it both large and small, we wanted to be able to ascertain the vents control technology versus those that did not, and that there would be a representatives of ground silica operations for different parts of the country.

These we selected in Beckley, West Virginia, Lexington, Jackson, Tennessee, Illinois, Ohio, Arkansas, Missouri and Oklahoma. The ranges ranged from 12 employees to 50. Some are individually-owned companies, and some were part of larger corporations.

One of the concerns on the compliance on the health status was, we have what we call the ping-pong effect, that we issue a citation and I think this is common too, you know, probably across the agency where you issue citations, they get brought into compliance and maybe a year or half a year goes by and they are out of compliance again. So this ping-pong effect we felt was contributing to the disease.

The protocol required NIOSH and MSHA to notify management and the employee representatives about the project prior to initiation. This involves meetings and letters, some site visits to work out details, such as placements of X-ray vans and need for copiers.

Both entrance and close-out meetings were held with both management and labour, and all current and former employees received invitations to participate. NIOSH examined current and former employees using (inaudible) X-rays. If there were recent chest X-rays done within a year of this study, we would use the company's data. NIOSH also obtained medical questionnaires and other relevant information from the workers in evaluating pulmonary function.

MSHA determined the exposure levels. If we found overexposures, we issued citations and we provided evaluations of the dust control and the other respiratory protection at the mills. An important point to recognize is that MSHA only has authority if there is an outstanding citation. So in a lot of these operations, they will have mandatory respiratory protection and voluntary respiratory protection programs. Mandatory will meet our specs; on respiratory protection, we encourage them to meet the mandatory standards.

The results were discouraging at best. They did get some help. In Hot Springs, Arkansas, 39% of the current and former workers had silicosis; 50% of the current workers had silicosis; four were less than 40 years old, 20.66% of the workers had abnormal lung function. Environmental measurements showed three baggers were overexposed, and there were significant problems in housekeeping and ventilation. This is one of our particular operations that had the ping-pong effect where they would go in and out. Some of our operations may have had a sporadic one, this one has a consistent pattern of being in and out of compliance on a yearly basis.

Jackson, Tennessee, another small operation, had no silicosis. One abnormal lung function, one overexposure found, and again problems with ventilation and maintenance.

Alco (sp), Illinois had 21% of the workers having silicosis, with 8% of the current workers having silicosis. However, the hope was that no worker with less than 10 years exposure had the disease. Again, on this case almost 25% of the workers were overexposed. Again, problems with basic ventilation and housekeeping.

Glasrocco (sp), Ohio, 12% of the workers had silicosis; 30% of the current workers, eight had abnormal lung function, all were overexposed.

Seneca, Missouri, 11% had silicosis; one out of nine of current workers had silicosis. Both of the cases had more than 15 years of exposure. Here, one third of the workers were overexposed and again, in ineffective maintenance and in a defective voluntary respiratory program.

What we felt, and there are three more sites that studies are still in draft, we felt this showed that you could achieve compliance. We did have mines that had no current disease but people were underestimating the effect of the small excursions on a daily basis and none of these cases with overexposures more than two times, three times the limit. It was not extraordinary overexposure, but there was a pattern where operators could maintain consistent compliance where we were seeing lack of disease.

Since that time, MSHA used this data to go into enforcement agreement with the operation that had the 50% silicosis and force them to get state-of-the-art compliance where they now are in consistent compliance. We have used this to heighten awareness about the risk of silicosis. There is a perception that this is an old disease, and it is not. It is still a current disease.

We have partnered with the National Industrial Sand Association to develop videos on the training of this disease and National Industrial Sand Association has been on the forefront to heighten awareness of the need to control the hazard.

I have made available two of the copies for Canada and for Mexico, and I have other copies that I will be glad to give out to anyone interested, and if I do not have enough, I will send them to you.

To address the concern on coal, on October 1st of this year, MSHA has initiated a new program to identify disease and lung surface coal mine workers. It will impact all coal mine workers both surface and underground.

The pilot program will evaluate alternatives to the current Coal X-ray Program, currently administered by NIOSH. This new program is to try and encourage both participation and then to cover the surface coal miners.

In order for you to understand this program, I need to discuss with you some background.

The underground coal miners and underground coal mine contractors can receive free employment and periodic chest X-rays that are paid for by their employers. Surface coal miners and surface coal mine independent contractors are not eligible to participate in the current program.

Mine operators must submit X-ray plans which include completing employee rosters. Participation in this program has steadily declined. Currently, less than 25% of the eligible coal mine workers participate.

Since the mine operator is so involved in the current NIOSH administered program, some miners have the perception that the mine operator may have a knowledge of the X-ray, or have the perception that it is to their operator's detriment to participate in the program, even though NIOSH regulation prohibits that from happening.

Also, there have been some claims that operators have discouraged miners from participating. By doing this new program, we hope to make this association complete and to be able to encourage people to go in and determine house status without fear.

The key features of the House Screening Program is to increase the participation at a level where we have a goal of 85% and expanding the scope of eligibility to include the surface workers.

The pilot program that was initially done indicated that of the close to 2,700 miners surveyed -- and this was done in all parts of the country -- almost 6% of the current walk-in miners had either some version of lung disease. They did not differentiate whether it was CWP or mixed dust fibrosis or silicosis. So we do believe that there is a fair amount of disease that is being under-reported.

MSHA will run this program, people will be targeted at certain mines in the country, all miners will receive letters of invitation, they can go to any X-ray provider they wish and NIOSH will pay for it. They will receive the confidential information.

We hope that this will encourage people to participate and therefore heighten awareness and that we can make these two diseases, silicosis and black lung a disease of the past but it is clearly -- it is a modern-day disease even though we keep thinking, that it is not.

We hope that these activities will heighten awareness that you need consistent compliance, that this can happen and does happen in this day and age, that there is a need for medical surveillance to determine your health status, and that we need epidemiologic studies, as discussed this morning, to determine, you know, what happens after the individual leaves work, you know, what happens into retirement.

Certainly it is all our goal to protect the miners from the time they become a miner to the time, you know, they are enjoying their retirement.

Thank you. I appreciate your attention, and I will be glad to answer any questions.

Question Period - Période de questions - Período de Preguntas

DR. AGUILAR SALINAS: Gracias Margie, preguntas o comentarios para la presentación de Margie, por favor.

NEW SPEAKER: I was just curious of the group you work with. Did you have anybody who absolutely would not come into compliance, they just were not going to have any part of it?

MS. ZALESAK: Some of the smaller operations who had limited resources were probably the most difficult. They were willing only to be into marginal - I would call it marginal compliance and then it would be very easy to let it go. It was very difficult to get them to do like the OASIS system which was more costly but was more effective in the long term.

NEW SPEAKER: With people like that, did your inspectors do anything?

MS. ZALESAK: Pardon me?

NEW SPEAKER: When you have companies like that, do you take any drastic steps with them?

MS. ZALESAK: Yes, we have the right to do closure. However, politically, closing small operations when it may be the only employer in the area is something that we do not like to do, but it has to be done.

DR. AGUILAR SALINAS: ¿Tenemos otra participación, por favor?

NEW SPEAKER: This morning's presentation, and I think what was discussed this afternoon, talked of the importance of gathering data like exposure in terms of long-term health effects.

I would be interested in hearing from the panel, actually, as to how you factor a lifestyle effect, such as smoking, and lifestyles into these long-term health effects.

MS. ZALESAK: In terms of silicosis, there is not a known association like there is on asbestos. But clearly, most of our larger ground operations actually do ban smoking. And you would have to think that there might be some synergy between smoking and other occupational lung disease hazards, that the lung can only take so many onslaughts.

DR. AGUILAR SALINAS: ¿Alguna otra participación?

NEW SPEAKER: Ustedes han tomado en cuenta para este tipo de contaminantes las deficiencias de ventilación que existen ya que el trabajador puede estar expuesto a una sobreexposición en ese tipo de ambientes laborales con deficiencia de oxígeno.

MS ZALESAK: Most of these operations are surface operations. Where we see the lack of ventilation is the capture control, in the grinding, where it is not so much oxygen as much as it being so fine that it looks clean and actually it is very contaminated.

NEW SPEAKER: Yo me refería a minas subterráneas, ¿no tienen investigación al respecto?

MS. ZALESAK: In the underground operations, we usually do not run into oxygen deficiency as more a build-up of contaminants, NO2, blasting gases, carbon monoxide from diesel and that type of activity. It is more a build-up of contaminants than oxygen deficiency being our concern.

NEW SPEAKER: Me refiero porque el trabajador al hacer un esfuerzo de trabajo dentro de la mina subterránea, no es lo mismo que haga un esfuerzo en superficie, es como si corriera uno, en este caso requiere mayor oxigenación los pulmones, también en el caso de minas subterráneas ¿hay una mayor inhalación de polvos sí?

MS. ZALESAK: We do not adjust the exposure limits right now based on work activity, but we do adjust them based on extended not-worked shift. We do not make that accommodation for heavy work, but if a person works a 12-hour shift as opposed to 8-hour shift, we would sample the entire shift and only divide by 8. So we would find out what the equivalent would be in an 8-hour day. We do what we call shift-weighting for exposures.

DR. AGUILAR SALINAS: Más intervenciones, le agradecemos a Margie su presentación, ahora invitamos a hacer uso de la palabra a Juan Rauda Esquivel quien es maestro en ciencias y maestro en salud pública, es médico cirujano de la Universidad Autónoma de México, graduado de maestro de salud pública en la Escuela de Salud Pública de México, como experiencia laboral ha sido coordinador de asesores del secretario del medio ambiente del Distrito Federal, director de efectos del ambiente en la salud en la Dirección General de Salud Ambiental de la Secretaría de Salud de México. Ha sido también subdirector de vigilancia de enfermedades no transmisibles en el Estado de Chihuahua, jefe jurisdiccional de salud pública en Ciudad Juárez, epidemiólogo jurisdiccional en Chihuahua.

Como experiencia en prevención y control de enfermedades transmisibles y no transmisibles, sistemas de vigilancia epidemiológica, diseño y evaluación de programas de salud pública, miembro de sociedades de profesionales como por ejemplo la Sociedad Mexicana de Salud Pública, la Asociación Fronteriza México-Estadounidense de Salud y la Asociación Mexicana de Epidemiólogos.

Tiene la palabra el Dr. Juan Rauda Esquivel.

DR. JUAN RAUDA ESQUIVEL(Director de Efectos del Ambiente en la Salud, Secretaria de Salud): Muchas gracias Dr. Aguilar. Muy buenas tardes a todos, les agradezco su presencia y la atención que puedan brindarme el día de hoy. Voy a tratar de hacer un recorrido histórico acerca de los conceptos de la epidemiología y de cómo éstos han evolucionado, de los resultados que han habido de algunos trabajos realizados recientemente en el mundo y de lo que han sido las experiencias más recientes en nuestro país.

Los escritos de Hipócrates desde 400 años antes de Cristo en su libro sobre los aires, aguas y lugares constituyen la base sobre la cual inició el concepto de la epidemiología. En su libro el autor especula sobre las relaciones entre las enfermedades y el ambiente físico del clima, las aguas, los suelos y los vientos dominantes.

El fue el primero en utilizar los términos epidémico y endémico, es decir epidemión endemión, para diferenciar las enfermedades que visitan a la comunidad, de las enfermedades que residen en ella. Aun entonces todavía no se agregaba el concepto de ocurrencia desusada o grave de las enfermedades.

Algunos de sus planteamientos originales sólo pudieron ser corregidos muchos siglos después y durante ese largo período de tiempo no se hicieron contribuciones más valiosas a sus conceptos sobre la distribución de la enfermedad en términos de tiempo, espacio y población afectada.

La palabra epidemiología se usó por primera vez en España a fines del siglo XVI por Angelerio, un médico que escribió un estudio sobre la peste que era el problema número uno de aquellos lugares, y a ese libro le puso como título "epidemiología".

El advenimiento de la Revolución Industrial a mediados del Siglo XVIII trajo consigo condiciones inhumanas para el ambiente de trabajo, viviendas miserables y hacinamiento en las ciudades, pero también trajo consigo a un primer plano, la preocupación por las condiciones de vida de los trabajadores y posteriormente la aplicación de medidas para mejorar la salud de la población.

A principios del Siglo XIX en Inglaterra, se promulgó la Nueva Ley de los Pobres que permitía que la gente pobre recibiera atención médica en el lugar de trabajo y no en las parroquias como era la costumbre.

Esta ley sin embargo, no contemplaba mejores condiciones de trabajo en las fábricas y así, las enfermedades infecciosas se convirtieron en el gran problema, debido principalmente a las deficientes condiciones de vida, hacinamiento y falta de saneamiento en los tugurios creados para los trabajadores pobres en las ciudades más industrializadas de aquella época.

Las enfermedades infecciosas atraían principalmente la atención de los estudiosos de esa época, pero ahora surgía también el interés por el estudio de las enfermedades relacionadas con el trabajo.

Un ejemplo de lo anterior se encuentra en el libro el Desafío de la Epidemiología, problemas y lecturas seleccionadas que fue publicado en 1988, por la Organización Panamericana de la Salud, en él se presenta un resumen de la declaración que hizo el Dr. William Farr en 1864 ante la Real Comisión sobre la condición de las minas en Inglaterra. Destacamos en esta declaración las tablas de mortalidad prevalentes entre los mineros de Cornwall en diferentes períodos de la vida, los datos de las tablas se comparaban con los que prevalecían entre la población no minera de los mismos distritos en un período de cinco años.

En la primera tabla pareciera que las tasas de mortalidad entre los mineros no son distintas de las que prevalecían entre los hombres no mineros, hasta la edad de 35 años, pero a partir de ahí se muestra un exceso importante y progresivo de la mortalidad en el grupo minero, puede deducirse que ese exceso no comienza hasta que las condiciones de insalubridad en él tuvieron un tiempo suficiente para afectarlos.

El hecho de que la mortalidad excesiva de los mineros de Cornwall no se debía al mero hecho de trabajar bajo la tierra en galerías obscuras y que por lo tanto tenga que deberse principalmente a otras causas, se demuestra por las estadísticas relativas a los mineros del carbón en Durham y Noterbilang (sp). De la tabla número 2, de acuerdo con el testimonio del Dr. Farr complementado con el informe del registrador general, parece además que la excesiva tasa de mortalidad de los mineros de Cornwall se debió principalmente al gran número de muertes causadas por las enfermedades pulmonares.

El campo de la epidemiología. Aunque históricamente la epidemiología nació relacionada con el estudio de las grandes enfermedades epidémicas, especialmente la peste, el cólera, la viruela, el tifo y la fiebre amarilla, conviene hacer notar que el término epidemia, se ha definido simplemente como el aumento en la frecuencia usual de una enfermedad, de ahí que surgía la necesidad de conocer la frecuencia usual de la enfermedad a la cual se le llamó endemia.

La habilidad para identificar o diagnosticar una enfermedad específica de manera razonablemente segura, es un pre-requisito para un buen estudio epidemiológico de ella.

El reconocimiento específico de la enfermedad o sea el diagnóstico es el dominio de la medicina clínica, pero en si mismo depende de una variedad de otras disciplinas por ejemplo de la bioquímica, la microbiología, de la radiología, etc.

También la epidemiología se relaciona con el estudio de los agentes específicos de la enfermedad para lo cual depende por ejemplo de la química, de la física, la toxicología, etc.

Pero el área de interés común más importante en la epidemiología es la población humana para lo cual requiere asociarse en las ciencias sociales como la demografía, la antropología y la sociología.

Finalmente y no importando el tipo de enfermedad, la naturaleza de los factores o influencias que se investigan y del método que se utilice ya sea experimental u observacional, el epidemiólogo invariablemente confronta problemas con el diseño de los estudios y la recolección, tabulación, análisis, presentación e interpretación de los datos, puesto que su objetivo fundamental es el de proveer información nueva concerniente a la causalidad de la enfermedad para así desarrollar y ensayar métodos preventivos.

La vigilancia de la salud de los trabajadores mineros - el primer ejemplo del uso de las estadísticas vitales recopiladas de forma sistematizada y que por su presentación permitieron hacer reducciones sobre el efecto que tenían sobre la mortalidad y las condiciones de trabajo de los mineros, fueron las que presentó el Dr. Farr de las que vimos las láminas anteriores, ante la Real Comisión sobre la condición de las minas, la descripción que hizo de esos datos, nos muestra cómo el registro minucioso y el análisis dirigido que se hace a partir de las estadísticas vitales es una de las principales herramientas que deben utilizar los epidemiólogos como parte de sus actividades de vigilancia.

El desarrollo de otros esquemas como el que describe Ross en "Occupational Medicine", con el título "Surveillance of Work Related and Occupational Respiratory Diseases in the United Kingdom", permitieron conocer que las tasas de incidencia de asma ocupacional fueron más altas entre los trabajadores de la manufactura de la lana y alimentos, principalmente granos y crustáceos, pero adicionalmente en los trabajadores dedicados a la producción de metales preciosos y metales no ferrosos así como entre los mineros.

La encuesta nacional sobre dolor lumbar en los sitios de trabajo que se llevó a cabo en Japón en 1986 y 1988, publicada en la revista "Industrial Health" de 1997, reveló que la incidencia de esa afección en los hombres fue cuatro veces mayor que entre las mujeres y por tipo de industria fue más alta entre los trabajadores mineros y de las empresas de carga.

También el análisis de los registros de egresos de hospitales es otra herramienta de gran utilidad como los describe Lizt en "the American Journal of Industrial Medicine" de 1997 sobre un estudio realizado en 1993, mediante el cual se examinó la asociación entre neumoconiosis y corpulmonal en trabajadores de minas del carbón a partir de una base de datos computerizada del hospital de Ontario en Canadá.

De la misma manera el estudio de las causas de ausentismo al trabajo en una compañía minera de Chile llevada a cabo por Canturías y colaboradores mostró que las tasas de ausentismo fueron de .8 días por 100 días laborables y que las causas más comunes de ausentismo fueron las enfermedades digestivas, las respiratorias, ostiomusculares e intoxicaciones.

La situación en México, la transición demográfica y epidemiológica en México, es un fenómeno que se puede observar a partir de los 90. La transformación estructural de la pirámide de población y el incremento en la esperanza de vida al nacer, son indicativos de los cambios positivos que se han venido sucediendo.

Las tasas de mortalidad por grupos de edad muestran significativas reducciones en los grupos de edad más joven, así mismo, las tablas de las principales causas de muerte muestran que las enfermedades transmisibles han sido ya desplazadas en forma considerable por las enfermedades crónico degenerativas y por los accidentes.

Estas son las defunciones separadas por enfermedades respiratorias, una parte de ellas seguramente deben corresponder a trabajadores de la industria minera.

La investigación epidemiológica en el campo de la salud ambiental y ocupacional recientemente ha empezado a tomar impulsos y la producción científica aunque no es abundante, va tomando rumbo positivamente.

Estas son las causas de muerte en el grupo de 15 a 64 años de edad, donde los accidentes y los tumores malignos ocupan las dos primeras causas de muerte.

Estas son las diferencias por grupos de edad de las tasas de mortalidad en México que se han ido recorriendo precisamente hacia las edades más avanzadas de la vida.

La necesidad de actualizar las reglamentaciones y las normas vigentes para proteger la salud de los trabajadores y que al mismo tiempo faciliten al país su plena incorporación a los mercados internacionales es un factor que está favoreciendo el cambio. La misma industria está siendo promotora muy vigorosa de ese cambio, pues también resulta beneficiada a consecuencia del mismo, de las industrias en México la primera en contar con un reglamento de seguridad para los trabajadores debido a la naturaleza de su actividad fue la industria minera.

Las previsiones que se contemplan en las actuales legislaciones sanitaria, laboral y minera así como en los reglamentos y normas oficiales mexicanas específicas representan la base más sólida para alcanzar el desarrollo de modernos y eficientes esquemas de vigilancia de la salud de los trabajadores.

La interacción sectorial y la participación conjunta de autoridades sanitarias y laborales para la revisión y emisión de normas para proteger la salud de los trabajadores es actualmente una realidad. Sin embargo, hay que reconocer también que la vigilancia de la salud de los trabajadores y mineros en México no ha alcanzado el desarrollo que se requiere para el avance que ha logrado en cambio la industria minera.

Una de las causas principales que no ha permitido un mayor avance en esta materia, ha sido la orientación que se ha dado al gasto en salud, de acuerdo a las prioridades sanitarias del país. Éste se ha canalizado principalmente hacia la consolidación de los programas para la prevención y el control de las enfermedades transmisibles y hacia el desarrollo de la infraestructura de servicios de atención médica para los grupos de población económicamente más desprotegidos.

También hay que reconocer que recientemente las actividades en salud ambiental y ocupacional están siendo apoyadas con recursos crecientes. Sin embargo, es conveniente señalar también que cada vez los investigadores mexicanos acortan más la distancia que nos separa en este campo del avance logrado en otros países.

Un estudio de caso por contaminación de plomo en una ciudad del norte de México, los resultados preliminares de un estudio descriptivo realizado recientemente en una ciudad del norte de México, mostraron la presencia de altos niveles de plomo en sangre de niños, que asistían a escuelas de educación básica cercanas a una empresa minero-metalúrgica. Ese hallazgo movilizó a las autoridades sanitarias estatales y federales para llevar a cabo a principios de este año 1999, un amplio estudio poblacional para evaluar los riesgos.

Altos niveles de plomo en sangre se identificaron en los residentes del área de mayor riesgo localizada en las inmediaciones de la empresa. Un estudio ambiental complementario identificó también altos niveles de plomo en el suelo de la misma área. Se inició el monitoreo de las concentraciones de plomo en el aire y los resultados mostraron valores por arriba del nivel máximo permisible por la norma oficial actual.

Con estos hallazgos se procedió a ordenar la suspensión de las actividades de mayor riesgo en la empresa y paralelamente se inició un procedimiento para una valoración especializada de los casos y proporcionar atención médica a la población afectada.

Complementariamente se procedió a evacuar a los habitantes de las viviendas del área de mayor riesgo y a ampliar el monitoreo biológico de la población del área identificada con riesgo intermedio, actualmente se está evaluando el riesgo concomitante que pudiera deberse a la contaminación y exposición a otros metales en las mismas áreas.

Estos hechos descritos motivaron la necesidad de realizar estudios semejantes en otras poblaciones del país donde operan industrias minero-metalúrgicas que pudieran representar riesgos similares, los resultados preliminares han permitido identificar algunos sitios de trabajo con procesos industriales que conllevan un riesgo potencial para la salud, tanto de los trabajadores como de los grupos de población residentes en las áreas vecinas.

Conclusiones: actualmente están disponibles diversas metodologías para aproximarse al conocimiento de los efectos a largo plazo en la salud de los mineros, varias de las metodologías más importantes para aproximarse a ese conocimiento, son de aplicación relativamente fácil y de costos reducidos. Es conveniente sistematizar las actividades de vigilancia de la salud de los mineros, también nos hace falta establecer mecanismos de colaboración e intercambio de asistencia técnica entre los países para desarrollar y fortalecer más la epidemiología como una parte fundamental de los esquemas de higiene y de seguridad en el trabajo. Muchas gracias.

DR. AGUILAR SALINAS: Agradecemos la presentación que nos acaba de hacer el Dr. Rauda. Los invitamos a que si tienen algún comentario o pregunta disponemos de escasos cinco minutos.

Question Period - Période de questions - Período de Preguntas

Pudiese yo estimular un poco la participación preguntándole al Dr. Rauda su opinión sobre este campo que cada vez amplía su aplicación como lo hemos visto por ejemplo en Canadá que ha pasado del campo de la salud en el trabajo u ocupacional a incorporar la salud ambiental.

Esta tendencia por el ejemplo que también nos presentó de la industria minera en la cual existe una relación muy intensa entre la empresa y sus desechos y sus efectos a la salud comunitaria. Este amplio terreno o campo de aplicación plantea retos muy especiales. ¿Cuál considera usted que puede ser el futuro en México de esta ampliación en el campo que involucra a la empresa, al ambiente comunitario, como lo vemos inclusive en la ciudad de México con los efectos de la contaminación a la atmósfera, en fin, un terno bastante amplio, su opinión? Por favor, Dr. Rauda.

DR. RAUDA: Como no doctor. Creo como epidemiólogo, no solamente mexicano sino creo que esta opinión pudiera compartirla con mis colegas de otros países, podríamos coincidir en que el terreno de la epidemiología es uno de los terrenos más amplios y fértiles para la investigación en materia de salud. Una gran parte de los desarrollos de los avances que se han logrado en los sistemas de salud del mundo, han sido apoyados en investigaciones de orden epidemiológico o de tipo epidemiológico. Cuando usted considera que la importancia de la salud no está restringida a un individuo o a un grupo de población, sino a la mayor parte de ellos, entonces puede encontrar que nuestro campo y nuestro terreno es de los más vasto. Lamentablemente tenemos también diferencias en el desarrollo económico y en el desarrollo cultural. Tal vez una gran parte de los trabajos que han desarrollado mis colegas mexicanos no han sido suficientemente difundidos o no han sido publicados en revistas que tienen una difusión amplia a nivel internacional, pero hay una buena cantidad de ellos, lo cual no significa que no estemos haciendo trabajo. Hay un buen trabajo realizado. Nos hace falta estimular esa investigación y promover mejores espacios donde podamos difundir y compartir esas experiencias, pero seguramente también requerimos en forma muy importante de la colaboración y del intercambio que pueden tener cono nosotros los colegas de otros países que han logrado avances más importantes y más significativos en esta materia y que nos pueden ayudar a evitar lo que hace un momento comentaba alguien en una de las sesiones de la sala de allá abajo, que por qué seguir haciendo más investigación para cosas que está suficientemente investigadas como la neumoconiossis, cuando debiéramos mejor aplicar mayores esfuerzos y recursos para hacer reglamentaciones más específicas y más completas. Yo creo que en este caso él tiene una parte de la razón, este colega, que hay que aumentar el esfuerzo al aspecto de la regulación, es eso estoy totalmente de acuerdo, pero no estoy de acuerdo con él es que no podemos frenar de ninguna manera, reducir o quitarle recursos a la investigación porque finalmente, esto es lo que da el soporte para las normas y las leyes, sino hay una buena base científica que a usted le haya permitido sacar conclusiones sobre lo que es el problema y los fenómenos de salud en la población, sus causas y cómo se comportan, entonces sus reglas no van a ser suficientemente fuertes.

Creo que estamos en un campo tan amplio todavía de investigar, tan fértil para poder sembrar en él, que yo me siento orgulloso de pertenecer al grupo de los epidemiólogos.

DR. AGUILAR SALINAS: Gracias Dr. Rauda. ¿Algún comentario por parte de los asistentes? Margie.

MS. ZALESAK: One area of the interface between the worker environment and the outside environment that we are finding is the carry-home contamination with mercury and lead among American miners to their families.

We have been working with NIOSH on the whole contamination study, as well as trying to increase the awareness among miners. Are you finding a similar interface?

DR. RAUDA: Sí, no específicamente con el gobierno americano. En alguna parte del estudio, ha habido una participación con el asesor y creo que es alguien que trabaja con NIOSH y también con gente del gobierno de Canadá de la provincia de Columbia Británica donde hubo un accidente muy parecido al que hemos tenido en México nosotros.

Pero sí estamos tratando de obtener lo mejor de las experiencias de los colegas en otros lugares ante problemas similares, pero insisto, nos falta un terreno grande por caminar y sobre todo, por caminarlo juntos.

DR. AGUILAR SALINAS: Muchas gracias. ¿Algún otro comentario o participación? Estamos en el tiempo y solo me resta agradecer a los expositores por mantenerse dentro del tiempo, me hicieron muy grata la tarea de coordinar la meta, la conferencia, sin sacar la tarjeta amarilla o roja, muchas gracias a los expositores y muchas gracias a todos por su participación. Gracias.

Concurrent Session - Diesel Exhaust Emissions Issues - Séance simultanée - Questions relatives aux émissions des moteurs diesels - Sesión Simultánea - Temas sobre la Emisión de Motores Diesel

MR. WILLIAM POMROY (Industrial Hygienist, Mine Safety and Health Administration, U.S. Department of Labor, North Central District): (Off-microphone) -- Peñoles Industrial Services, Mr. Fernández.

ING. ABEL FERNÁNDEZ TIJERIN: Gracias a todos, quiero agradecer la invitación a la cual venimos ahora en esta vez para exponer algunos de los problemas ambientales que tenemos en México, en la industria. La conferencia está relacionada con lo que se refiere más a industria limpia, la parte de gases o de diesel, gases de mina, ventilación. Está incluida en esta presentación que voy a hacer de certificación de industria limpia. Este es un certificado que da la Procuraduría Federal de Protección al Ambiente en un convenio voluntario que hace con las empresas, en donde cada una de las empresas se auditan, ven los puntos que hay que corregir, las áreas de mejora y el gobierno - la PROFEPA en esta caso directamente - hace una evaluación del cumplimiento de los programas que se realizan y entrega un certificado de industria limpia a esa empresa. La empresa lo puede reanudar el siguiente año con una verificación especial también por parte de PROFEPA, auditores cumpliendo todo aquello que se generó en las diferentes áreas como son la de atmósfera, ruido, agua, aire, suelo, subsuelo, seguridad e higiene y dentro de estos van todas las instalaciones llámese plantas de beneficio o mina, equipo, procedimientos de mantenimiento, ejecuciones a las operaciones, programas de trabajo, programas de mantenimiento, cumplimiento de programas de mantenimiento con los equipos.

Esta conferencia tiene esta introducción, los antecedentes, los objetivos, primera etapa de certificación y tenemos una de nuestras empresas que fue certificada la primera como unidad minera en México y fuimos la primera empresa de minería subterránea que obtuvimos el certificado de industria limpia.

Las conclusiones y los beneficios a los cuales nos hacemos acreedores cuando ya tenemos el certificado.

Las auditorías ambientales son parte de una herramienta que el gobierno emplee, una empresa privada. Me hago una auditoría ambiental voluntaria. Tengo el beneficio de que la autoridad no me hace inspecciones, sino que me hace recomendaciones y durante el período que yo tenga ese beneficio de alguna forma es beneficio para la empresa porque el costo que se genera a la hora de tener concluidos los programas en obras y los trabajos que se requieran pues obviamente va de la mano por un lado, nos beneficiamos todos.

Para inicio de esta auditoría ambiental, obviamente iniciamos con una elaboración de lo que se llama términos de referencia. La autoridad escribió la legislación donde se basa, en qué artículo de la ley general de equilibrio y protección al ambiente está basada la auditoría ambiental.

La auditoría ambiental fue convenio que hizo Industrias Peñoles con la PROFEPA, la cual en la primera evaluación nos aceptó seis minas completas con todo y sus plantas para la certificación, obviamente para poder hacerlo, existen dos formas: una se puede hacer con un equipo auditor externo o se puede hacer con un equipo auditor interno de personas especialistas por cada una de las áreas.

En nuestra primera auditoría ambiental la hicimos con un equipo de auditor interno y externo y las siguientes las hicimos con un equipo de auditor interno.

Algunas de las inspecciones que en la primera etapa se realizó, tenemos un 72% del cual los auditores y la parte del gobierno fueron los que generaron esto, sólo el 21% lo podemos hacer.

Aquí vemos el número de auditorías concluidas que son 1070, y están en proceso 79, tenemos ahora 1149 empresas que están repartidas en la petroquímica, la industria minera, el área de las maquiladoras, en toda la industria minera la cual y gracias a esta nueva modalidad de convenios voluntarios por parte de las empresas estamos en el orden del control de la contaminación ambiental.

En 1999 decíamos que llevábamos después - de las auditorías ambientales, obviamente bajó a un 19%.

Vemos aquí que bajaron las irregularidades del 15% en 1992 y tenemos en 1997 25% o sea que con las auditorías voluntarias ambientales bajó.

Nosotros en unidad Fresnillo, lo primero que realizamos fue un equipo de trabajo, firmamos el convenio con PROFEPA e hicimos nuestra coordinación de la auditoría ambiental voluntaria.

Una de las primeras funciones que debe haber o una de las primeras responsabilidades es que cada una de nuestras direcciones a nivel general esté comprometida y quiera firmar el convenio. Firmar el convenio con seis empresas estamos hablando de una inversión de más de dos millones de dólares para poder costear todos los programas y las áreas de oportunidad que se relacionaron con ésta.

La dirección debe estar comprometida. Si el compromiso no es de la dirección, obviamente lo demás no funciona. Aquí como en todos lados si la dirección tiene el firme compromiso de acabar con la contaminación, con los accidentes, con las enfermedades profesionales etc., lo va a lograr.

Aquí en la parte de los fundamentos, o de los requerimientos que se realizan en la parte de los términos de referencia como lo vemos en esta lámina podemos ver los requerimientos a los que nos tenemos que sujetar el equipo auditor para poder realizar estas auditorías.

Estos son los rublos los cuales el equipo auditor tiene que evaluar: riesgo, agua, aire, residuos sólidos, residuos peligrosos, suelo y subsuelo, ruido, seguridad e higiene y energía nuclear.

La parte de energía nuclear es la parte del equipo que tiene pastillas radioactivas para el control de algunos de los procesos que tenemos en las áreas operativas de la planta de beneficio.

¿Cuáles son los alcances que tenemos en este renglón de auditorías? Tenemos los alcances de procedimientos ambientales, tenemos los alcances en los términos de referencia, tenemos los alcances en los códigos, normas internacionales, buenas prácticas de ingeniería, disposiciones legales, estudios, casos, investigaciones y todo aquello que nos pudiera llevar a identificar áreas de oportunidad, áreas de mejora.

Los responsables del equipo auditor tienen sus responsabilidades. El auditor líder en este momento está aprobado por PROFEPA. Este líder debe hacer un examen ante la PROFEPA, concretamente ante la academia de auditores ambientales y es aprobado por ellos y a partir de ese momento está calificado para poder realizar auditorías ambientales. Actualmente esta es la modalidad.

El auditor coordinador se crea un problema si miente en alguno de los resultados. Si, tenemos código, si en alguna información ocultó algún riesgo hacia la población, riesgo hacia las personas de trabajo, riesgo de contaminación al medio ambiente, se le aplica el código penal, el código civil y la ley de protección se le aplica al auditor coordinador.

Para hacer la planeación de la auditoría, el auditor coordinador lo primero que hace es un plan de auditoría, ese plan de auditoría está basado en el tamaño de la empresa, en la producción que tiene, en los productos que maneja, en el material que maneja y en todo aquello que vaya relacionado con la planeación.

Una vez determinado el plan de auditoría se lo entrega a PROFEPA quien lo revisa, lo autoriza y en ese momento se fija una fecha para firmar un convenio que se llama: convenio de auditoría ambiental. Ese convenio se firma en las oficinas de la empresa y después se hacen los trabajos de campo.

El equipo auditor debe tener especialistas en cada una de las áreas y después de eso entonces empieza a realizar su auditorazgos. Debe estar soportado por una norma. Si alguno de los hallazgos que encontró no está soportado por alguna norma, puede aplicar alguna norma de ingeniería, es decir en términos de ingeniería o buenas prácticas de ingeniería. En el caso de no encontrar nada, no hay ninguna infracción. Todo tiene que ser soportado por una norma.

Completada la auditoría entrega un informe de auditoría, un programa de obras y actividades y la fecha de terminación para los trabajos que se registraron o que se generaron en ese plan.

Al final cuando termina su trabajo en la empresa, la PROFEPA hace una auditoría de cumplimiento y llega lo que se llama una carta de liberación de la auditoría en donde da por concluido todos los hallazgos que encontró.

Estos elementos son los elementos que revisa el auditor y empezamos por el diseño de las instalaciones, de las obras, de los lugares, la construcción del mismo, los materiales que tenga, de la operación y el cumplimiento de las normas, los estudios de polvo, ruido, de iluminación, de ventilación, de gases. Las inspecciones de las autoridades de PROFEPA y si tenemos algunas quejas de los vecinos que podamos relacionar ahí, las políticas internas de la empresa y de la autoridad, la estructura funcional de la misma empresa, los procedimientos administrativos y operativos que tengamos y el entorno, los convenios que se hayan firmado con la misma autoridad que tengamos en alguna otra ocasión, esto es lo que constituye el sistema de auditor.

Hablando de normatividad estamos cumpliendo aquí, cumpliendo la ley general de agua y equilibrio, el reglamento de materias peligrosas, la ley general de equilibrio y protección al ambiente, el reglamento de materiales peligrosos, el de aguas, el de aguas nacionales, el reglamento de protección civil, la ley de protección civil, la ley de derechos y de agua y el reglamento en materia de transporte y materiales peligrosos, las auditorías ambientales, las inspecciones, ¿quién nos hace inspecciones? La Secretaría del Trabajo, la PROFEPA, la Comisión Nacional de Agua, la SEDENA es la parte del gobierno para revisar explosivos, el Instituto Mexicano del Seguro Social, Protección Civil, el Instituto Nacional de Ecología, todas estas autoridades hacen inspecciones a las empresas y cuando lo hacen revisan la última acta para verificar si no hay alguna cosa pendiente encontrada en la última inspección.

¿Por qué se hacen estas auditorías al sistema? Por varias razones, por una denuncia popular, porque como empresa queremos hacer la certificación de industria limpia y por una denuncia empresarial, es la forma en la que se pueden hacer estas auditorías. Básicamente optamos por la forma de auditoría voluntaria.

Las políticas de diseño, cada una de ellas las tenemos que cumplir, en este cuadro vemos los registros ambientales que debemos de tener, por ejemplo: registros de inspecciones, capacitación, desarrollo, infraestructura, información de los productos, y todo aquello que debemos tener documentado ya sea en forma de manual o en electrónica, pero debemos tener una serie de registros que obviamente son revisables.

Los procedimientos, aquí tenemos un serie de procedimientos que deben ser revisados por los auditores.

Los programas, hay que verificar todos los programas tales como medicina ocupacional, de protección ambiental, de capacitación, de seguridad e higiene, de protección civil, de orden y limpieza, de medicina ocupacional y la parte operativa como ustedes pueden ver ahí también se refiere a los procesos, primeros auxilios, protección personal, respuesta a emergencias, equipo de control y emisiones esto es un ejemplo de todo aquello que debemos revisar.

Convenios, ¿cuáles son los convenios? Una vez efectuada la primera revisión del resumen ejecutivo, se hace un plan de trabajo de lo mismo o lo que … en ese momento hace una carta para pedir el convenio de certificación, la autoridad tarde unos tres o cuatro meses en responder y en un evento social o en evento como convención o algún evento de control ambiental ahí se entrega por parte de la autoridad a la empresa el certificado de industria limpia. Muchas gracias.

MR. POMROY: Do we have any questions for the speaker?

Question Period - Période de questions - Período de Preguntas

NEW SPEAKER: In Canada (inaudible) we have a program to certify (inaudible). That program keeps (inaudible) out of the mines. Do you have a similar program in Mexico?

ING. FERNÁNDEZ TIJERIN: Este es el programa de auditorías ambientales.

NEW SPEAKER: You don't have any for (inaudible).

ING. FERNÁNDEZ TIJERIN: No, no para los motores diesel. La ley o norma oficial mexicana, la 121 nada más tiene reglamentaciones sobre los gases que se generan en el ambiente de trabajo, también los requisitos para las características del combustible, pero no tenemos un programa o un convenio como usted lo menciona en México para la no contaminación del diesel, o al menos yo no conozco alguno.

MR. POMROY: Are there any other questions? If not, please join me in thanking Mr. Fernandez.

Our second speaker this afternoon is Dr. Arnold Miller, who is President and Director of the Fuelcell Propulsion Institute in Denver, Colorado.

Dr. Miller will be making his presentation from that end of the room, and he also has a demonstration involving a small model of a fuelcell vehicle. Some of you, especially over here on this end of the room, may want to migrate down to the other end so that you can see that demonstration better.

I can't order you to move, but I can suggest that you might want to move.

DR. ARNOLD R. MILLER (President and Director, Fuelcell Propulsion Institute, Denver, Colorado): Thank you for the introduction. I am Arnold Miller, as the host indicated.

This is a session on diesel emissions. This is an important problem in mining, and it is essential that the mining industry get the right solution. There is a lot more at stake than you may think. If you cannot find a suitable underground power source, then mining may depart from North America, or at least large pieces of it, and the most profitable mines may be the only ones left.

Also, you do not want to get in a situation like what the asbestos industry got itself into. What matters ultimately is the truth on the emissions, whether they are carcinogenic. It does not matter what people try to say. But eventually this will be known and this can come back later to haunt one. So it is a very important problem.

The other thing is, if you continue with the approach that is being taken, which is to add more and more patches to the diesel engine to make it suitable to work underground, then you lower reliability, you lower availability, and you increase cost. When you have done that, then you can turn your attention to noise, which will be the next challenge facing diesels, and the same thing will apply. As the complexity goes up, the cost will go up, reliability and availability could go down.

What I would like to do is to propose -- it is not the first time that we have discussed this, but to some of you it will be -- a different way of solving this problem. It is often good to try to think outside of the box, and this box now has all the possible solutions for diesels, but why not go outside of the box, in fact get rid of the box altogether and have a different one. This is a completely different power technology. It can operate vehicles. It is called Fuelcell.

Probably almost everyone now has heard about fuelcells, because it is in the news. In Canada here it is almost on the nightly news, because of Ballard Power Systems in Vancouver, which is one of the leaders in fuelcells.

What I would like to do is not tell you about the problems of mining but show you how this technology can replace the diesel engine. I will leave to what you conclude on your own whether this will actually do a better job than diesels. Let me begin.

I am going to do basically three things. I am going to briefly discuss the Fuelcell Propulsion Institute, which is a consortium; secondly, I am going to talk about the technology in general, give you a background of how this works; then I am going to talk about a specific project that is funded by the U.S. Department of Energy to build the first fuelcell underground vehicle, a locomotive. My talk will be on those three items.

The fourth thing I will do is demonstrate a small fuelcell vehicle, this one right here. The other half of this is, how do you store the energy on board the vehicle? I will also demonstrate that.

This fuel graph introduces the Fuelcell Propulsion Institute. It is a consortium that is structured as a non-profit corporation. It has presently 20 members. The members are all institutions. Most of these are from the mining industry. The Institute is not a mining institution. What we are concerned with is fuelcell vehicles, but it turns out that mining is the most important and the earliest application of fuelcell vehicles that will be commercially successful.

We have this mining vehicle program, which is one we have made a lot of progress on. Mining is represented here more than the other programs.

We have a mine vehicle company here, a gold corporation, CANMET, Canadian Federal Laboratory, a fuelcell company, another well known mining company, INCO, a mine vehicle company, three U.S. national laboratories here, a Finnish mine vehicle company, a consortium in Québec, SORDAM, made up of six mining companies. These are concerned with our other program, agricultural, a mine vehicle company, and a U.S.-federal laboratory here, and a spin-off on that (inaudible) concerning safety -- hydrogen is a safety.

This is an international consortium. Presently, with the exception of San Vic Tamrock (sp), which is Finnish, they are all North American, that is, all Canadian and U.S. About a third of them are Canadian, but I am very interested in having our Mexican colleagues join us, and I hope to talk later today with Dr. Lee, who is the President of the Mexican Chamber of Mining, and also involve the Mexican industry in this new technology.

Now, let's go to the second part, about the technology, what is it. As I said, most people probably heard about it. You perhaps know what a fuelcell is. In case someone hasn't, we will define it. It is a device that converts the energy of a fuel directly into electric power. So you think of it in this block diagram. It is very analogous to an engine.

Inside of a fuelcell, it acts like a battery but it is really closer to an engine in its function. In fact, it is very similar. In both cases, an engine or a fuel cell, what the thing does is it takes an energy input, which is in the form of a fuel in either case, it converts energy to power. The engine converts the chemical energy of a fuel into mechanical power. The fuelcell analogously converts the energy of a fuel into electric power.

Then, the electric power from this device will operate an electric motor and drive a conventional electric vehicle -- conventional in all other respects.

This is a large fuelcell power plant of a transit bus. This is 205 kilowatts. This is the same technology that is in this little vehicle in front of you, which we will see later. There are six of these buses operating. Three are operating in Chicago, and three in Vancouver, British Columbia. This particular one was developed by Ballard in Vancouver.

We don't have time to go into detail on these. You will just have to accept these as assertions basically. The benefits of fuel cells as a power source, they are non polluting. There is no pollution whatsoever from a fuelcell. The way this works, most people are familiar with electrolysis of water. It is not very sophisticated to do this. You take a cup of water, put two electrodes in it, run an electric current through it, and you will get hydrogen bubbling off of one electrode and oxygen off the other.

What a fuelcell does is it puts these back together, reverses that process. So it combines oxygen and hydrogen, makes water, and gives you back electricity. This has been used for many years. This is a very old invention. It is over 150 years old. It has been used since the 60s in aerospace. The Gemini mission was the first to use fuelcells for cabin power. All of the Apollo missions used it, and all of the Orbiters, the space shuttle, use it. There are over a hundred missions of the Orbiter, and they have all used -- actually three fuelcells. So there have been over 300 fuelcells that have gone into space. These are fairly large ones.

Excellent reliability also. They are quiet. There are no moving parts in the fuelcell itself. It is very much like a transistor in that it is a solid state device. It gives you power. It is the power analog of a transistor switching device. A transistor is a solid state switch, this is a solid state power device -- power source.

They are safe, very reliable and have a long life. There are no moving parts. There are no liquids in it. They are about twice as efficient as engines. They are more power dense than diesels. They are approaching the power density of spark ignition engines. When you couple it with an electric motor, you have ideal tort characteristics.

This technology is superior in engines in every respect today, except cost. It is more expensive than engines. That is because there is no market for it yet. It is all hand-built.

This is like the computer chip, the same situation was presented to it. It is a sort of chicken-or-egg problem. This will happen. It will eventually be less expensive than engines.

The other part of the problem in a vehicle that is providing power is energy storage. So vehicles not only have to produce power to propel it, but you also have to store the energy on-board from which you get that power.

This is the kind of technology that we are using in underground mining. This in fact is the very system that will be used in the locomotive that the Department of Energy has funded. This holds 7.5 kg of hydrogen in a very safe way. It is not really hydrogen, it is potentially hydrogen. It is called a metal hydride, and it is of low flammability. It is very safe. But this will operate this locomotive that we are going to put it in, for 20 hours without refueling it, versus about 6 hours, maybe 8 hours, for the battery version of the locomotive.

I will show you how one of these works, and we will talk a little bit here -- I have a couple of U-graphs that talk about also how it works, laying some background on it.

This is functionally a fuel tank. It stores hydrogen, but it does not store it as compressed hydrogen, which most people are familiar with, or liquid hydrogen. It stores it as a solid form of hydrogen, called a metal hydride. This thing acts like a sponge for hydrogen, and only hydrogen works this way, because hydrogen is so small.

It will store it, then it will release it. So it acts like a fuel tank. You charge it with hydrogen and you use that then to run the vehicle, then you recharge it.

This is a bus that used that hydride system I showed you on the previous U-graph. It came out of this bus. This bus had two of them in here. They are actually not out of the bus. The bus is out of service. It is going to be used for other experiments -- it is owned by the Department of Energy. They are going to be taking them out.

This ran in Augusta, Georgia, on the streets and is entirely successful. This was an engine powered vehicle. It used hydrogen engine. It was not a fuelcell.

How does metal hydride store hydrogen in a safe and compact way? Most of you people know something about metals, I would think. You know that metals are crystalline materials. What makes a crystal a crystal is you have this regular array of atoms. That's what we mean when we say it is a crystal.

Atoms are spherical, therefore they cannot pack perfectly. This is not a microscopic phenomenon. You see these holes, but if you go into a grocery store and look at a stack of oranges, you will see exactly the same thing, with these holes left over.

The way this works is that hydrogen, by being the smallest atom, can fit in those holes, then it bonds to the metal surrounding it. It can form a weak chemical bond. That is what we call a metal hydride. It does not have the properties of hydrogen anymore, but the bonds are very weak and this is reversible. So you can put hydrogen in there, and you do that by removing heat from the crystal. To get the hydrogen back out, you put heat back in, and it drives out. It is a phase change. It is very much like when you have, say, lighter fluid in your hand and you let it evaporate. How it cools down your hand is putting heat into it, and that is what is causing the release of the gaseous form of the lighter fluid.

The benefits of this are twofold. I have four here but there are basically two benefits to this, and one disadvantage. It is an exceptionally safe way to store fuel. It is exceptionally safe because the metal hydride material, and I will show you, I have some here. Let me pass it around. We will start over here. I would like to have this back, if you would be so kind, whoever has it last, if he would bring it back to me.

This is a metal hydride materials, and that is what it is. This does not have any hydrogen in it. It is not toxic and it is not flammable. It is quite safe.

If we exposed that to hydrogen, it would absorb the hydrogen like a sponge absorbs water, and we would have to remove heat to do that. And if it were charged with hydrogen, if you poured it out here and set it afire, it would burn -- you would probably not even know it was burning. It would burn so slightly. It has low flammability, even when it is charged with hydrogen. That is one advantage.

The second one is quite important in mining. It is very compact. It is as compact as liquid hydrogen, that is, the volume required to store a certain amount of energy. So it is really the most compact way to store hydrogen. These are advantages, but they are not overriding. It is very reliable and, as you will see, there are no moving parts in this either. It is very efficient, there is no energy penalty in this.

Even your compressed hydrogen there is a penalty there. It takes energy to compress it, and you don't get that back. That is a loss. But you don't have that in metal hydrides.

So what is the disadvantage of metal hydrides? Any thoughts on that? You have essentially a metal fuel, so what is –

NEW SPEAKER: Weight.

DR. MILLER: Weight. Yes, weight. It is heavy.

For some vehicles, this is not a problem. Any counterbalanced vehicle, such as a loader, lift truck, locomotive -- it is not counterbalanced, but you need weight -- it is no problem at all.

It turns out that some vehicles, like light duty vehicles, cars, some day but not yet, it will be practical. Even though it is heavy, it is still not as heavy as batteries. You take the fuelcell and the metal hydride system and it will be in the order of ten times less weight than the battery that carries the same amount of energy, and also one-tenth the volume.

So that is the overview of the technology. Now let me say a little bit about the locomotive project, then we will go to the demonstration.

This is the battery version of this locomotive that we are going to build. This project started September 1st. This is the battery version of it, so this is all battery. It is 11 kilowatts, about 14 horsepower. This version of it is what is used in tunneling. I think this is actually a tunneling version that is shown here, but it is used in metal mining and tunneling and coal of course too. So locomotives are the most cross-cutting underground vehicle technology, as you use locomotives in more applications than any other vehicle.

In metal mining it is used in narrow vein extraction, and in coal mining, moving the long wallroof support shields.

This project is funded by both the United States Government and the Canadian Government. Most of it is -- the total value of the project, if you include all the cash in kind capital equipment, those would be the three, it is about $868,000 U.S., something like that, approximately $900,000 U.S., $150,000 Canadian are included in that. NRCAN provided that, and CANMET is one of the partners in this. CANMET will be evaluating the vehicle underground in three metal mines in Ontario: A Barrick mine, the INCO Garson (sp) mine, and a Placer Dome mine in Timmins. So three mines.

Also, NIOSH, the Pittsburgh Research Lab will be involved in a surface evaluation of the vehicle. It will go there first. How much time do I have?

MR. POMROY: A couple of minutes.

DR. MILLER: MSHA will also be involved in that surface evaluation.

Here is a fuelcell. This is the same kind of fuelcell that will be used in the locomotive. This is a standard 5 kilowatt stack made by H Power Corporation. We will use two of these in the locomotive and they will be stretched, that is, the stack will have about 20 per cent more cells in it, and it will be about 7 kilowatts each. So both together are 14 kilowatts.

One last U-graph. This summarizes the battery and the hydride fuelcell versions of this locomotive. This is the existing battery version of the locomotive, and this is the fuelcell -- hydride fuelcell. So these parameters include both: The hydride system for energy storage, and the fuelcell for power production.

The fuelcell vehicle is superior in every respect. It has more power, it has more current at that power, which means greater tractive effort, it has the same voltage. This is just a power plant. It weighs about two-thirds what the battery weighs, and likewise about two-thirds the volume of the battery. This is both of these together. It has three times the energy capacity, and will operate therefore about three times longer than the battery.

So this technology is available today. It is completely mature technically. If I had more time, I would go into this in more depth, but there is no technical barriers here. There is really no safety barriers. It needs to be examined of course. We have excellent relations with the labour unions, and they are very progressive and interested in examining this, also with the regulators.

The problem that mining faces is that it is a small market, so it is really a market for -- that is the real barrier, because if we do not work on this in a very proactive, in fact aggressive way, mining will not get this technology, because the technology developers will see that they can sell not a couple of units a year underground, but they can sell millions on the surface with a whole lot less effort, because you do not have to deal with the regulators. So that is what we have to overcome.

It will be a shame if mining does not -- if it does not happen, because the trick is to be first to get established, like IBM was the first on the -- or the Intel chips were the first with the personal computers, and then it all gets locked into your benefit. If you are not first, I believe mining will be last actually. It will go to the transit buses, lift trucks from the surface, in warehouses. Then in the second generation, it will finally come to mining.

We do not want that to happen. That is one of the things our Institute is working on. We have a number of partners and members who are working with us on that. It takes a consortium to get it done.

Now I would like to demonstrate this vehicle. I have probably five minutes, maybe that will be enough.

What I would propose, if we could have more lights, I would recommend maybe that people just come up here, and come up closer so you can see it. Where you are now, you will not be able to see very much.

This is a fuelcell vehicle. This is the fuelcell up front here. This one is about 30 to 35 watts. You saw some other pictures of fuelcells. It is the same technology, it's just that it is smaller. The nice thing about fuelcells is they scale linearly, so you can scale this up and you will get exactly the same behaviour.

In a fuelcell what you are doing is you are taking hydrogen and oxygen and putting them back together to make water and give electricity. What we are going to do in demonstrating this, we are going to put a balloon on the back that has hydrogen in it. I am going to fill the balloon from a metal hydride system, so you will see both of these technologies.

The hydrogen will come down this pipe here, this tubing, into the fuelcell. Now, we need oxygen. Just like engines or people for that matter, it is an air-breathing system. So it gets the oxygen out of the air. So we have right here an air pump. That air pump is electrically powered, and that is also powered from the fuelcell.

This is a teleremote, or remote radio controlled vehicle. You have a radio receiver right there in the very middle of the vehicle, where my finger is pointing. That radio is also powered by the fuelcell.

Then there are two servo motors. There is a steering servo up front and there is a restat servo back here. Both of the servos are also powered by the fuelcell. So there is no battery on this vehicle at all.

Let's put it back together, then I will charge up the balloon. I am going to need some help on that, because we need heat –

NEW SPEAKER: Hot air!

DR. MILLER: Hot air, as if there isn't already enough!

This is a metal hydride system, a very simple one. The whole thing is very simple. There is nothing here that is high tech. The high tech part is in the metal crystals, which have gone around the room. They are inside here, a similar kind.

To show you how compact this is -- it is almost empty actually. This, once filled, holds 20 litres of hydrogen. That is at low pressure. It is only 25 psi. At 25 psi, at equilibrium, it will hold about 20 litres.

So this stores and moves hydrogen unlike anything you have ever seen before. You do not move the gas around by pressure differential. That is usually how you put your gas, right? You apply pressure to it. This does not work that way at all. The pressure is constant. The temperature is constant. You put heat, low temperature heat, into it. In fact, our hands will be perfectly satisfactory as a source of heat.

This is a self limiting -- if I can just pass that around. Grab that, and put some -- this is a consortium effort! This is teamwork here, providing heat to blow up the balloon. And it is the heat from your hand that is blowing up the balloon.

This is a self limiting system, so that if we, say, did not have the balloon there, we would just open the valve and let the hydrogen come out, it would take about an hour for that 20 litres to escape. That is because as it escapes, it cools down, just like when the lighter fluid evaporates from your hand. That slows down the process.

If this would be punctured, for instance, you will not have any great rapid release. It will be a slow release.

I think that is probably good, so let's -- we will just turn this off. If we had more time, we could send it all around, but I think we had better make this work.

What noise you hear is the air pump. That is the only moving part that there is in it.

Now we have just a standard radio controller. There is a little steering. You hold it with your left hand. It is the way it is designed to be held. This is like a steering wheel, so you can steer it. Then if you pull the trigger, it will go forward, and if you push it, it will come back. Steve is a pro at this, and I am going to ask him to do this. He knows about this. It will go faster -- he doesn't want to crash it!

This could run for a long time. We could run this around the hotel on that balloon. When it uses up all the hydrogen, we simply refuel it, the way you do any conventional vehicle.

So you have all the benefits of an electric vehicle, but you have the advantages of the refueling. So it has both characteristics, the range and energy storage of a fuel, coupled with the environmental benefits of electric drive.

I think we are finished. I appreciate your attention and interest in this.

MR. POMROY: Maybe you can stay after the session.

DR. MILLER: Sure. I will stay around, so after the end of the session. If anyone else wants to see it, I will be happy to show you. Also I would like to have back the metal hydride, if it has not already come back.

MR. POMROY: Thank you, Doctor Miller. That is a real crowd pleaser. That is a tough act to follow.

Our last presentation for this session is actually divided into two parts. The first part will be delivered by Joe Main, who is the Administrator of the Department of Occupational Health and Safety for the United Mineworkers of America in the U.S. The second part of this last presentation will be delivered by Bruce Watzman, who is Vice-President for Health and Safety of the National Mining Association. So we have this last half hour divided into two parts of about 15 minutes each, beginning with Joe Main.

MR. JOE MAIN (Administrator for Health and Safety, United Mineworkers of America): If I get to speaking too fast, which I have a habit to do, if the interpreters would just throw a rock at me I will slow down a bit.

I appreciate the opportunity to be here today. I am Joe Main. I have as my primary job the responsibility of overseeing the Health and Safety Program for the United Mineworkers of America. I have been doing that since about 1982. The more things change, the more things stay the same, I find in this business many times.

The issue I am going to be talking about today is of course the diesel emissions issue. One of the first things that I dealt with when I started to work in the Safety Department back in 1976 in our union was diesel, as it was just beginning to come into U.S. coal mines.

I first want to say that the demonstration by Arnold Miller, we have had the opportunity to see that on different occasions. As a matter of fact, we are working as a support partner, I guess would be the best way to put it, in taking a look at the value of this technology.

I believe that we do have to find other alternatives to diesel, for many reasons. That is our primary interest in working with the project. I am going to be talking a little bit more about that tomorrow, in another program I am going to be on, talking about some labour-management cooperation issues.

The other point that Arnold raised, and I think it is very valid, if this technology will work in mining, and if it does not get to mining first, it will get there last, because the history of the way equipment is developed and utilized in this world is that the products go to the highest market areas, so we wind up, in the diesel realm, with the dirtier engines winding up in coal mines, and the cleaner engines operating on the interstate highways. That is just the way things are.

The shrinking of the coal in other markets around the world makes the marketing of technologies to fit what our needs are more difficult every time.

I would like to say that I understand I am the first labour representative that is speaking here at this conference, and maybe the last other than the one. I do appreciate the opportunity to be here with some of my friends, who are also in the labour movement in Canada, one of which worked with me about 1992. We were working on the ILO International Standards for Mining Health and Safety.

The presentation today is going to be about diesel. It is going to be from a different perspective than I think most of what you have heard here so far. It is going to be from a labour perspective, and it is going to be from the perspective of workers, and what workers really want to get out of having a healthier and safer workplace. It is not (inaudible), it is what they really want to see. I think when you get down to the bottom line of health and safety in the workplace, that is exactly who we are talking about, and that is exactly who we need to design programs to fit. I think it becomes that simple.

As maybe the only representative of labour who gets the chance to present those views here at this conference, I am going to try to do the best job that I can speaking on their behalf.

I will start out by saying that I spent nearly nine years in the mining industry myself as one of those young folks. I saw, through the course of time, many of my friends and working partners become sick, become injured, die, as a result of their exposure to the conditions in the mining industry.

A lot of that drives me, because even today I see some workers, that are friends of mine, that are workers that I represent, becoming sick in the workplace. I just have frustration sometimes because we do not make the right kind of decisions to prevent that from happening. The fact of the matter is, we have the ability to do that, just like developing new technologies on fuelcells. If we can put our brains to work and figure out technical improvements like that, surely we can sit down and figure out some of these simple minded things that put workers in such a precarious position that ruins their life, and sometimes ends their life.

I think that is the kind of cultural change that needs to take place in workplace health and safety, and I do not think we have arrived there yet. I don't know if any of the countries that we have here today have arrived at that pinnacle of being able to do that.

With respect to the diesel issue, my understanding is that the United States have long complained about the health effects that diesel exhaust has caused them, the harm that is in the workplace as a result of their exposure to unhealthy exhaust that is poured into a very confined space, and I am talking about underground mines, of which they have to breathe.

Arnold brought his truck in, and I thought if there is some way I could back a truck up to that door or a bus up to that door and leave it on while I am speaking, I think my point would be made, because I think everyone in this room would pour out of here. They would figure it is so uncomfortable, and probably some of them, maybe Bruce, would wind up suing the hotel management because they not only made the conditions so uncomfortable that they dumped such pollution in here that they had to breathe that every day. They don't have the choice, like we do, to walk out the door. Whatever management puts in the workplace, that is what the miners have to breathe.

The point that Arnold raised, one of the reasons that labour is involved in issues like that is because we are trying to get ahead of these curves and trying to develop some new technologies out there to help this poor miner. He is not the one that issues the procurement order to buy a piece of equipment. He or she, in that workplace, is the one who gets stuck with whatever somebody else decides to buy.

Our objective here is to try to find better products. If I can get through all this today, and I am going to try to do that, I will explain what we are doing at that end. Part of that will probably be picked up tomorrow in the discussion.

There is considerable controversy about the use of diesel equipment in the U.S. A lot of that is in the mining industry, but it is also in the general public. The debate rages throughout many heavily populated areas, about the contaminants that come from diesel, and about what health risk that poses for the general community. California is probably one of the areas of the country that has the most discussion and debate, but it is not limited to there.

With respect to the mining industry, coal miners started to see diesel equipment come into the mines about the early 1970s. By 1975, there was about 75 pieces of diesel equipment in the entire underground mining industry in the U.S., which consisted of about 2,600 underground coal mine at that time. So it was a very small amount of diesel.

From the very beginning, miners started to complain about the exhaust fumes coming into the workplace. They did not need a scientist or a doctor to tell them this stuff was bad. Two things they knew. One is, when God created the Earth and created air for them to breathe, He surely did not dump carbon monoxide, nitrous oxides, all these other pollutants in the air, foreign air that they were breathing.

The second thing is that a lot of them had side effects fairly quickly from being exposed to diesel -- headaches, nausea, burning eyes, burning throats, all those kinds of things that come with a lot of the pollutants that you find. So from the very outset miners said: This stuff shouldn't be here -- at least shouldn't be here the way that it is. And they started to clamour for some action.

In our country, in 1975, NIOSH then, which is an agency that is responsible for the evaluation of workers' occupational health issues and safety issues, made an assessment that there was a problem here. In 1975, that agency issued a notice that there should be a moratorium on any more expansion of diesel equipment in the mining industry until this was sorted out.

Unfortunately for miners, the industry in our country was able to raise enough clout to politically kill that whole idea and that issue. So for the next several years, including up to today, miners have had to live with the results. What happened is that we have decided in our country, and I think it was a very wrong decision, to allow the proliferation of diesel equipment in the mining industry, have miners exposed to all those exhaust while everybody sits down and sorts it out.

Today, there is about 950 underground mines in the U.S. Of those mines, there are 3,000 pieces of diesel equipment now located there. Some mines do not use diesel. As a matter of fact, the majority of mines in our country, underground coal mines, do not use diesel. Only 18 per cent of the underground coal mine population in the U.S. uses diesel.

You can imagine 3,000 pieces of equipment, around 19 per cent of 950 mines. That means that there may be a lot of them using a lot of equipment. The truth is that some mines only have 1, 2, 3, 4, 5 pieces of equipment, a small inventory, while other mines have up to 150 pieces of diesel equipment that they use in all these confined spaces of the coal mines.

That poses a real serious problem for those miners working in those coal mines in terms of what they have to live with every day. As a matter of fact, about two months ago I got a call from one of my representatives that handles the Alabama area, who called to let me know that he just visited a coal mine all night. A miner collapsed at the elevator, on his way out at the end of the shift. The problem was, the miner had been exposed to diesel the entire shift, at a point that it basically overcame him. What is in diesel that does that? One thing for sure is carbon monoxide will cause those kinds of reactions.

The bottom line is that these miners are exposed, where diesel equipment is used, to a wide range of health risks.

Just what are the risks? There has been a lot of debate over the last several years. I unfortunately engaged in those debates and I have committed, about five or six years ago, to get out of them because all we got done doing was holding conferences and debating over which study was right and which study was wrong. We have come to the conclusion that we are getting nowhere but delaying the process. It is time to quit the debate and fix the problem.

There are numerous studies and reports and publications that answer that question. I would be happy to provide at least the locations of those documents for anyone that would like to get their hands on them.

I do not have the time today to go into great detail, but I want to provide some summary information that I think would make a reasonably minded person have great concern about the health risks at mines where these miners are working with this diesel.

In 1989, for instance, the International Agency for Research for Cancer, IARC, concluded that sufficient evidence for the carcinogenicity of whole diesel exhaust existed, and they classified diesel exhaust as a probable human carcinogen. That was in 1989.

In 1994, the EPA, Environmental Protection Agency, which is our U.S. government agency responsible for looking after the interests of the general public on environmental issues, cited findings that diesel exhaust also was considered to be a probable human carcinogen.

In 1994, the Air Resources Board, ARC, a panel of scientists and experts commissioned by the State of California, on April 22, 1998, that California panel, which consists of scientists and academia and experts, issued another report, updating the 1994 study. The panel cited that after years of study, that diesel exhaust has, without a doubt, the most toxic sets of constituents that you would ever find. They found that diesel exhaust is a brew of more than 40 compounds, such as benzine, dioxin and formaldehyde, that have already been declared carcinogenic.

The scientists said that more than 30 human health studies provide strong support for the conclusion that diesel exhaust causes lung cancer. The studies the California panel referred to found that railroad workers and other workers regularly exposed to diesel fumes suffered a 40 per cent average increase in lung cancer.

They also found that in laboratory tests the fumes cause cell damage, lung tumors and gene mutation.

The Health Effects Institute Diesel Workshop group published a special report in April of 1995 on diesel exhaust, citing that diesel emissions have the potential to cause adverse health effects, including cancer and other pulmonary and cardiovascular diseases.

The Federal Occupational Safety and Health Administration, OSHA, has declared the contaminants harmful, with adverse effects to workers ranging from headaches to nausea to cancer to respiratory disease. They cited that numerous studies show that exposed workers have an elevated risk of lung cancer, with some evidence of bladder cancer.

Two other federal agencies, MSHA and NIOSH, have weighed in extensively with similar findings. I plan on addressing some of those findings, and I will do that really quick, because I think they are important.

There is a report that everyone in this room should get. It was prepared by NIOSH. It was published in the American Journal of Industrial Medicine last year. It is called "The Predicted Lung Cancer Risk Amongst Miners Exposed to Diesel Exhaust Particles".

What that study showed, is I that with a lifetime exposure, working 45 years exposed to one milligram per cubic metre of diesel particulate matter, that the number of miners range from 2 to 380 per thousand that could expect to get lung cancer.

When they looked at the epidemiological data, it even got much worse. They found that 97 to 870 per one thousand workers could expect to get lung cancer when exposed to one milligram over 45 years. That tells us that if you believe half of it, this is bad stuff. We need to be doing something about it.

We have done a number of (inaudible) to show that for those who say that air takes care of this problem, it does not. We picked the engine, which is one that is pretty commonly used in the U.S., it is the 94 hp (inaudible), 1916-6 engine. MSHA publishes on their whole web page a formula with which you can calculate the amount of air it takes to reduce the DPM down to a one milligram exposure. I think it is a very handy tool for everybody to use. You can find it on the web page.

We used that same formula and we found that this one engine, to get to one milligram, it would take 11,500 cubic feet of air per minute to dilute it to one milligram. To get to recommended levels that the ACGIH, which is a government organization group that has a lot of representations on it, recently proposed that that level should not be one milligram, but 0.05 milligrams.

To get to 0.05 milligrams, you would have to have 230,000 cubic feet of air per minute going over that engine. That is unrealistic in the mining industry to have this kind of ventilation, but you understand the drift here. To get down to what is considered safe levels, it is going to take some dramatic actions.

We believe that the only way to do that is to implement diesel equipment with high efficiency filtering systems to achieve those, as well as reduce the sulfur content within the fuel that is used.

In the State of Pennsylvania, about two and a half years ago we worked with an industry group to develop what we consider a model diesel law. That law is on the books today. It sets forth several different standards of protection that is needed to operate any piece of diesel equipment in any underground coal mine in the State of Pennsylvania.

It requires a high efficiency, 95 per cent quality filter efficiency, yet permits only a 0.12 milligram per cubic metre of diesel particulate matter on an averaged basis using a special ISO standard test, to be admitted from the tailpipe with half the plate reading that is on there for the ventilation to be used.

It also requires an oxidation catalyst. That is another sad thing. Any highway vehicle you find has a catalyst converter on it while the coal mines do not have them, and some of them that put them on there clip them off. It requires a catalyst, and it requires that the carbon monoxide level not exceed 100 parts per million in the tailpipe, undiluted, on any test. It has to be approved that way, and maintained that way. What we found is that a lot of these catalyst converters can easily achieve those kinds of levels.

I am going to cut off my presentation here. Anybody who is interested in the Pennsylvania Mining Law, which I think is very important -- the sad thing that I am finding is that when I get around to talk to all these groups, nobody has heard about this. That is very sad, because there are some standards in place that can be used as the model to reduce the levels of DPN in gases that threaten miners' lives.

I will conclude by saying thank you very much. If you need any more information, please give me a shout. Thank you.

MR. POMROY: We are running a little bit late, so I think rather than taking questions for Joe, we will let Bruce give his presentation and then ask for questions for the entire panel, to finish up.

At this time I would like to introduce our last speaker, Bruce Watzman, who is Vice President of Health and Safety for the National Mining Association.

MR. BRUCE WATZMAN (Vice President of Health and Safety, National Mining Association): Thank you, Bill, and thank you for the opportunity to be here today. On the short time provided, I will cover a couple of points.

I must say, as is so often the case, I find myself following Joe Main in speaking, and it often appears that I am trying to contradict what he says. That is really not the case. I think what we do agree on is that there are some problems out there. The difference is how we approach those problems.

We believe that we should take realistic steps, and necessary steps, things that we can accomplish today and not pie-in-the-sky solutions that do not get us very far.

The U.S. Government examination of the health consequences, both from the environmental and occupational exposures to the constituents of diesel fuel, has a long history. As Joe mentioned, the EPA, the ACGIH, the National Toxicology Program, the State of California, the Health Effects Institute, and most recently MSHA, have been studying the potential health consequences of exposure to diesel exhaust.

Most if not all of these agencies have had difficulty establishing a unit risk factor or permissible exposure limit based on the studies conducted to date.

MSHA has taken the lead in this endeavour. In fact, they are the sole federal government agency today who has promulgated standards and proposed forms to limit worker exposure to diesel exhaust. They did this for three reasons: (1) they believe that there are excessive exposures in the underground environment; (2) they believe that diesel exhaust is a human carcinogen; (3) even if not a human carcinogen, there are non-carcinogenic effects that must be addressed.

We believe there are three questions, yet there are not exact answers. First, the reliability of the existing science.

The first overhead presents the results of two reports, one dealing with the review of animal studies that have been conducted, and second, the human studies that have been conducted. These are from the U.S. Environmental Protection Agency and from the Health Institute.

The bottom line conclusions of both of these bodies, bodies that do not represent industry, bodies that are the pre-eminent researchers out there today, their bottom line conclusion is: We don't know all the answers. We need to do more study.

Simply stated, we believe that there is insufficient medical and scientific evidence to categorize diesel particulate matter as a human carcinogen, and we have yet to be able to conduct a quantitative dose/response relationship to establish what is a safe or non-safe level. But I must say, without the ability to establish that level, I would say to you all again, we believe more can be done, and more should be done today.

The second issue, and it is an issue in large part for the metal and non-metal sector of the mining industry, deals with sampling and analytic methodology. Today, there are three methods available to sample for diesel particulate: Respirable combustible dust, elemental carbon, and size selective method. It is generally recognized by all that all three methods are insufficient for sampling in coal mines, but significant controversy remains regarding the application of sampling in underground metal and non-metal mines.

To look at the question of sampling and analytic variability, a study was conducted in Nevada at the gold mines, the underground gold mines. The purpose was to test the reliability and accuracy of the proposed sampling and analytic methodology put forth by the Mine Safety and Health Administration. That is referred as the NIOSH 50/40 method.

These are 40 samples that were taken in an isolated, non-dieselized lab. No diesel equipment was present whatsoever.

--- Slide presentation

What this shows, and I put this up in all of the slides, look at both the elemental and the organic fractions of diesel, because using MSHA's methodology, you are supposed to look at the total carbon, both the organic and the elemental, to determine whether a sample is in compliance with the levels that have been proposed.

Of these 13 samples, the organic fractions range from 440 to 2,662 micrograms per metre cube. The elemental fractions range from 0 to 1,031 micrograms per metre cube. This is carbon that comes from the ore body itself. There is no diesel equipment in the environment, there is no diesel exhaust in the environment. Yet this is the sampling and analytic technology that we, the metal and non-metal industry in the U.S, would be required to use to test for compliance underground.

There are two known compounders that MSHA has recognized, one being cigarette smoke and the other one being oil mist from equipment used underground. But they have discounted both of these in their thinking.

--- Slide presentation

This is the results of a sample collected in a break room where employees smoke. MSHA's solution to this problem is to prohibit smoking underground.

The elemental carbon of this sample was 128 micrograms per metre cube. The organic fraction was 7,876 micrograms. This is about 20 times the proposed level that MSHA has put out, and about 200 times the final level that they have suggested. Once again, no diesel equipment present, no source of diesel exhaust present, yet this would be deemed to be a sample that is out of compliance.

--- Slide presentation

These are four samples taken to determine the effects of oil mist on the reliability of the 50/40 method. No diesel equipment running, no source of diesel exhaust present. These range, for the elemental carbon, from 93 micrograms to 109, and for the organic fraction, 2,700-plus to 2,800-plus. Four samples that would be deemed to be out of compliance if taken in an underground metal and non-metal mine in the U.S.

--- Slide presentation

One of the suggestions has been that when sampling you use a sub-micron impacter. These are a series of samples that were taken: Open faced, cyclone, and an impacter. One set in the lab, one on the underground left rib, the third on the underground right rib.

While you will note that a reduction was achieved from the open face sample to the sample with the cyclone, what is most significant in this slide is the sample taken in the lab. The impacter was unable to eliminate 47 micrograms of the airborne dust. Once again, no dieselized equipment in the lab, yet it would show up as there being diesel particulate matter in the environment.

--- Slide presentation

There currently exist in the U.S. three or four labs that can utilize the NIOSH 50/40 method to analyze for compliance with the standard. I'm sorry for the size of it, you may not be able to see it in the back. These were a series of samples that were run intra- and inter-lab.

There is consistency, we found, interlab, but the consistency falls off significantly intralab. What they did is they took a punch from a sample, from a filter. The remaining portion of the filter was then sent to a second lab, who took a second punch. What we found is that there is significant inconsistency in the laboratory determination of compliance.

The bottom line in our mind related to sampling. The sampling and analytic methodology is that the methodologies are insufficient to determine concentrations of diesel particulate matter in underground metal and non-metal mines.

The third issue regards control of DPN in the underground environment. Joe made reference to the requirement that MSHA has put out which would require that all diesel equipment - not all, much of the diesel equipment used in underground coal mines - be equipped with after-treatment systems sufficient to capture 95 per cent of the particulate emitted into the environment.

The simple fact of the matter regrettably today is that we do not have a system that can capture 95 per cent. It has been shown to be available in limited applications. It has not been tested across the range of engines used in underground coal, and we do not know whether there is a technology out there.

With regard to metal and non-metal control, as I mentioned, MSHA proposed an interim standard of 400 micrograms and a final standard of 200 micrograms. We are concerned that there is insufficient evidence that the existing technology can consistently reduce levels to that proposed by the Agency.

As many of you know, the pieces of equipment used in underground metal and non-metal operations are dramatically larger than those used in coal mines. It is not uncommon to see a 450 or 300 or 350 horsepower piece of equipment underground. We have yet to see technologies that can be retrofitted onto these pieces of equipment, in combination with low sulfur fuel and ventilation, and maintenance practices, to attain the levels that MSHA has proposed.

Well, where does that leave us? Should we do nothing? Should we wait until all the answers are in? Absolutely not. And that is not what we, in the industry, believe should be the route we follow. We should be doing more, we can be doing more, and we will do more, but what we want to ensure is that what we do today is both realistic and necessary to protect the health of the workers underground. Thank you.

MR. POMROY: Thank you, Bruce.

Are there any questions, for any of the speakers this afternoon? There must be one.

Question Period - Période de questions - Período de Preguntas

MR. MICHAEL SPRINKER (International Chemical Workers Union): We have members in metal and non-metal -- salt, zinc primarily. One of the concerns which has come up has been the change to longer shifts, especially in one mine in east Tennessee, well known to at least a number of the folks in the States.

What has happened is that, going to these longer shifts, maintenance becomes much rarer. They want the equipment to run longer. Both the miners and those doing maintenance say that things are not taken out of service. That ends up creating a number of problems, not just of equipment failures, which sometimes injure people, but with the diesel emissions.

What kind of suggestions might there be to deal with this problem? I am also quite interested in this from both the equipment add-on and from operations.

MR. POMROY: Were you directing that to the panel as a whole?

MR. SPRINKER: Yes, to the panel as a whole.

NEW SPEAKER: Let me start, if I might, Michael.

In 1996, the Mine Safety and Health Administration promulgated safety standards for the use of diesel equipment in underground coal mines. That was only coal mines. As a part of that proposal, there were very detailed requirements regarding maintenance standards when diesel equipment is used in underground coal.

Clearly we believe that a good, effective maintenance program must be put in place and must be adhered to. The proposal that MSHA put out last year, dealing with diesel particulate matter, incorporated maintenance requirements for underground metal and non-metal mines who used diesel powered equipment.

MR. MAIN: To answer your question, Michael, I would say that if you believe half of the information that is contained in the studies that have been evaluated, it tells you that on a normal exposure basis, that miners are at risk. When you look at what the numbers mean when you crunch them down to a point of -- trying to define what is a safe level over a period of time, it would be questionable to point that a person who breathes those particles in 12 hours, or 10 hours versus 8 hours, is going to have a more adverse effect.

If you look at the data and it tells you the folks that may be working 8 hours are already highly at risk, it says that something needs to be done.

As I said earlier in my presentation, when I first began dealing with this it was back in the 70s, and I have listened year after year after year. As I said, we need more studies. We need to figure this out. We do not know all the answers. The day I die, we are not going to have all the answers, I can guarantee you that. There will always be a need for study and reason to study.

One thing that we have found is that there is technology available, and the availability to develop more technology to deal with these emission issues, if in fact we are going to still use diesel in the mines. What was pointed out, the 95 per cent efficiency standard which is in the State law of Pennsylvania and is in MSHA's proposal.

What we have proposed, with respect to the objections from industry that we have seen over the last three years, is that probably what we should do is start out with a lower efficiency rating of using filter efficiency around the 80 percentile capacity. As we develop better technology to satisfy the interest of having more equipment on the market, we move there. If we even had 80 per cent capacity or a filter efficiency and changed the fuel ratio and fume mixture, we could reduce the contaminants down.

We can talk about it, or we can do it. I would encourage everyone here to go back home and start talking about what filtering devices are available, and there are several. We hope to have more on the market. As a matter of fact, there is another manufacturer building another system to comply with the Pennsylvania system. It will be on the market fairly shortly. So, what is it that I can do to fix this problem on my own, before even waiting for regulation? (Inaudible), put catalysts on them, do your own checks, check the environment, and do a lot of the things that need to be done while we are trying to get this in place.

MR. POMROY: Any comments from our other panel members?

NEW SPEAKER: Just one comment. I think your point about reliability, or it is implied anyway, that the longer shifts would perhaps cause greater problems in emissions because of lack of maintenance.

This is a very good point. I think as this problem is addressed and the effort is made by patching the diesel, the reliability will continue to decline and it is going to take ever more stringent efforts to maintain them, just like in surface automobiles. It is well known that when a car is new, it's fine as far as emissions, but if you take an 80,000-mile car, they are really bad. Just a few of those are responsible for a very large portion of the emissions in a city, a relatively small fraction.

NEW SPEAKER: Bueno esto se tiene que ver como un problema integral no es únicamente la responsabilidad de la empresa, la responsabilidad de los sindicatos, la responsabilidad de las leyes, tenemos que verlo desde el punto de vista de buscar siempre que nuestros trabajadores no se lleguen a enfermar. En la mañana aquí escuchamos una conferencia sobre la toxicología y al final de cuentas, el problema es de todos, la solución es integral no es de una sola persona, de un gobierno, sino que tiene que haber una solución en donde los equipos estén siempre nuevos, en donde las personas y los trabajadores se cuiden y tengan sus responsabilidad de lo que tiene que hacer y en donde el dueño de la empresa tenga suficiente dinero para estar cambiando los equipos y en donde la sociedad y todo el mundo seamos conscientes de que lo mejor es la participación de todos, siempre viendo la mejora de la salud de todos nosotros.

MR. POMROY: Since we are running quite late, I would suggest we end the session now and if you have additional questions or wish to continue discussing this topic, I am sure the authors will remain available for you.

Please join me in expressing our appreciation to the speakers for these interesting and informative presentations.

General Session - Occupational Injury and Illnesses: Compensation and Reporting - Séance générale - Accidents du travail et maladies professionnelles : indemnisation et rapports - Sesión General - Las Lesiones y Enfermedades Ocupacionales: La Indemnización y la Presentación de Informes

LIC. JOAQUIN BLANES CASAS(Director General de Inspección Federal del Trabajo de la Secretaría del Trabajo y Previsión Social):

Muy buenas tardes, soy Joaquín Blanes, soy Director General de Inspección Federal del Trabajo de la Secretaría del Trabajo y Previsión Social de México y tengo el gusto de moderar esta sesión general que está intitulada: Las Lesiones y Enfermedades Ocupacionales, La Indemnización y La Presentación de Informes.

Contamos con la presencia de tres magníficos ponentes y me voy a permitir presentar individualmente a cada uno de ellos antes de su intervención para que también como se ha hecho en las otras reuniones puedan hacer preguntas a cada uno de ellos cuando terminen.

En primer término y en representación de la delegación de Canadá, estará con nosotros el Sr. Jean-Marc Mackenzie, que es vicepresidente principal de asuntos corporativos y legales de MEDCAN Health Management Inc. MEDCAN es un destacado proveedor canadiense de servicios de gestión en el campo de minusvalías y medicina del trabajo. Jean-Marc es licenciado en derecho y en administración de la salud por la Universidad de Dalhousie, también es miembro del Colegio de Abogados de Ontario, ha trabajado en un destacado bufete de abogados canadiense, en un importante hospital docente en Canadá y en la Comisión de Accidentes de Trabajo de Ontario. Además fue jugador profesional de hockey con los Balleneros de Hartford. Como profesor invitado imparte en la escuela de derecho de Osgoode un curso de negociación para abogados.

Hace más de 10 años que MEDCAN provee servicios en el campo de la medicina del trabajo en la industria minera de Canadá y en el extranjero, recibamos por favor al Sr. Jean-Marc Mackenzie.

MR. JEAN-MARC MACKENZIE (Senior Vice President, Corporate & Legal Affairs, MEDCAN Health Management Inc.): Thank you very much for the opportunity to speak with you today.

As I started off in my last presentation I gave upstairs, I grew up in an area in Cape Breton, Nova Scotia, where they teach us to speak not in sentences but in paragraphs. So I have to go slow, I understand, for the translation.

Being from Cape Breton, I would be remiss not to start off on the issue of Workers' Compensation without -- I guess my first introduction would be through humour, that in Cape Breton once a time appeared a wonderful healer, and everyone in the city was running in the direction. All of a sudden people stopped on the street and said, "What is going on here?" The guy said, "Well, there is a healer here, and he is curing everyone." The guy took off in a dead terror in the other direction, and the guy said, "No, no, he is in this direction", and the guy said "No. I'm on compensation".

Workers' Compensation in this country is an interesting device that was legislated, and a device that served the purpose. I am going to speak more on the rehabilitative managed return-to-work process. My colleague from Mexico is going to speak on the compensation system, and my friend from the U.S. is going to speak on reporting functions.

I am going to try and address what we often do not perceive in our country, a managed care approach within compensation to reduce costs.

Managed care with our U.S. healthcare partner, AccessHealth, is much more viewed as providing managed care, but we try to provide managed care as a private corporation within the compensation system. I will talk a little bit about some of the things that we do, specifically in the mining sector, where we have had some success.

MedCan, just by way of background, is a private health management company. There are not too many of them probably in this country. We provide services to corporations as well as to governments. We probably manage within our umbrella about a quarter million employees under this system with Occupational Health. So we are responsible for the return to work function as well as working with corporations to facilitate return to work of occupational health injuries.

Within the mining sector specifically, we have over a decade of experience of looking at these issues and dealing with it, so we have some broad understanding of not only healthcare in general but specifically the mining sector.

When we started off in the presentation earlier in the day about epidemiology, when a corporation engages us, whether it is to provide occupational health, short-term disability or workers' compensation, they engage us to take care of risk management, both financial and legal. We spoke earlier on the occupational health sense. Legal risk may be with mandate of compliance with autometric or biological monitoring, testing or what-have-you.

The financial management side of it deals with compensation. Your employees, whether they are at work or not at work, they are a cost factor, and we are engaged to manage the financial exposure.

Within the compensation umbrella, our employers here in this country also have the duty to accommodate. So if someone does become sick or injured in this country, we have to accommodate them back into the workplace. If we fail to meet that mandate, then we are legally responsible for that as well.

So there is risk exposure within the compensation system here, not only meeting filing requirements, not only duty to provide work, but the accommodation function that extends beyond compensation legislation but crosses into human rights legislation and other areas of the law -- labour law, employment law. So we are apt to look at this from our client perspective.

We also provide assistance to the employees, because it is not only a risk exposure for a corporation when an employee goes off, but their pay is generally decreased down with occupational experience. As well as, most importantly, where there is a support tool to human resources and health and safety, it is our job to function within the corporate environment to meet the corporate environment's need in compensation management and to work with them with what they need to have done.

The first exposure I got to - I think - pure managed care, or in an area of occupational, was playing hockey: If you get injured in that business, they get you back to work pretty quick. They do a good job of it. I found out at a very early age that there were three elements in the success in reducing cost from compensation or even non occupational injuries: Functional ability, opportunity, and motivation. That is what it comes down to.

We are in a complex legislative scheme of legislation of rights for the employee, of rights for the company, but when it comes down to identifying one, what is the functionality of the worker? What can he or she do, and what can he or she not do? Opportunity: What will the company provide by way of opportunity? What opportunities is the employee willing to do? The last trigger is motivation.

Motivation is the true thing that you have to try to manage in order to reduce costs. Sports people come back quick because they are motivated to come back, they want to. They have some functionality to play, they have an opportunity if the coach gives them a chance, but they want to go out there and do it.

The element in a managed care system is managing motivation. I will talk to what we try to do in that regard as a facilitator between the corporation and the compensation system.

What we do is that the goal for us is not claims adjudication. The insurance board, makes adjudication decisions. It is based on policy. Do you or not meet the requirements to get compensation? It is a policy decision. If you have a psychosocial injury, you are not going to meet it because it is not covered. If you have a degenerative disc problem, you are not going to meet it, it is not covered. If you have an occupational injury, we know how we go through the test, it has to be work related and you go through your checklist.

They will make the decision on claims administration. We view our role as health management. Whether they approve or not approve it, it is a cost exposure for the company: We have to try to get this person back to work. We do not wait on claims to be managed, to be approved by compensation or to be approved by short term disability or whatever they sit. It is an exposure to the corporation, it is an exposure to the employee, and we begin the management process.

In a perfect world, we would have the person back at work before the Board makes a decision on whether it is approved or not approved, because we want to focus on the individual.

Return to work: We are facilitators. We do not control the process. It is not our program, it is the company. The company working with management and the union have to make a commitment that we want to work on functionality, we want to work on opportunity, and we are going to agree on how we are going to agree to motivation, when we are going to give this type of thing.

You have to be able to sit down and give them the tools to make informed decisions, that are governed by health and safety. We do not want to make a mistake by putting someone back quickly to reduce costs, but to expose us over here to a hazard. That is bad business, it is bad law, it is bad policy.

We have to do it in approval of medical governance that is supported. There are checks and balances, and due diligence is done to make sure that this is the right fit.

Our role is (inaudible). They will make the decision if you meet the policy or not. We are not the company doctors or the company lawyers or the company anything. We look at independent medical - to determine what is your functionality.

As an individual, we are going to assess your functionality and try to pair it up with the company to offer opportunity, and then to work on motivation. Our role is an objective medical function.

Building on that, the first thing that we have to do is give tools to the front line people. If an occupational injury happens, how does the process go? How does the compensation board make their decision? How do I, as a supervisor or front line worker who is being told to control costs or to watch this area or to reduce absenteeism, how do I get the tools to do it? So our front line focus becomes on the supervisor or the manager responsible for an area, to give them tools to make judgement decisions on what an individual can do with respect to functionality, and what would be appropriate with modified work or returning them back to the workplace.

We provide access to medical specialists. In some of the areas where we operate, whether it is in mining or industrial, not all the towns and communities have physiotherapists or kinesiologists or occupational therapists, or whatever. It is our role to ensure, to limit this process, that we have access to healthcare professionals, that the delays in receiving access to physio or to treatment is not delayed. So we try to manage process gaps.

Resolution of Issues: We try to take the company off the front line. It is not the company saying "You are going to come back to work", or the employee disagreeing to come back to work. It is the sort of the "getting to yes" approach to compensation management. We do not take positions. It is not "I can work" or "I can't work", it's "Why can't you work?"

We go through the issues of functionality or opportunity or motivation. We draw it back to interest. The same thing with management saying "I cannot give this guy work". It's "Why can't you?" You draw it back to interest, that you can then discuss. So it is facilitation of resolution through that. So we become facilitators in that role.

That is generally the magic trick of getting the days lost down to managing the costs, is moving people away from physicians in this area, which has been largely adversarial and largely positional, "can work" or "not work", into looking at these three components that I spoke of.

Then proactive medical programming, which we spoke of upstairs with the epidemiological data, then working to introduce elements that we can attack trends and patterns and absenteeism.

The keys to a managed care approach within compensation or managing occupational injury here, it is set out as I discussed. The first thing is the identification of functional abilities.

For a long time we used to hurry up and fill out the insurance forms, hurry up and fill out whether you are going to be approved or not, and allow decisions to be made in that regard. Then we would send the stuff off and wait. So now we are waiting, it is costing us. The ticker is now running. It is either a productivity issue, it is a cost issue, everything is going on.

So now the approach has been flipped. Now we want to focus on what you can do today. Functionality today. The employer has the obligation in this country to accommodate. Duty to accommodate does not start six months out. I want to try and accommodate you into the workplace. I am mandated to accommodate you into the workplace, and I am going to work hard to accommodate you in the workplace, identify functionality and bring you back. That becomes the goal of the whole process and the goal of reducing costs.

Available work opportunities: An issue when you are working with your unions or employees on this, that we cannot bring people back to do non-productive or not meaningful work. What we have to do is -- generally when we work with corporations is define what is reasonable. Well, reasonable is work that needs to be done, that we agree that has to be done for the company's benefit and it is productive. Then we go from there. And it works on the opportunity side of it, so we have the functionality side, get it right away, the opportunity side.

Medically support our role: That is for health and safety. Don't bring it back if you are going to jeopardize safety. We see that with some doctors, or insurance companies for that matter, that adjudicative policy. They will make a decision that this individual is no longer entitled to benefits, so they cut him off or they force him to go back to work.

From a health management perspective and from a health safety perspective, we have to look beyond whether this individual meets a policy, and whether this individual will cause harm to himself or to the workplace if we bring them back. So it is the matching of the responsibility.

They may not meet the requirements for compensation over here, but that does not mean that they have to show up on our doorstep and work the next day if there is going to be risk presented to the corporation. You have to pair that up.

Set realistic goals, then we medically manage. I am just going to give you a quick overview of how this process works. It is a process we use for one mining client.

To manage the compensation costs and the rehab side of it and to reduce costs, if there is an occupational injury, the first element, the first goal, becomes to get functionality from day one. If the individual gets injured at work, we request that they go to the doctor. In some areas it is not generally a doctor, because they do not have access, it is to the Emergency. They get a functional ability form filled out by the doctor. That says: What can we do right now?

We expect the individual to come back to the workplace, unless they are in traction or unless they cannot do it. Theyer (sp) identification, and that begins the managed care process of compensation.

The doctors that we have done, we have done study groups across the country with physicians, they are happy with this approach, by just giving us the functional abilities of the individual, because they do not have to make the decision that this individual is not going to work for six weeks, or this individual is not entitled. We take the obligation away from them, because the people that truly know whether this individual is able to do work is not the doctor, it is the workplace, it is the supervisors, you health and safety people. It is the people that are in control of the process. You know what the jobs are, you know what the workload demands. What you need to know is functional information from the physician, and then we come back and we pair it up with the workplace.

If the functional capability evaluation is not good enough, then we will send for a more detailed assessment with kinesiologists or physiotherapists to have them follow up.

Once we identify functionality, it becomes managing the process through giving job opportunities. So, functionality, and the next thing is opportunity. If you have a job bank in your organization, then it's fine, you can pair them up. Put the workplace people back in control.

If you are going to be responsible for managing costs, if you are going to be responsible for reducing costs in this area, which are significant, it could account for 10 per cent of payroll in direct cost, then you have to have the tools to take control of this responsibility.

A job bank is wonderful. If you do not have a job bank, there is another thing called "Job Demands Analysis", which is a very simple form that you fill out. So when the worker comes back to the workplace, you have information to compare.

This is just again talking about the matching of the abilities towards it.

The bottom point there, to manage the process, in this country they call it the self-reliance model. Ontario refers to a self-reliance model of compensation, of managing costs and reducing costs.

The problem is that we have not put in the infrastructure or the tools and the support system to have self-reliance. You have to work with -- company people define what is self-reliance. What is your duty to accommodate? How do you accommodate? What forms do you need? What process do you have to go about doing it?

The bottom point there, which we work in developing with the unions and management, it is a form. So when the employee comes back in, they sit down and meet with their supervisor. They have their functional ability information and the supervisor's information on the jobs. We can have the nurse there or not.

They fill out a form. Together, they work on it: What can you do? What do you think you can do? Then we document it and we sign it. If we cannot come to agreement on opportunity, there is lack of motivation. Then we put it into the system and go back how we can get feedback. It puts process, it puts structure.

When we first introduced it, the union did not if they liked it, because it may be forced back, but then we went through it more. They liked it because it gave them a chance to have a say in documentation, so they were not being forced back, which makes sense. The goal is not to force anyone, it is to work together in the sense of a structure.

The next key in the managed care approach is to bring back to the workplace, particularly with the psychosocial injuries that we are seeing more and more of now, stress-related cases, the biggest key to get to is motivation. If we allow someone to sit out there with depression or stress for two months or three months, the chances of him coming back into the workplace drop right off the table.

The earlier we can get the individual back to have a meeting with their supervisor, the more likely we are going to have success. It could be a human resource issue, it could be a workload issue, whatever, but the longer that we allow them to sit out there without the contact back to the workplace, statistically we continue to see the delay. So the goal is, the earlier that we can facilitate that initial meeting, the chances of reducing cost go through the roof. That is the key, and then put governance and structure around this process.

Once the individual is back, we monitor weekly with the kinesiologist or physiotherapist or nurse. Again, it is communication with the employee (How did you feel doing your job this week?), communication with the supervisor (How was it engaged? How was everything working out? Where do we go with it next week, and what is our goals for next week?).

The whole structure, what we have done, and we have been working in the compensation business in this country for over a decade, that we are now putting more structure into this managed care process. The results over the last six months, including in the mining sector, have been significant.

Just a structure and a process where the self-reliance model, with some objective medical support on it, has achieved significant returns for the company.

The data side of it that we spoke about on the epidemiology side upstairs, it begins to give us patterns and trends. We recently went in for another mining client that just in the business of developing with. We looked in one area and they had 40 per cent absenteeism. That gives us a stack of what do we have the absenteeism for? Is it respiratory? Is it musculoskeletal? Where do we go with it? What are we targeting here? And what are we looking at trying to achieve here?

So we need to get more than just broad data about absenteeism or rates of absenteeism, and take it down to the next level if we are going to get proactive with reporting and information.

Scheduling efficiency with the data: With some of our clients now, with the compensation side they can log on to the Internet -- everyone has ".com" these days -- and find out across the country where the employees are off, when we expect them back, and the type of broad category of what is going on. So you can know whether the patterns are trends that are going on here.

We respect the confidentiality of medical information, but we get a broad overview so we can start making decisions on scheduling or efficiency of productivity across the system.

That becomes a reporting function for the client. They need to have the broad knowledge turned into stuff that they can manage, whether it is a cost element or a scheduling element or what-have-you, but we have to report back.

The management support, with the documentation, a lot of our clients ask us within the compensation system to tell us: Is it the employee that is not participating? Is it the supervisor that is providing the opportunity?

In some cases, it is the physician. The physician is a friend of the individual, or they do not want to give a medical, or they do not think the individual can ever work again, or whatever, and in some of those cases they are not helping the individual. So we look at non-compliance and report on it and follow up.

Basically the final thing that we are asked to do is to look at the health status of the individual to measure are we impacting. That is more of a qualitative assessment. A lot of our people from our programming, more that we talked about upstairs, as opposed to this return-to-work program, talk about the benefits of having structure, about the benefits of having: You understand what is going to happen; what are the steps in this managed process; what can I expect; where do we go next; and what are the returns.

The last thing for our corporate clients is to look at, if we put this in place, what is our return on investment?

We are able to quantify, based on what your return is on investment based on this intervention against guidelines, what would have happened if we did not do this process. It is based on industry guidelines to that effect.

What I attempted to do with the follow-up on the compensation reporting was just to give an overview of the managed care environment with compensation reporting here in this country, that there is success there, there is good initiatives going on. Most of the clients in corporations have started this in some way, but it just becomes putting more structure and more medical governance around it, and taking advantage of some opportunities that both the employee has, the right to be taken back to work, and the employer has, the duty to accommodate and working within this environment.

Thank you.

LIC. BLANES CASAS: No sé si haya alguna pregunta para el señor Mackenzie. Parece que fue muy claro en su exposición porque no hay preguntas, sin embargo él nos pidió que los disculpáramos porque tiene que salir a una reunión urgente, tiene que tomar un vuelo. Así que les ruego que despidamos al Sr. Mackenzie. Muchas gracias.

A continuación me permito presentar a la atención de todos ustedes al Sr. David Blumenstein, él es especialista en seguridad y salud en las minas dentro del Departamento del Trabajo en los Estados Unidos, de la Administración de la Salud y la Seguridad de Minas y específicamente en la Oficina de Información sobre Daños y Empleos.

El Sr. Blumenstein es licenciado en ciencias, Ingeniería de Minas por la escuela de minas de Colorado, tiene una maestría en ciencias del medio ambiente por la Universidad de Oklahoma, es ingeniero de minas y por 25 años empleado en el apoyo técnico de la administración de la salud y seguridad en las minas en Denver, Colorado.

El Sr. Blumenstein es especialista en seguridad y salud durante dos años con la oficina de información sobre daños y empleo de la administración y salud y seguridad en minas en Denver, Colorado. Recibamos por favor al Sr. Blumenstein.

MR. DAVE BLUMENSTEIN (MSH Specialist, Office of Injury and Employment Information, Program Evaluation and Information Resources, Mine Safety and Health Administration, U.S. Department of Labor): Good afternoon.

I represent the Mine Safety and Health Administration's office of Injury and Employment Information in Denver, Colorado. My task here today is to briefly describe to you MSHA's injury and employment and reporting system.

--- Slide Presentation

If you have not heard it yet, the mission of the Mine Safety and Health Administration is to administer the provisions of the Federal Mine Safety and Health Act of 1977, and to enforce compliance with mandatory safety and health standards as a means to eliminate fatal accidents, to reduce the frequency and severity of non-fatal accidents, to minimize health hazards, and to promote and improve safety and health conditions in the nation's minds. The Act of 1977 placed all mines in the United States under one law for the first time.

--- Slide presentation

Prior to 1978, the U.S. Bureau of Mines collected accident data for coal and metal and non-metal mines, but it was not mandatory for operators to report this data in a uniform way. The data before 1978 does not contain the great detail and consistency that the data since 1978 does.

The purpose of MSHA's reporting system is not to assess blame, but is to allow interested parties to identify trends within the industry. The incidence rates, or incidents per 200,000 hours of work, can be calculated, and different operations can be compared to each other in terms of relative risk.

The Act requires mine operators or their agents to investigate accidents and report the findings of the investigations and hours worked to the federal government. This system is not coordinated with a Workers' Comp program, so MSHA does not have the privilege of seeing Workers' Comp records when they are investigating these accidents. But MSHA inspectors can do Part 50 audits, where they interrogate and interview and so forth, to try to find out if accidents have not been reported.

MSHA has developed a system for administering this reporting. The system includes the mandatory reporting requirements, forms for recording accidents and employment, a database to capture the elements of these rules, and the publishing of detailed and summary reports of data. Much of this information that I am giving you is also available on the Internet, at "www.msha.gov".

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The reporting requirements are codified and titled "30: Code of Federal Regulations", or CFR, Parts 50 and 45. Part 50, enacted in 1977, defines the reporting requirements for mine operators. Part 45, enacted in about 1980, defines reporting requirements for independent contractors who do work at mines. All date reported by operators and contractors is commonly referred to as Part 50 data, even though the contractor portion is mandated by Part 45, because contractors must also use the Part 50 forms.

MSHA publication report on Part 50 is a guide to interpreting parts 50 and 45. This guide was published in 1986, and amended in 1988. The purpose of the publication was to answer some of the many questions the mining community had asked about parts 50 and 45.

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Injuries and illnesses must be reported on MSHA form 7001. Hours and employment and, for coal mines, coal production, must be reported on MSHA Form 7002.

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7001 forms are available from the MSHA district offices, and a supply of the form should be kept by the operator or contractor so that timely reporting of illnesses and injuries can be made. Hard copies of this form can be printed off of the MSHA home page.

Most of the elements of the 7001 form are specified in the Part 50 regulations.

It is kind of hard to see, but I will talk about each section so you can get the general idea of what the contents of the form is.

Section "A", at the top, is the mine or contractor identification data. The MSHA ID, which is put up here, is the key field for our database. The MSHA ID is assigned. It is the unique identifier that is assigned by MSHA to every operator and every contractor.

Section "B" asks for immediately reportable accident information. If the accident is of a certain type or if death or life threatening injury occurs, this section must be completed. About 10 to 15 per cent of all 7001 reports are for immediately reportable accidents. All other accidents or injuries must be reported within 10 working days of the occurrence or the diagnosis.

Section "C" asks for detailed information for all reportable accidents or injuries. This is where we ask for enough data about the accident so that we can group the incident with other similar incidents. Each item reported is assigned a code, which is entered into the computer database. We have developed a coding manual which is used by our coding clerks to interpret each item.

Item 9 in the form asks the reporter to describe the incident in his or her own words. This is a very important item, as it allows the coder to determine the class of the accident.

Section "D", at the bottom, asks for return to duty information. This section must be submitted when the miner returns to work after missing days or duties. If there are no days lost, it is submitted at the same time as the rest of the report. This section allows us to count the total days lost due to accidents and injuries. A day lost is defined by MSHA as "any day where a miner is scheduled to work, but he could not do 100 per cent of his normal duties". We do not count the day of the injury as a day lost.

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7002 forms are mailed out to every mine and every contractor before the end of each quarter, and are to be filled out and returned by the 15th day of the month after the close of each quarter. 7002 forms are available for online filing at MSHA's home page. Hard copies of the forms can also be printed off the home page.

The 7002 form asks for the average number of employees, the total number of hours worked, and for coal mines, the total clean coal production for each quarter. The form is further broken down into sub-units or place and mine. For example, sub-unit 1 is "underground", sub-unit 2 is "surface and underground", sub-unit 3 is "strip, quarry or open pit", sub-unit 30 is "mill operations at a mine", and sub-unit 99 is "office".

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Completed 7001 and 7002 forms are sent to the Accident Data Interpretation Branch, or ADIB, of the Office of Injury and Employment Information in Denver. ADIB clerks enter the data from the forms into a mainframe computer, which we call Sunguard, where the data is permanently stored. Once a week, new data is copied to a data warehouse, a separate memory, which we call "terra data". Terra data allows more user-friendly retrieval of the data by way of user defined queries.

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Part 50 data is public information except for the names and social security numbers of individual workers. For private enquiries, there is normally a nominal fee for researching and photocopying. For governmental and other institutional enquiries, the fee is usually waived, except in the case of some very large or time consuming searches.

The data is furnished to the public in several formats. Information reports, commonly known as IRs, summarize Part 50 data by many different categories, and are published yearly and are distributed upon request. An IR is published for each of five commodity groups. These groups are: Coal, stone, sand and gravel, metallic minerals, and non-metallic minerals other than stone.

Mine injury and work time quarterlies are published for each quarter, and are distributed on request. These quarterlies summarize injury and employment data by a limited number of categories for the calendar year to date.

A number of standard reports showing more detailed data for accidents, (inaudible) or employment is sorted by categories, such as state, district office, accident classification, work location of the mine, or mineral commodity, are published quarterly and kept on file in Denver. Copies of these reports and portions of these reports can be requested from OIEI, the Office of Information and Employment Information.

OIEI does custom searches on the Sunguard database and on the Terra database. Requests for searches are received from mine inspectors, mine operators, miners, unions, attorneys, universities, other government offices, mine equipment manufacturers and vendors, and anybody else interested in Part 50 data.

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You cannot see this data, but you can all have a copy of this. This table shows a one-page summary of all the injury and employment for all coal mines in the U.S. from 1973 to 1997. Data for 1998 will be final or closed in the next week or two, I am told.

The table shows, by year, the number of "fatal", "non-fatal with days lost", and "no days lost" injuries. It also shows the incident rates or incidents per 200,000 hours worked for each of these degrees of injury. Also shown are the total hours worked and the coal production for coal mines.

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This slide shows the same data for metal or non-metal mining, without the production figures. These reports show the most basic summary statistics.

The data can also be broken down or sorted by almost any item within the database.

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For example, this slide shows the trend in underground employment for all mines in the United States. The black bar shows the operator reported hours from 1983 to 1998. The white bars, much shorter, near the bottom, you can barely see them, show the reported hours for the same years for contractors.

What this graph shows is that underground operator hours have been trending downward while the contractor hours have been trending upward, but at a slower rate.

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This slide shows by year, from 1990 to 1995, the number of chemical injuries occurring in all U.S. mines. The injuries are further broken down into categories of source of injury.

For each year, the first bar shows the injuries due to contact with acids, alkalis or wet cement. The second bar shows injuries due to contact with other chemicals and chemical compounds not elsewhere classified. The third bar shows injuries due to exposure to coal and petroleum products, such as organic solvents.

These injuries can be further subdivided by route of exposure, such as skin, lung or ingestion, by type of mine, and just about any way you can imagine.

Part 50 data is used to determine the standings of mines in our sentinels of safety program. The sentinels of safety program is voluntary on the part of mine operators. Each year, participating mines with no loss time injuries and more than 30,000 hours worked, in each of eight categories, are recognized for their outstanding safety records. These mines agree to undergo special audits to ensure that all the work conditions have been met. This is the only case where MSHA inspectors can look at Workers' Compensation files, because the operators have agreed to do that, to participate in this program.

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As I mentioned, the MSHA home page provides summary sources relevant to Part 50, Reporting and Data. The complete title, 30 CFR, including Part 50 and Part 45 regulations can be found at the Statutory and Regulatory button that is on the left near the bottom. The Mine Safety and Health Act of 1977 is also there.

Electronic versions of the 7001 and 7002 forms are at the Forms and Online filings button. It is halfway up on the left. 7001 forms can be printed, filled out and mailed or faxed. 7002 forms can be printed and used or can be submitted electronically.

Some Part 50 data is available at the Statistics button. Summary mine, accident, injury, illness, employment and coal production statistics from the Mine Injury and Work Time quarterly for the last seven years are found at this site. Also found here are the raw Part 50 data files in year 2000 compliance format, beginning with 1983.

A new addition to this home page is found at the Safety and Health Information button, where we have a listing of details of individual accidents, injuries and illnesses reported to MSHA since January 1st, 1998. Every accident that has occurred since January 1st, 1998, is found there and indexed by MSHA ID. This list is frequently updated.

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Part 50 and Part 45, Reporting of Accidents and Employment, serves to allow MSHA inspectors and policy makers to identify trends in the safety and health component of mining. It also makes operators and contractors in mining aware of the negative impact of injuries on their industry.

This data is available to the public. For all serious enquiries, just go to the MSHA home page or contact OIEI at the address or phone number you see up there on the screen.

I encourage you to call or have somebody call us requesting some kind of a report. I will send each of you a quarterly report, just to get you started, to remind you to think about our data and to think about how you can benefit from it.

Thank you.

LIC. BLANES CASAS: A continuación tengo el placer de presentar a todos ustedes al Dr. Alberto Aguilar Salinas, que es el titular de la Coordinación de Salud en el Trabajo en el Instituto Mexicano del Seguro Social. El estudió la carrera de medicina en la Universidad Nacional Autónoma de México con especialidad en medicina del trabajo y maestría en salud pública.

El Dr. Salinas ha sido profesor en la propia Universidad Nacional Autónoma de México, así como en los cursos de especialización de medicina del trabajo e instructor de programas básicos de salud en el propio Instituto Mexicano del Seguro Social. Dentro de sus actividades profesionales destaca el haber sido becado por el Consejo Nacional de Ciencia y Tecnología para realizar estudios en el Instituto de Medicina en Edimburgo sobre neumoconiosis en los trabajadores de minas del carbón. Además ha sido funcionario internacional especialista en el área de salud en el trabajo de la Organización Internacional del Trabajo, la OIT, ha sido asesor médico de la Secretaría del Trabajo y Previsión Social y asesor académico del Centro Interamericano de Social.

Recibamos por favor al Dr. Alberto Aguilar Salinas.

DR. ALBERTO AGUILAR SALINAS (Titular de la Coordinación De Salud en el Trabajo, Instituto Mexicano del Seguro Social): Gracias por la presentación Sr. Blanes. Muy agradecido por esta distinción de participar en esta importante reunión de la industria minera.

La presentación que traigo para ustedes relacionada con este tema de compensación habla de la experiencia del Instituto Mexicano del Seguro Social en la materia. Está estructurado en una primera parte sobre información general del Instituto para que lo conozcan de manera similar a como escuchamos en la mañana al Sr. Wally Fox-Decent.

La segunda parte es la información estadística de los riesgos de trabajo en los últimos cuatro años 95, 96, 97 y 98 de la industria minera y por último la respuesta que el Instituto ha armado para cumplir con su misión de atender la salud de los trabajadores a través del programa estratégico de salud en el trabajo.

Por último un cuadro comparativo de convenios ratificados por México, Estados Unidos y Canadá en materia de la seguridad e higiene, condiciones y medio ambiente de trabajo en la industria minera.

Antes de empezar con la presentación en unos minutos quisiera mostrar algunos aspectos relevantes del Instituto Mexicano del Seguro Social.

México, como los países que están aquí representados al término de este milenio, vivimos un proceso muy dinámico en el cual se pretende mejorar la calidad de los servicios, los productos, la eficiencia y a hacer frente a todas esas exigencias cada vez crecientes, de la sociedad. Los mexicanos estamos orgullosos del sistema de seguridad social que tenemos creado desde el año de 1943 y actualmente con 56 años de vida en el cual precisamente para estar acorde con las situaciones actuales del país y de la población trabajadora y de sus familias ha vivido en los últimos años para acá un proceso de modernización muy intenso.

Cualquier empresa con tantos años de vida requiere revitalizarse, renovarse, buscar nuevas formas de brindar los servicios a su población afiliada.

El seguro social en 56 años lo ha hecho en repetidas ocasiones, más de 20 veces se ha reformado la ley, pero esta última reforma iniciada en 1995, ha sido la más grande, la más profunda, la más intensa al grado que hablamos de que tenemos un instituto del Seguro Social nuevo, porque tiene nuevas bases jurídicas, financieras, administrativas, nuevos enfoques y nuevos programas para cumplir con la responsabilidad social que tiene de brindarle servicios a su población afiliada, población que actualmente es de once millones y medio de trabajadores. Cubrimos o proporcionamos servicios a once millones y medio de trabajadores que laboran en 700,000 empresas las cuales están aseguradas al Instituto.

Consideramos que la fortaleza del Instituto radica en su estructura, estructura tripartita integrada por las empresas representantes de los trabajadores y sus organizaciones y representantes del gobierno. Tenemos en su infraestructura lograda durante 56 años de lo cual nos sentimos muy orgullosos más de 600 unidades médicas, 168 hospitales generales, 10 centros médicos, unidades de tercer nivel donde laboran 350,000 trabajadores.

Nacen en las instalaciones del Instituto; dos de cada tres mexicanos y se otorgan 800,000 consultas diarias a los trabajadores y sus familias.

En el área de la salud en el trabajo la integramos 2200 personas de las cuales 450 son ingenieros de seguridad, higienistas o técnicos, 700 médicos y enfermeras, trabajadores sociales y personal administrativo, alrededor de 2200 personas.

La misión del Instituto ha sido la misma desde que se creó en 1943, atender la salud de los trabajadores y sus familias es un elemento de su misión. El otro es otorgar las prestaciones que marca la ley, son tres tipos de prestaciones: prestaciones médicas, prestaciones económicas y prestaciones sociales.

Las económicas son las que vamos a abordar principalmente en este tema que están representadas por los subsidios y pensiones, específicamente las que se otorgan a los trabajadores de la industria minera.

En estos últimos años para poner al corriente, para actualizar al Instituto con las demandas de la población mexicana que al término del siglo vamos a ser 100 millones de habitantes se ha trabajado en tres líneas principales: la primera la reforma de la ley, como les mencionaba en un principio, tuvimos un debate durante un año, durante 1995 todo el año, para revisar y discutir la ley. Una vez que se aprobó por las Cámaras legislativas, la Cámara de Diputados y la Cámara de Senadores se puso en práctica el primero de julio de 1997.

Tuvieron que pasar un año y medio - todo 1996 y mitad del 1997 - para hacer una serie de ajustes a las normas institucionales, a la reglamentación interna del Instituto para ponerla en práctica el primero de julio de 1997. Lógico que también está en un proceso dinámico muy intenso.

La ley tiene cinco ramos de aseguramiento uno que es para enfermedades generales y maternidad, el segundo que es el de riesgos de trabajo, el tercero de invalidez y vida, el cuarto de guarderías y el quinto de cesantía, retiro y vejez.

Específicamente nosotros vamos a hablar del segundo ramo que es el ramo de aseguramiento por riesgos de trabajo e invalidez cuya nueva ley promovió una serie de modificaciones para estimular la participación de las empresas y de los trabajadores en materia de mejoramiento del medio ambiente de trabajo y para la prevención de accidentes y enfermedades de trabajo.

La prevención se incorporó a la ley en la reforma de 1973, hace 26 años y ahora después de 26 años con la finalidad de destacarla más se habla de la movilidad de las primas del pago que las empresas hacen al Instituto de acuerdo con sus índices de siniestralidad, de acuerdo con el índice de frecuencia y de gravedad de los accidentes y enfermedades del trabajo.

También la nueva ley incorpora nuevas figuras jurídicas en torno a la compensación, hablamos de la creación de comisiones médicas tripartitas para la revisión de dictámenes por incapacidad permanente, invalidez y defunciones.

La segunda línea de acción fue la reorganización administrativa, una nueva ley para ponerla en práctica, requería de reorganizarnos internamente en el Instituto, así se crearon siete divisiones regionales para acercar la toma de decisiones y hacer más ágil al Instituto, evitar el gigantismo, la centralización y la burocratización. Se trata entonces de agilizar los aspectos administrativos de cobranza, de toma de decisiones, de adquisiciones, de compra de insumos, etc.

Una tercera línea está dada por la modernización incorporando los equipos de procesamiento de datos, de telecomunicaciones adquiriendo médica. Como ustedes saben, va creciendo rápidamente y la incorporación de este nuevo equipo de cómputo de comunicaciones y equipo médico es precisamente para mejorar la calidad de los servicios y su eficiencia.

Esto como información general en torno a lo que es el Instituto que me honro en representar.

Un poco la información de estos cuatro años de la industria minera para hablar de la magnitud de los accidentes y enfermedades de trabajo.

La legislación laboral de México habla de que los riesgos de trabajo están integrados por tres elementos, los accidentes de trabajo, las enfermedades de trabajo y los accidentes en itinerario que son aquellos en que las lesiones que afectan a los trabajadores cuando van de su casa a la empresa y de regreso de la empresa a su casa. Esos tres elementos de riesgo en su conjunto se llaman riesgos de trabajo.

Aquí vamos a hablar solamente de dos elementos - de los accidentes y de las enfermedades de trabajo en la industria minera en estos cuatro años.

Tenemos afiliadas al Instituto. Este cuadro habla de las minas no metálicas, después vamos a ver lo referente a las minas metálicas. Minas no metálicas afiliadas al Instituto en el último año fueron 1400. En estas 1400 empresas trabajaron en 1998, 33,066 trabajadores habiéndose registrado 2163 casos de accidentes de trabajo y 141 enfermedades de trabajo.

Esto ha dado un comportamiento de esta tasa, un comportamiento que va hacia abajo con una tendencia descendente que nos habla de que existe una mayor participación tanto en el campo de los accidentes de trabajo como de las enfermedades de trabajo una mayor participación para el mejoramiento de las condiciones y del medio ambiente de trabajo.

Hay una preocupación mayor, hay una concientización por parte de los sectores de la producción para atender el asunto de los accidentes y de las enfermedades para proteger la salud de los trabajadores…este comportamiento, por accidentes de trabajo, dando una tasa de 104 incapacidades permanentes por cada 1000 accidentes de trabajo.

Las defunciones están en este renglón, han tenido este comportamiento, serán muchas o serán pocas con respecto a su tasa nosotros pensamos que cualquier defunción por accidente de trabajo es importante y todos los accidentes, todas las defunciones consideramos son susceptibles de prevenir, en el caso de las enfermedades de trabajo las incapacidades permanentes en la industria no metálica han registrado este comportamiento, un descenso importante y las defunciones por accidentes de trabajo lo mismo.

¿Cuál es el panorama en las minas metálicas? El último año teníamos 388 empresas con 32,458 trabajadores. Si sumamos las dos podemos decir que alrededor de 65,000 trabajadores laboran en la minería, según las cifras del Seguro Social.

En esta industria se registraron un descenso en los casos de accidentes de trabajo que se refleja en un descenso de su tasa, 5.4 accidentes de trabajo por cada 100 trabajadores expuestos, las enfermedades de trabajo de la misma manera han descendido, aquí con un incremento y la tasa también ha presentado una tendencia descendente.

La trascendencia, los accidentes de trabajo han originado este número de incapacidades permanentes y este número de defunciones, las enfermedades de trabajo por su parte también un número descendente de casos y de incapacidad permanente y un número descendente de defunciones.

Hay una situación muy particular que la contemplamos como una amenaza para el comportamiento de los indicadores, que lo hemos registrado en los últimos cinco años, un gran número de demandas de trabajadores de la industria minera que por alguna razón están siendo despedidos de la empresa ya sea por recortes de personal o por cierre de minas.

Tenemos por ejemplo en los últimos meses el caso de Coahuila, con un Arbitraje y ante las Cortes y que obligan a que se atiendan estas reclamaciones de prestaciones económicas por riesgos de trabajo que en su totalidad ascienden a alrededor de 40,000 en la República. Consideramos que es una cifra excesiva, una amenaza no tan solo para las empresas, porque esos datos afectan el comportamiento, la estadística de la empresa, sino también para las finanzas del Instituto.

Una vista rápida a las variables epidemiológicas más importantes, con respecto a la ocupación estas son las ocupaciones principales, las seis ocupaciones principales en las cuales se han reportado los accidentes y las enfermedades.

El 41% de mineros y canteros y casi el 20% en peones. Con respecto a la antigüedad de esos trabajadores es sorprendente que el 80% son trabajadores de menos de cinco años. Aquí nos habla de que se requiere una mayor capacitación del trabajador de nuevo ingreso que acumule experiencia para saber los riesgos a los que se expone, pero también para saber las medidas preventivas que debe usar para proteger su salud.

Las causas externas, las principales que se han registrado son estas cinco. Se muestran, los golpes, golpeado por o contra los objetos es lo principal.

Los riesgos físicos, en la estadística de estos cuatro años están representados por los métodos y procedimientos peligrosos así como los peligros que existen en el medio ambiente de la industria minera.

Por parte de las enfermedades de trabajo esta tabla nos habla de lo que escuchamos hoy en la mañana, los padecimientos broncopulmonares, las bronconeumopatías, dentro de las cuales la neumoconosis por sílice, silicatos y antracosis, antracosilicosis son las principales aunadas con los padecimientos auditivos, los trastornos del oído como es la hipoacucia o el trauma acústico.

Para atender la salud de los trabajadores mexicanos y con la experiencia de 56 años el Instituto construyó una estrategia nueva, las prestaciones económicas que le permitan al trabajador y a su familia sobrevivir cuando tienen un accidente, una enfermedad que los incapacita y que les impide trabajar pero que tienen que cubrir sus necesidades de alimentación.

Para cumplir esta misión establecimos cinco procesos fundamentales, estamos involucrados en la promoción a la salud lo que en inglés se conoce como: "Promotion at the workplace", que es toda esa información relacionada con educación para la salud que permita elevar el nivel de cultura médica de trabajadores a través del autocuidado de su salud.

Se les habla a los trabajadores del alcoholismo, del consumo de drogas, del tabaquismo, de la necesidad de realizar actividades deportivas, del ejercicio, de combatir el sedentarismo, se les habla también de programas de higiene, de alimentación, de la vivienda, de planificación familiar.

Junto con las otras áreas del Instituto tenemos tres áreas dedicadas a los aspectos de salud. Una es salud comunitaria, la otra salud productiva y la tercera es precisamente ésta, salud de los trabajadores.

Todo eso engloba el proceso de promoción a la salud. Su objetivo general es realizar acciones educativas. El segundo está relacionado con el mejoramiento del ambiente de trabajo, con eliminar o minimizar el riesgo para proteger la salud del trabajador y de esta manera evitar los accidentes y enfermedades de trabajo.

La tercera son los aspectos de higiene industrial y la protección al ambiente todo lo relacionado a la ecología que es el ambiente donde vivimos y donde nos desarrollamos todos, es el ambiente comunitario que tenemos que cuidar todos y que muchas veces se ve afectado por las emisiones o desechos de las empresas.

Estos tres procesos están encaminados sobre todo a los aspectos de salud, de atender al hombre sano, pero expuesto a riesgos. Los otros dos son de atender al trabajador lesionado o accidentado en empresas.

Empresas de alto riesgo, empresas seleccionadas por su comportamiento en sus tasas de accidentabilidad y los otros dos, el cuarto y quinto, son procesos que se llevan a cabo en el interior de las unidades médicas, en las clínicas y hospitales para atender al trabajador enfermo o accidentado y proporcionarle las prestaciones médicas y económicas que marca nuestra ley.

Para medir los resultados de todas acciones usando la metodología de procesos se han establecido los indicadores, indicadores de morbilidad, de días de incapacidad, el tercer indicador es de secuelas que es la incapacidad permanente sea parcial o total y por último el indicador de defunciones o de mortalidad.

Tenemos también el indicador de invalidez, la invalidez es el resultado de una enfermedad general que afecta tanto las condiciones, las capacidades del trabajador para realizar su trabajo, lo diferenciamos de lo que son los riesgos de trabajo que son los accidentes y enfermedades que se desencadenan en relación con el proceso de trabajo, las enfermedades generales son por ejemplo el caso de la diabetes, el caso del infarto del corazón, de embolias, todo ese grupo de enfermedades que no tienen una íntima relación con el trabajo pero que pueden generar secuelas muy importantes que impidan al trabajador realizar su trabajo y que por lo tanto, lo lleven a un estado de invalidez.

Para que se den ustedes cuenta de la importancia de estas prestaciones económicas, en estos dos años de vigencia de la nueva ley se han otorgado en total en la República 40,000 pensiones, pensiones de incapacidad permanente, pensiones de invalidez y pensiones de defunciones, por esas 40,000 pensiones en dos años el Instituto ha erogado alrededor de $1,300 millones de dólares.

Con la nueva ley esta cantidad tan grande de dólares americanos, perdonen pero no me alcanzó el tiempo para hacer la conversión a dólares canadienses, en el curso de dos adoras (sp) para garantizar el pago de las pensiones a trabajadores.

Esto es un procedimiento nuevo de la nueva ley, antes el Instituto garantizaba el pago mes a mes ahora junta el dinero de toda la pensión hasta los 72 años y los pone a disposición de empresas aseguradoras.

Por último quiero ponerles a su consideración esta lámina de las cuales seleccioné 13 convenios internacionales de la OIT relacionados con la materia que nos ocupa: la compensación y la industria minera, enfermedades de trabajo, el trabajo de mujeres bajo tierra, las horas de trabajo en minas de carbón, la seguridad social, el Convenio 102 se creó en el año de 1952, la abolición del trabajo forzoso del año de 1957, y en estas columnas se marca la ratificación de países. Éste ha sido ratificado por los tres, este otro estadísticas de trabajo también ha sido ratificado por los tres países en total, de estos 13 convenios internacionales Canadá ha ratificado ante la OIT 3 y denunciado uno, Estados Unidos ha ratificado 3 y México ha ratificado 12 con lo cual incorpora todos estos conceptos, todas estas disposiciones de sus instrumentos internacionales a su legislación nacional, por eso decimos que nos interesa a los mexicanos actualizar cada vez más nuestra legislación y nuestra reglamentación tomando en cuenta los avances, los conocimientos internacionales, los programas de cooperación técnica internacional y creo que si tenemos este importante marco normativo internacional que ha promovido la OIT desde el año 1919 es muy recomendable conocerlo e incorporarlo ahora en esta etapa del acuerdo laboral de América del Norte para promover su homologación, su estandarización y trabajar más para lo que es la salubridad del medio ambiente, la seguridad del trabajador y la cooperación internacional.

En este sentido también me complace mucho extenderles una invitación. Han visto seguramente en la mesa de allá afuera que existe un documento como éste que tenemos una reunión en Cancún con temas principales, la investigación en servicios de salud y la educación y capacitación en materia de salud y seguridad en el trabajo, para lograr mejores niveles de calidad y eficiencia en materia de salud y seguridad en el trabajo.

El programa está a su disposición en esas dos direcciones de correo electrónico y esperamos que esta importante conferencia continúe permanentemente y esperamos verlos a todos ustedes en Cancún. Muchas gracias por su atención.

Question Period - Période de questions - Período de Preguntas

LIC. BLANES CASAS: Yo quisiera aclarar que por parte de la delegación mexicana, los funcionarios federales no estamos autorizados a viajar a Cancún, pero todos los demás sí lo pueden hacer, no sé si haya alguna pregunta para el Dr. Aguilar Salinas.

NEW SPEAKER: I was very interested in the data about the young miners being a high risk category, those with less than five years experience. Does that parallel some of the United States' data?

Another risk group that we have identified is the supervisors who do jobs that are not routinely theirs. Do you have a similar pattern?

NEW SPEAKER: Quería pedirle al Dr. Aguilar Salinas una aclaración en la penúltima lámina que pasó, se menciona o entendí yo mal, examen médico a menores, trabajos subterráneos, pero en realidad en México el trabajo de menores en trabajos subterráneos, está prohibido, no sé si es una confusión por lo rápido que pasó la laminilla.

NEW SPEAKER: Bueno, se ha de referir usted al convenio 124 de la OIT que lleva como nombre el examen médico a menores en trabajos subterráneos. Efectivamente este convenio es del año 1965 y lo ratificó nuestro país. Yo creo que a pesar de que no trabajen los menores bajo tierra, pero pues existe la posibilidad de que se lleven a cabo los exámenes, a lo mejor, no sé porque se haya ratificado, si la legislación lo prohibe.

LIC. BLANES CASAS: ¿Alguna otra pregunta?

NEW SPEAKER: Sí tengo una. Es que en su lámina, en la de las convenciones de la OIT, ¿si hay política oficial o si se ha condenado? Y me imagino que quizá si usted no lo sepa en cuanto a los detalles de la política, el Lic. Blanes quizá pueda contestar esta pregunta.

LIC. BLANES CASAS: Bien, les puedo decir que por parte de la autoridad no hay como política ninguna limitación al hecho de que las mujeres entren en las minas salvo aquellas que se encuentren en estado de gravidez y en algunos casos en período de lactancia. Fuera de eso se ha incrementado la presencia de las mujeres en las minas en México y eso lo pudimos observar derivado del último apelativo de inspección a la industria minera en México.

Quizás también aquí el Dr. José Luis Lee es presidente de la Cámara Minera de México, les pueda explicar cuál ha sido el incremento de la presencia de mujeres dentro de las minas.

DR. JOSÉ LUIS LEE MORENO: Realmente hasta el momento no tenemos muchas mujeres que participen en trabajos subterráneos en minas, en México, de hecho tenemos ocho, y los trabajos de ellas se iniciaron a fines del año pasado en una mina muy grande de plata que tenemos en el Estado de Hidalgo. Los informes que tenemos del desempeño de estas damas en la minería son muy favorables en forma tal que se está haciendo ya una campaña de promoción para invitar a que más mujeres vengan a desempeñar algunos trabajos en las minas. Ellas por supuesto, se ocupan en sitios en donde no vayan a tener alguna limitación física dada su calidad corporal, están como operadoras de algunos equipos y la realidad es que se han desempeñado en una forma muy positiva y en ocasiones con mejor desempeño que su contraparte masculino.

NEW SPEAKER: I was very interested in the data of the young miners. They are a high risk category, those who have five years experience, because that parallels some of the United States data, but another risk group that we identified is the supervisors, pero hasta donde tengo yo entendido no es tanto la participación del supervisor como lo menciona usted. Pero no sé si los compañeros que conocen y que viven más en las minas pudieran ampliar la respuesta.

DR. LEE: Posiblemente la pregunta de la señorita está enfocada a la causa básica por falta de la supervisión adecuada, del grupo de gente que entra en la accidentalidad a menos de cinco años de la exposición, sí es una de las causas fundamentales de accidentalidad, definitivamente, la falta de supervisión adecuada en la indicación del trabajo preciso que va a desarrollar el trabajador.

Gracias.

Quisiera aclarar que también es el grupo más numeroso de la población laboral.

DR. AGUILAR SALINAS: Tal vez aquí sería bueno conocer la tasa, la tasa por los distintos grupos de antigüedad y nos daría un reflejo más preciso de lo que sucede.

DR. LEE: Quisiera agregar algo en relación con el trabajo de mujeres en minas. Anteriormente me referí yo específicamente al número de mujeres que tenemos hasta el momento en minas subterráneas, porque en minas a cielo abierto tenemos muchas más, creo que ni las podría yo contar en este momento, tenemos muchas mujeres trabajando en minas a cielo abierto.

LIC. BLANES CASAS: ¿Existe otra pregunta, alguna otra inquietud? En este caso, antes de ceder el micrófono al Sr. Geoff Bawden, para dar algunos anuncios, yo quisiera primero que nada agradecer la participación de nuestros expositores, el Sr. Mackenzie que se tuvo que retirar, el Sr. Blumenstein, el Dr. Aguilar Salinas. Agradecerles a ustedes, su presencia, su activa participación. Extender nuestro agradecimiento como grupo muy especialmente a todo el equipo de traducción que nos ha posibilitado llevar a cabo estas sesiones de trabajo, les brindamos a ustedes nuestro agradecimiento y agradecer también a todo el "staff" de apoyo.