EXERCISE 1

One of your patients, Joe Smith, comes to you with a disability claim form to be completed. He had been employed as an engineer in a metal refinery for 20 years, and has been on treatment for Parkinsonism for the past 6 months, after a prolonged period of intensive investigation. He has not, to date, responded to treatment and his company has decided that he should be boarded. He is 42 years old.

His employers, International Alloys Inc, produces metal alloys. According to Mr. Smith, there are several chemicals and metals to which he has been exposed over the years, but you establish that he has been exposed to both manganese and cadmium.

Questions:

1. Could either of these have caused his condition? Discuss the health effects of both, and the relevant pathophysiology.

2. Mr. Smith’s trade union contacts you, after negotiation with the employer, to ask if you would conduct screening on their members for the effects of these 2 heavy metals, and develop an information sheet for distribution to their members.

3. What health effects would you screen for, and how? Design a screening protocol.

• How could you assess exposure?

• What information would you provide to the union members?

4. To get back to Mr. Smith : what could be done for him, clinically and legally? What would you advise on the medical boarding issue?

5. The employers ask your advice on how to go about setting up an occupational and environmental health programme at the factory. What steps would you advise them to take, assuming that no measures were currently in place?

6. What are the South African standards for manganese and cadmium exposure and how do they compare to international standards?