Treating rehabilitation Center # 2, 

Shakhty, Russia

 

During 70-80s last century in Rostov region the edifice for prevention of occupational diseases in mining employees (staged health examination from enterprise health unit to occupational pathology center) was developed and realized.

The hierarchy was developed: industrial sections (radiation therapy rooms and inhalatorium) ‒ health unit ‒ sanatorium-preventorium ‒ medical sanitary unit ‒ occupational pathology center.

Objective ‒ to assess the efficiency of system of staged periodic health examination for miners at the mining enterprises of Rostov region, to develop measures for improvement.

 

MATERIALS AND METHODS

Research subject ‒ occupational assistance and periodic health examination for mining industry employees. According to the given tasks, the different ways of periodic health examination for miners and efficiency of rendering medical and occupational assistance for miners were investigated.

The study was based on the mining enterprises of Rostov region. Bibliographic method and the results of the analysis of the occupational disease register from Rostov Regional Medical Rehabilitation Center #2 were used. There was a comparative analysis of efficiency of periodic health examination for miners at the different stages of industrial development in the Eastern Donbas for 1970-2013.

 

RESULTS

The research of twenty year experience of staged treatment and periodic health examination for miners showed appropriateness and high efficiency of the administrated methods for medical prevention of occupational diseases.

The prevention of occupational diseases was initiated at the enterprises immediately. All mines were equipped with radiation therapy rooms and inhalatoriums which were situated in the industrial premises. In the health units the preventive drug therapy was realized, particularly, vitamin therapy, inhalation and physical therapy, and dispensary observation for persons with initial stages of occupational diseases, sickly and long term sick persons were realized [1].

The presence of health and recreation resorts with the modern measures for drug, physiotherapeutic and balneological treatment allowed revitalizing almost all miners each year.

The uniform system of preventive measures was developed. It included medical employees, administration, work safety service, sanitary and epidemiological supervision territorial bodies, labour unions. It was organized through participation of engineer physician teams, with monthly sessions.

Factory's sectorial doctors realized full periodic health examination for both patients with clinical evident occupational diseases and employees with signs of harmful factors influencing on the body, initial signs of occupational diseases, sickly and long term sick persons who had some health disorders during periodic examination. All of them received appropriate outpatient and inhospital treatment in conditions of a medical sanitary unit.

The issues of prevention of occupational morbidity were discussed during weekly sessions of occupational safety with participation of enterprise’s director, factory's sectorial doctors and sanitary inspectors.

The engineering medical team performed analysis of occupational morbidity rate and morbidity with unpermanent disablement at the different industrial sites. It identified the relation between high rates of morbidity and unsatisfactory work conditions that allowed implementing specific targeted technologic measures for improving work conditions at different sites, i.e. real managing professional risks.

The team looked into the matter of rational employment for persons without ability to work in harmful conditions as result of different (including occupational) diseases [2].                                         

Already in 1976 Rostov Regional Center of Occupational Pathology developed and implemented the scheme for staged treatment (medical rehabilitation) for patients with occupational diseases including a health unit, sanatorium-preventorium, a station of Ministry of Emergency Situations, occupation pathology center station.

According to the scheme of staged treatment, persons with occupational diseases, including initial stages, could receive preventive medical and physiotherapeutic treatment immediately in the enterprise, and take a course of medical rehabilitation in hospital and health resort two times a year, particularly, at the expense of an employer [3].

The developed scheme allowed significant decreasing progression of an occupational disease and development of complications.

At the present time the role of employers in rendering medical assistance for the working population of Rostov region and other regions of Russia is brought to naught.

Since 1997 in Rostov region the number of medical sanitary units reduced from 44 to 4 in 2000, health resorts – from 38 to 2. There is no radiation therapy room and inhalatorium in the mining enterprises, no health unit activity in periodic health examination and preventive treatment for miners. Factory's sectorial medical services were reorganized into territorial services. The engineering medical teams were closed and forgotten [4].

The Labor Code does not include issues of employer’s responsibility for rendering medical prevention of occupational diseases in an enterprise and at the expense of own costs [5].

The order #302n, April, 12, 2011, by Russian Ministry of Public Health and Social Development does not include any regulations for development and realization of preventive and health precautions, including periodic health examination [6].

The order by the Ministry of Health of Russian Federation #911n, from 13.11.2012, “About Confirmation of the Order for Rendering Medical Assistance in Acute and Chronic Diseases” is an institutional document, in consequence of which the Application #1 “The Rules for Organization of Activity in Health Unit” has declarative character [7].

The coal industry is characterized with highly harmful and dangerous working conditions. Again, at the present time the main and almost single mechanism for prevention of industrial accidents due to human factor and prevention of occupational diseases are obligatory medical examinations.

The regulations for these examinations are extremely unsatisfactory. There are no developed criteria for efficiency estimation. Suspension from work for miners with medical contraindications is quite problematic in the coal industrial region, and it does not solve the problems of saving and strengthening health in the working population.

 

CONCLUSION

The performed analysis of the accumulated experience of staged periodic health examination for miners and analysis of the state of modern prevention of occupational diseases allowed suggesting the number of measures, which can favor saving health in mining industry employees:

1. Introduction of changes and supplements into the Labor Code and the medical regulations for realizing preliminary and periodic medical examinations (1 time in 5 years) in an occupational pathology center, with regulations of dispensary observation, medical rehabilitation and health promotion in employees.

2. Development of standards for activity of health units in mining enterprises, with giving functions for prevention of occupational diseases and employees’ health promotion, provision of appropriate equipment, material and staff resources; resumption of work of radiation therapy rooms, inhalatoriums and health resorts.

3. Return to the system of shop floor service for miners, using complete schemes of periodic health examinations, staged treatment and medical rehabilitation.

4. Development of mechanisms for financing in-depth examination and staged treatment of employees of high risk (long term working persons), individuals with signs of influence of harmful factors and initial signs of occupational diseases in conditions of occupational pathology center.

5. Realization of system for assessing individual professional risk, subsequent development and implementation (by means of employer and other legitimate sources) of measures for health promotion, prevention of occupational diseases and saving work longevity.

At that, the state, an employer and an employee must participate in realization of tasks for saving health and miners’ labor longevity.