FIVE STEPS TO FOLLOW ON DIAGNOSING AN OCCUPATIONAL DISEASE

1. Remove from exposure:

Once an occupational disease is suspected, the worker needs to be evaluated and the diagnosis confirmed. After discussion with the patient, the medical practitioner should write a motivating letter to have the person moved to a job that has no or minimal exposure or declare the person temporarily unfit to work (in the acute phase of the illness). The various options should be discussed with the worker and due consideration needs to be given to the worker�s rights under the LRA code of good practise. (Back to main page)

2. Institute appropriate treatment where possible:

Institute appropriate treatment (e.g. acute symptoms) and preventive measures (e.g. post-exposure prophylactic treatment or vaccination) for as yet unaffected workers. The treatment of occupational diseases is no different from treatment of these conditions from non-occupational causes. In certain situations of acute heavy metal toxicity, chelation therapy may be indicated. The more intense the treatment required (e.g. for asthma), the more pressing the need to assist the patient to cease exposure. (Back to main page)

3. Submit a claim for worker's compensation:

Submission of a claim under the Compensation for Occupational Injuries and Diseases Act (COIDA) follows a similar route as for an accident on duty, requiring First, Progress and Final Medical reports (specific for occupational diseases) with supporting documentation. The degree of impairment associated with the disease should be assessed and stated, where possible. The Compensation Commissioner is in the process of developing and publicising its criteria for compensation. For mineworkers with occupational lung diseases different procedures need to be followed under the Occupational Diseases in Mines and Works Act (ODMWA) for submission to the Medical Bureau for Occupational Diseases (MBOD).(Back to main page)

4. Notify the case to the Chief Inspector in the Department of Labour :

Medical practitioners are required by the OHSA to notify all cases of suspected occupational disease to the Chief Inspector, Department of Labour (Fax: 012-309 4382). This should also be done on form WCl 22 (see section 3 above). (Back to main page)

5. Investigate and treat the workplace:

The diagnosis of an occupational disease in a worker implies that measures at the workplace are inadequate and pose a potential health risk to co-workers similarly exposed. The incident requires investigation and prompt action.  The exposure should be evaluated by an industrial hygienist who has been certified as an approved inspection authority (AIA) by the Department of Labour. The employer or the workplace occupational health service should be advised to contact the Department of Labour for the approved list of AIA and their contact details. This evaluation will identify sources of high-risk exposure and provide recommendations for controlling the hazards either through substitution, engineering controls (eg. exhaust ventilation) and/or administrative controls (eg. relocation). This will contribute to decreasing the health risks to other, as yet unaffected, workers as well reducing the risk of disease progression among already affected worker/s.

Exposure monitoring using industrial hygiene surveillance programmes can evaluate the effectiveness of control measures in decreasing the health risk of as yet unaffected workers. It should be noted that personal protective equipment such as respirators are never used as first line control measures but usually as interim measures to prevent exposure to unexpected high ambient levels of hazardous emissions or aerosols.

The employer should also make use of the expertise of an occupational medical practitioner in designing appropriate medical surveillance programmes for the workforce as an adjunct to industrial hygiene evaluation and control measures. Various early sub-clinical biomarkers (eg. skin prick testing, serum antibodies, target organ tests) can be used to identify signs of early disease before overt symptoms and clinical disease manifest. These tests can also be used to assess the effectiveness of control measures instituted.

Education and training programmes are essential in informing and educating workers about the health effects of hazardous agents they are exposed to so that they may take the necessary precautions when working with these agents.(Back to main page)

Postgraduate Diploma in Occupational Health (DOH) - Modules 3: Occupational Medicine & Toxicology (Basic) by Profs Mohamed Jeebhay and Rodney Ehrlich, Health Sciences UCT is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 2.5 South Africa License. Major contributors: Mohamed Jeebhay, Rodney Ehrlich, Jonny Myers, Leslie London, Sophie Kisting, Gail Todd, Neil White. Source available from here. For any updates to the material, or more permissions beyond the scope of this license, please email healthoer@uct.ac.za or visit www.healthedu.uct.ac.za. Last updated Jan 2007.
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