A Roadmap to Combat Silica-tuberculosis

WorkshopFB - 1 of 32The relationship between silicosis and tuberculosis is complex and often challenging to address. Both lung diseases gravely affect communities throughout India and while many of the symptoms are similar, the causes and treatment plans for each are distinct. Tuberculosis is an infectious bacterial disease and unlike silicosis, can be treated with proper medication, whereas silicosis can only be managed, never cured. Conversely, silicosis is entirely preventable. The illness develops due to unhealthy exposure to silica dust, and so limiting this exposure dramatically reduces the likelihood of an individual developing the disease.

However, throughout mining communities in Rajasthan and Gujarat, a lack of awareness about silicosis combined with insufficient safety measures puts thousands of mineworkers at risk, many of which develop the disease and eventually are forced to stop working and die decades younger than otherwise projected. According to a number of national laws (the Workman Compensation Act of 1923, the Mine Act of 1952 and the Silicosis Rule of 1955) mineworkers have a right to a healthy and safe working environment, and workers who develop occupational lung diseases, like silicosis, are owed compensation by their respective state government. Therefore, unlike TB, a silicosis diagnosis ascribes responsibility for the health issue onto the mine site and the government.

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Silicosis is often confused with TB and miners are frequently misdiagnosed. Moreover, TB and silicosis are often co-occurring diseases—together named silica-tuberculosis—as silicosis significantly increases a patients vulnerability to contracting TB. This creates two key problems: 1) it makes it possible for a patient who has silicosis or silica-tuberculosis to be misdiagnosed as someone who only has tuberculosis, which voids their ability to access compensation for the occupational health hazards from which they are suffering; and 2) it further exacerbates the spread of TB, a disease that infects 9 million new patients annually and has been declared a global health emergency by the World Health Organization for nearly 30 years. Considering this, a joint approach is essential to properly address both silicosis and TB.

GRAVIS has worked to treat and prevent silicosis and TB for many years, and as part of their effort to advocate for better health in Rajasthan, especially within mineworker communities, GRAVIS organized a two day long workshop in partnership with the International Union Against Tuberculosis and Lung Disease in Jodhpur on July 6th and 7th to address the link between these diseases. The workshop joined together over 50 professionals from a variety of backgrounds, including medicine and public health, government and politics, non-profits and community organizing, and the mining industry, to share expertise and develop a roadmap to combat silica-tuberculosis.

Into the Field with Gravis

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Last week part of the GRAVIS team visited the field and met Gorakhram Bishnoi, the Sarpanch, or leader, of Mansagur Village in Osian Tehsil of Jodhpur District. His village consists of 566 households and nearly 3,000 people. As Sarpanch, Gorakhram Ji also acts as the president of one of GRAVIS’s 825 VDCs, which is comprised of about a dozen community representatives, almost half of which are women.

We spoke to Gorakhram about a number of topics, from Prime Minister Modi and crop failure compensation to the future of traditional drought mitigation technology. Generations of indigenous knowledge equip Gorakhram’s community with a variety of strategies for coping with drought, including storing emergency water supplies, grain and fodor as well as predicting drought patterns based on historical trends. However, Mansagur village also incorporates modern technology, like weather monitoring systems, that allow farmers to record the information necessary to prove their crops were damaged in order to receive compensation from the government. More remote villages who either do not have access to government data or whose local weather is inaccurately represented by that data (for example, if there is rain where the governments monitoring system is but not in a more remote part of the Thar) are unable to prove they are owed compensation when their crops fail. To help improve crop-failure reporting and communication between rural farmers and government officials, VDCs advocate for farmers in their village and ensure those who are owed compensation receive it.

GRAVIS is a unique non-profit in a number of ways, but their focus on community empowerment and the way Gram Swarajya—Gandhi’s principle of village self rule—is integrated in all of their programming is an essential ingredient to their success. Village Development Committees are a key component to GRAVIS’s commitment to this philosophy. Every village where GRAVIS works has a VDC, a group comprised of various community representatives that acts as an intermediary between GRAVIS and the rural community. VDCs have a range of responsibilities including managing village funds, selecting development initiatives, supervising projects and allocating wages and materials. 

The Future of Preventing Silicosis

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On June 23rd GRAVIS organized a comprehensive day-long workshop on Silicosis in partnership with the United States-India Educational Foundation (USIEF). A series of expert speakers discussed the nuances of the disease and its effects while specifically focusing on prevention and intervention strategies. The presentations covered a range of topics, from the link between Silicosis and TB to the way the disease affects female mineworkers as well as the best ways to prevent the disease from developing. The day concluded with a round-table discussion where workshop participants shared experiences from the field and opinions regarding the most effective preventative strategies.

Silicosis—a debilitating and ultimately fatal respiratory disease caused by inhaling silica dust and irreversible scarring lung tissue—threatens the lives of roughly 300 thousands mineworkers living in Rajasthan. Those working in stone mines are especially at risk to the disease because their working conditions consistently expose them to high quantities of silica dust. Consequently, silicosis is the result of the mining industry’s failure to adequately protect the occupational health of its workers. Once developed, there is no cure for silicosis, and patients suffer from shortness of breath and eventually become unable to work due to the illness. Although many workers are aware of the negative health effects of the mining conditions, they do not have the agency to leave their job because there are no alternative employment opportunities. Furthermore, drought and water insecurity force many villagers—who generally depend on agriculture for their livelihoods—to work in the mines despite the threat to health.

For the past two decades GRAVIS has worked extensively with mining communities in the Jodhpur and Nagaur districts, and during this time, silicosis has been a major health concern and an important focus of the organization’s development work. To combat the disease, GRAVIS programming provides diagnostic and curative medical services to at risk community members and organizes awareness trainings for workers, employers, medical professionals and government agencies. GRAVIS also advocates for the occupational health safety of mineworkers in Rajasthan and has been an essential actor in securing workers’ compensation for patients who have been disabled because of their exposure to silica while working in the mines. Some of GRAVIS’s major achievements in the past 5 years include providing medical care to over 68,000 lung disease patients, organizing over 500 medical outreach camps and over 130 advocacy seminars, establishing a major rural hospital in the Thar along with 4 satellite clinics, and conducting 3 research studies on silicosis and tuberculosis (GRAVIS’s most recent report can be found here).

World Health Day at GRAVIS: Collective voice for right to health


World Health Day at GRAVIS: Collective voice for right to health

Healthcare is a major priority for GRAVIS, in the health services deprived region of the Thar Desert. It addresses healthcare challenges at various levels with a strong focus on public health perspectives related to prevention and education, as well as research. Through a holistic and comprehensive programme on rural health, which includes interventions in the spheres of ageing, eye care, maternal and child health, nutrition, HIV and TB, lung diseases and non communicable diseases, GRAVIS combines qualitative medical services delivery with community-based health education, training and capacity building and research. On an important event like the World Health Day, GRAVIS wishes to deepen its commitment towards public health interventions with a long term vision, and aimed at creating community based models to be replicated in needy settings across the world. The event was organized by GRAVIS on 7th April in Bap town of Jodhpur District. It was addressed by Block Chief Medical and Health Officer and attended by Senior Medical Officer of Bap Government Hospital. Pradhan and Sarpanch from local government and various representatives from Village Older People Association and like minded organization have gathered at same platform to raise their voice to generate greater awareness about health of common man.

World TB day at GRAVIS: Solidarity Against the Disease


Globally, tuberculosis continues to be a severe public health issue. In India, the threat is even more alarming. India accounts for over a quarter of global TB burden. Over 2 million new TB cases are detected every year in India, with nearly nine million people in the country living with the disease. Hence, TB is a critical health challenge in India and needs a comprehensive approach to solve the problem. Continue reading “World TB day at GRAVIS: Solidarity Against the Disease”

Women March for Equal Rights on International Women’s Day

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International Women’s Day fell on Sunday the 8th March this year, and presented a valuable opportunity for GRAVIS to promote women’s rights issues in the areas in which we work. The day kicked off with a large demonstration in Soorsagar, a mining community on the outskirts of Jodhpur. Hundreds of women joined in on a protest march which travelled through the area, demanding equal access to education, food and healthcare for women of the local community. Continue reading “Women March for Equal Rights on International Women’s Day”