The Return of Black Lung
The deadly disease thought to have been eradicated thirty years ago has made a nasty return, sending shockwaves through the Queensland mining industry. But did it ever disappear, or did the industry simply get lazy?
Coal Workers’ Pneumoconiosis is a chronic, incurable lung disease caused by the inhalation and accumulation of coal dust. The more common name of the disease, Black Lung, comes from the fact that the lungs turn from pink to black.
For many, there are no symptoms or noticeable effect on quality of life. But for those who have had longer exposure to the disease, or have worked underground for more than ten years, symptoms can include a chronic cough, shortness of breath, coughing up black mucus, high blood pressure, heart problems, and increased susceptibility to autoimmune conditions.
With prolonged exposure, the inhaled fine dust particles overwhelm the lung’s defence mechanisms. The particles accumulate in the parts of the lung where oxygen from the air is taken up by the blood and carbon dioxide waste is released from the blood into the air. This causes inflammation and scarring of the lung tissue. In the early stages of the disease these accumulations of coal dust and the affected lung tissue will show up as small rounded opacities on x-rays.
The longer the exposure to coal dust, the disease can progress to a more severe form, known as progressive massive fibrosis, which occurs when the coal dust accumulations and abnormal lung tissue lump together in larger lesions, causing the destruction of the lung tissue.
While smoking does not increase the risk of developing the disease, it can contribute to further destruction to the lungs. The only way to detect the disease is by analysing chest x-rays, which are mandatory for coal workers at the beginning of their career, and every five years while working in coal mines.
Black Lung was thought to have been eradicated from Australia in the 1980s. But, in November last year, Percy Verrall was the first Australian to be diagnosed in 30 years. And he certainly won’t be the last, with five other Queensland coal miners diagnosed since then, and several more awaiting results.
Percy, a former Ipswich coal miner, worked in the industry for thirty years. The 77-year-old featured in a heartbreaking film released in February by the CFMEU as part of their campaign, Dust to Dust: Make Black Lung History.
In the film, Percy and his family open up about life with Black Lung, and why they are fighting to make sure other miners don’t have to go through the same painful ordeal.
“I used to have a shower after work all the time, you know, and then one Saturday I said I’m going to drive home, I’m not gonna have a shower, I’m going to have a bath,” Percy says, reminiscing about his time in the mines.
“I took my shoes and that off outside, put them on the landing, and I was white from my hair up… my legs were pure white… The rest of me was black.”
He says back in those days dust masks weren’t worn – a safety failure that will haunt the mining industry with the return of Black Lung.
“When I was a miner I would be sitting there, and we would have the sprays going, but the water spray is not heavy enough to hold the dust down. You can see the dust floating back over the top of you. But the dust you see floating back over the top of you, is not the one that does the damage, it’s the real fine stuff you don’t see… And because they never used to supply masks or anything, and you are just breathing it in – and that’s what’s causing all the problems.”
While in the film Percy is at his home surrounded by family, his older brother Tom speaks of the horrific reality of the disease he witnessed while visiting Percy in hospital.
“The blood was like a waterfall coming out of his mouth, pouring,” Tom says.
“I’d take that one away (bag) and give him a new one… I took about four or five away…”
Percy’s son Greg says he took his mother to visit Percy at the hospital, and was so shocked by the condition of his father, he began preparing for the worst.
“I rang all my children, his grandchildren, and told him they better get down there. I said there’s a good chance he ain’t gonna come out… He was bad,” Greg says.
As Percy hears this information for the first time, he places his head in his hands, hiding his tears from the camera, clearly shaken by the effect the disease had on not only himself, but his loved ones.
“When the doctor was telling us about removing part of his lung… he (Percy) says I’m ready, I know this is coming, I’m ready for it. And he says about how he has had enough and he would like to take his own life… But I saw the terror in his eyes. He was terrified – I’ve never seen my father terrified,” Greg says.
“Not to downplay what’s happening to dad, but how it will really react on mum being left behind. That’s the part that really scares me. Mum’s never known dad not to be here… It’s gonna be hard to cope with.”
With that, Percy walks away unable to compose himself. He returns, but only to tell the camera he has had enough.
Since Percy’s case of Black Lung was made public, another five miners have been diagnosed with the disease. Another four miners were waiting for test results when this magazine went to print, and hundreds of chest x-rays have been sent to a doctor in the United States, who is properly qualified and has been heavily involved in the thousands of Black Lung cases in America.
“The government and the mines department know what’s gonna happen, and this is why we’re trying to get them to own up to it and say, yep, youse have got it, and change it so they can make it better for the new workers,” Percy says.
WHY DIDN’T WE LEARN FROM OUR NEIGHBOURS?
In the American mining industry, thousands of coal mine workers have been diagnosed. Today, it is estimated that 1500 former coal miners die each year in the US from the fatal respiratory disease, according to the United Mine Workers of America.
In 1969, after a huge industry wide strike, the US Congress ordered Black Lung to be eradicated from the coal mining industry. As a result, the new Permissible Exposure Limits for respirable coal dust was set at 3mg/ m3. In 1973, it was reduced to 2mg/m3 until August, 2014, when it was lowered further to 1.5mg/m3 – almost half of the Australian limit of 2.8mg/m3.
The compensation system and laws were also put into effect, compensating miners who had been disabled by the disease. Dr Robert Cohen began working with Black Lung in coal miners in 1988. He is the medical director of the National Coalition of Black Lung and Respiratory Disease clinics, as well as the medical director of the Black Lung Clinic in Chicago, and he works closely with the US National Institute for Occupational Safety and Health in the Respiratory Health Division.
He says the most recent laws finalised in 2012 and 2013 in the US allow for a 15-year presumption for Black Lung.
“That is, if a miner has worked 15 years in the industry and has a disabling lung disease, he/she is presumed to have Black Lung unless the industry can prove otherwise,” Dr Cohen says.
After it was revealed medical professionals in Australia were not qualified to properly diagnose Black Lung, Dr Cohen was tasked with the job of reading “several hundreds” of Queensland coal miners’ chest scans.
“We have been reviewing plain chest radiographs of coal miners which were taken as part of their routine medical exams. We are evaluating them according to the International Labour Organisation’s criteria to see if there may be signs of Black Lung or Coal Workers’ Pneumoconiosis,” he says.
Dr Cohen says Black Lung was probably never truly eradicated in Australia, and there could have been many undiagnosed cases up until now.
“It is a very difficult disease to eradicate completely so I would suspect that there may have been some cases. In the US the disease declined significantly after the passage of our dust control regulations until the late 1990s when the prevalence rates increased again.
“…it is estimated that 1500 former coal miners die each year in the US from the fatal respiratory disease, according to the United Mine Workers of America.”
Australia may have experienced a similar phenomenon,” he says.
“In the US we believe (the rising Black Lung cases) was due to overexposures to coal mine dust and some lack of attention to dust levels. We also believe it may be due in part to improvements in modern mining technology which allows the exploitation of narrow seams of coal which involves taking more rock above and below the seam potentially exposing miners to more silica.
“The mines which seem to have more of a problem are the smaller mines and contracted mines which perhaps don’t have as much to invest in health and safety technologies.
“I believe that a lower permissible exposure limit to coal mine dust similar to that in the US is appropriate (for Australia). The scientific literature indicates that levels higher than this are associated with increased rates of coal mine dust lung disease including pneumoconiosis, obstructive lung diseases, and lung function impairment.” The review is expected to be completed by the end of March to the many workers anxiously awaiting their results.
“I would caution that we should wait until the full review of the situation in Australia is complete before drawing any final conclusions,” he says.
“I would recommend that as much as possible miners should work with the health and safety officials at their mines to make sure that dust control measures including ventilation and water sprays to control dust are in place and operational.”
WHY IS BLACK LUNG BACK?
In the 1960s, a system was setup to monitor health issues affecting coal mine workers, but in the decades since, it is believed the mining industry has become complacent, leading to the breakdown of that system as governments and businesses fail to control their dust levels or carry out vital health checks for workers. The monitoring of coal dust levels has been proven to have slacked in recent years with Carborough Downs coal mine, where three miners diagnosed with Black Lung were employed, recording levels up to six times the legal limit.
Samples taken in a survey by GCG Health Safety and Hygiene at Carborough Downs coal mine revealed coal dust levels of miners not wearing a protective respirator recorded an average of 4.7mg/m3 in 2014.
But according to the data obtained by The Australian, one sample recorded an exposure to respirable dust of 6.9mg/m3, and another recorded 6.6mg/m3.
According to the CFMEU, there are a number of factors that have led to the re-emergence of this disease:
- Dust monitoring in mines has been left up to individual mining companies without independent checks, which has seen gaming of the system and long breaks in between dust level checks in mines.
- Health and regulatory authorities have become complacent when dealing with the disease, leaving no qualified B Readers able to review and identify Black Lung in coal mine workers.
- Without qualified health staff, a backlog of more than 100,000 workers medicals are sitting in a government office unchecked, leaving coalminers with the uncertainty of possibly living with Black Lung.
- Black lung takes time to set in, and workers who have long worked in the mines don’t receive the support they need to get proper health checks when they leave the workforce.
- With the supposed eradication of Black Lung decades ago, the community has forgotten about the insidious nature of this disease.
“TIP OF THE ICEBERG”
CFMEU mining and energy division district president Stephen Smyth says while there are six confirmed cases of Black Lung and potentially another 10-20 yet to be diagnosed, this is only the “tip of the iceberg”.
“At this stage it’s mainly become an issue in Queensland. I don’t doubt for a minute that other coal producing states like New South Wales, Western Australia and Tasmania are not isolated from having potential cases,” he says.
“This is really the tip of the iceberg. You throw into the mix 100,000-plus x-rays and health assessments unprocessed – it is a real concern.
“I don’t believe that we ever eradicated the disease and, in fact, people became complacent and stopped looking for it.”
Mr Smyth said said underground workers are being targeted for testing, as well as those who have retired.
“It’s important that if they have a concern or symptoms they need to see their doctor, they need to then ensure that if they have an x-ray it is a high quality one, and finally on some occasions they may require a CT scan. One of the problems is that we still don’t have the required people who can read these x-rays and at the moment the respiratory specialists are the only ones who can assist,” Mr Smyth says.
“We want the system to also look at those underground coal miners who may have retired, been made unemployed or put out with sickness, then those miners who worked underground and went to open cut, and the the open cut coal mine workers.”
He says the Australian mining industry should take a leaf out of the US’s book and introduce better healthcare, as well as lower dust levels.
“I know personally in the US they deal with around 2000 cases a year. So they have acknowledged that the disease is in the workplace. There is a different process in the US in which the companies and their doctors try to fight the miners getting compensation so that’s an issue,” he says.
“But they have world leading experts in the field of dust-related diseases, including Black Lung, they have the world’s leading experts in the diagnosis of this disease, and they have training standards and practices which far exceed the current Australian standard for this disease. They have established B Readers and data bases for doctors who have been trained and assessed as competent against the ILO standards for pneumoconiosis. Something we lack in Australia. We all continue to be told we have these people, when in fact we don’t.”
The CFMEU have started a campaign, Dust to Dust: Make Black Lung History, to educate and spread awareness of the disease.
“The aim of the campaign is to ensure that we actually fix the failed health monitoring and screening system, that we put a system in place for all coal mine worker’s present or retired to be able to access, that we fix the issues of coal dust in the workplace, that we get this disease accepted as a reportable disease and that we get compensation for those who may get the disease,” Mr Smyth says.
“We also believe that people need to be held to account over the failure of the system and why it failed.
“Enforcement will cost the companies little. They should be ensuring that money is no object when it comes to health and safety. They need to mine within the legislature requirements and if they cannot then they shouldn’t be in business – it’s quite simple.
“They all preach that safety and health is number one to them? Now the time for action over talk is required.
“We are aware at certain mines members of ours have been threaten with their jobs and in fact moved to other locations within the mine for raising safety concerns around dust levels. This has happened at Glencore, BHP and Anglo mines. As a union we want to ensure that our members can go to work and not be put at risk by the workplace or a system which is ineffective.
“These same workers should be able to have a healthy retirement, as well not have the effects of your working life destroy your quality of life in anyway.
“Samples taken in a survey by GCG Health Safety and Hygiene at Carborough Downs coal mine revealed coal dust levels of miners not wearing a protective respirator recorded an average of 4.7mg/m3 in 2014.”
“We won’t rest till we have achieved our goals and strategies with this matter and campaign.”
A Senate inquiry into the return of the deadly Black Lung disease was announced in February. The Senate select committee on health will hold public hearings in Brisbane and Mackay where they will investigate why the disease has made a comeback.
The Dust to Dust: Make Black Lung History campaign is seeking the following six clear commitments from Government:
- New legislation requiring dust levels to be monitored and publicly reported by an independent statutory body – identifying individual mines by name and company.
- Ensure suitably qualified “B Readers” review all x-rays taken of coal mine workers and fund a training programme in industry best practises for coal dust controls.
- Immediately clear the backlog of 100,000 outstanding worker medicals in Queensland.
- Healthcare and screening to be extended into workers’ retirement.
- Identify other at-risk workers by randomly sampling those with 15+ years service in the mining industry and performing checks.
- A community information program to encourage people in mining communities to be checked.
Watch Percy’s Story: