Black lung has reared its head in Australia after a long period of obscurity from the public eye.
Since the 1980s black lung has been regarded in the same category of diseases as polio and measles, as something thought to have been obliterated from our public health landscape.
New standards for reducing particulate matter in coal mines were introduced, improving the overall health of coal miners, but how many cases have gone ignored over the decades?
A renewed public focus on the disease has revealed six workers, at the time of printing this issue, had been diagnosed with black lung, and more expected to follow.
Typically thought to affect those with extensive experience in coal mining, particularly during the 1970s and 80s, the ages of the men recently diagnosed ranged from veteran retired workers in their 70s, all the way down to a man in his late 30s.
The young age for some victims has alarmed unions in Queensland, and a new push is on to review the system of medical scrutiny for coal workers.
Each of the six miners diagnosed so far had worked in at least one of the Oaky Creek, Grasstree or Carborough coal mines.
The most recent case was an unnamed Middlemount man who had been working underground since the 1970s, and was diagnosed with the symptoms of black lung by Dr Robert Cohen, an America expert in the field of coal worker’s lung diseases.
Queensland will soon commence a review of the Coal Mine Workers’ Health Scheme (CMWHS) which will involve key industry and medical stakeholders
The CMWHS involves taking x-rays of workers’ chests when they begin work in the industry, a minimum of once every five years, and when they exit the industry.
Professor Malcolm Sim of the Monash University Centre for Occupational and Environmental Health, who has been assigned to head the review panel, says it appears there have been cases of black lung going undiagnosed.
“It looks like there are at least some of those cases, so the number of those we are unclear about at the present time,” he said.
The Queensland review will involve at least two experts re-checking old x-ray lung screenings from long-term miners.
“We want to look, in the first instance anyway, at the longer term miners as this is the group where, if there is a problem, it will be most apparent,” Sim said.
“There will be some hundreds of the existing x-rays that will be looked at. It might be four or five hundred, it might be more, but it just depends on how many of those are available, and how many we have the x-ray reports for that we can compare with.”
The report from the review was expected to be released mid-year, however Sim said he wanted to make recommendations about changes to the health program before then, with the committee ready to release interim findings within the first quarter 2016.
Speaking with Australian Mining in January, Sim said he thought it was important to highlight that it appeared there was a failure by employers to correctly fill out work history information.
“One of the limitations in the current system is there is a section in the medical form, which is meant to be filled in by the employer, which tells about the kind of work being done by the worker,” he said.
“There is a box on the forms for what’s called the ‘Similar Exposure Group’, the classification SEG, and a lot of the time that’s not filled in properly.
“So it really gives the people doing these medicals and x-rays little information about the type of exposure that people are having.
“It is really important, useful information, so we would certainly be encouraging the mining companies and people responsible for organising the medicals to ensure that information is filled in, because it really helps doctors down the track to detect and interpret anything they might find that is abnormal on the scans.
“It really is critical information… it gives the people doing the medical a better idea of the likelihood of risk, and if there is an abnormality this impacts on the likelihood of a referral.”
Sim said workers who are worried about the state of their lung health should be observant of symptoms such as shortness of breath, coughing, and possibly chest pain.
“Shortness of breath is one of the first symptoms, which is not an uncommon symptom, a lot of people get that as they get a bit older, so there are other things that need to be ruled out in that case,” he said.
In January state mines minister Dr Anthony Lynham said inspectors were working closely with all of Queenland’s 12 coal mines to examine coal dust issues.
“Eight mines over the past 12 months have been directed to either improve monitoring or bring respirable dust levels back into compliance,” he said.
The minister said one of the mines was exceeding dust limits, but refused to reveal which mine because it would be “inappropriate” because the mine might already be in compliance with acceptable dust levels, and because workers were wearing respirators.
Minister Lynham said he had written to Federal Resources minister Josh Frydenberg to raise the issue on the agenda for the national council of mining ministers.
He also welcomed action by the ANZ College of Radiologists’ in compiling a register of radiologists who can report to an International Labor Organisation (ILO) classification of radiographs of pneumoconiosis.
“Coal mine operators have offered their workers new chest X-rays and specialist analysis since this issue emerged,” he said.
“I encourage any past coal miner with a concern to discuss it with their general practitioner.”
CFMEU Queensland mining division president Steve Smyth and industry health and safety representative Jason Hill have joined the review committee as stakeholders, voicing their concerns that the health system has failed coal mine workers.
“The good thing is that we know we’ve got a problem now,” Smyth said.
“They acknowledge and accept that a lot of work has got to be done to review the respiratory aspects of the health scheme.
“I think industry is accepting of that but from the unions’ perspective, I don’t think we ever really eradicated black lung, we just stopped looking for it.”
Smyth has raised issue with the possibility that Australian radiographers, while qualified to read x-rays, are not correctly accredited as competent to review and recognise early stage coal miner’s pneumoconiosis.
“There are set standards globally that health professionals need to be trained to a certain level of competency according to the International Labour Organisation,” Smyth said.
“The standard for identifying pneumoconiosis is the B-reader standard from the National Institute for Occupational Safety and Health in the US.
“Unfortunately since the late 70s the US had about 70,000 people die from pneumoconiosis, about 2000 cases every year, so they’ve established the standard against the ILO, and the standard is very high because the accreditation has to be retested every four years.”
“We certainly have trained and qualified radiologists here who can read x-rays, we don’t dispute that at all, but we don’t have people accredited to read these X-rays to a B-Reader standard,” Smyth said.
Smyth said that the biggest difference between Australia and the US was that B-readers in the US dealt with cases of black lung on a regular basis, and were more experienced and better qualified to identify the disease.
“That has been proven by the number of cases that have all been confirmed in the United States [after Australian X-rays were sent there] or have been confirmed by a lung biopsy, which is a very invasive procedure,” he said.
“It’s a terrible state of affairs when here in Queensland in the 21st century we don’t’ have qualified people that can read these X-rays, it’s a disease that has been around since the 18th and 19th centuries.”
Professor Malcolm Sim disagreed about the capabilities and training of Australian radiographers, suggesting the problem was more about the lack of context provided to radiographers.
“We have very good radiology training in this country,” he said.
“We have the Royal Australian and New Zealand College of Radiologists, which has a four year training program with difficult assessments and exams…there’s not a problem in this country with radiologists being able to read x-rays.
“What’s become apparent to me is they are not being given the information in many cases, that this person is a mine worker, that it’s part of a screening program, and when you’re looking at an x-ray from a diagnostic point of view, there may be minor changes that you think are not clinically significant, but in terms screening and detection of a particular disease, then you may report in a different way.”
Sim said he had spoken with the incoming president of the college of radiologists and reached an understanding that they would work together to tighten up the system and ensure that diagnosis was done in the right context.
Sim said the review would look at a range of issues to improve the current system, including quality control of the respiratory function test, or spirometry.
“For many of these respiratory conditions it’s the one function test that can indicate the first sign of a problem, not necessarily at x-ray.”
Sim also stressed that the level of concern from minister Lynham and those in his department showed their commitment to solving the issue.
“We have set up a reference group of all stakeholders, including two companies from the industry, the Chief Health Officer from Queensland, she is very concerned about it as well, as well as the minister and his department as well.
“One message that came through very strongly that people feel there has been some complacency about this, as it felt like it was something which had gone away, and I think that was right across the board, across all stakeholders, the companies, the trade unions, the medical practitioners and the government, and I think everybody has become very interested in it now.”
Queensland Resources Council chief Michael Roche said the QRC supported a government review of the CMWHS, and looked forward to the recommendations.
“The top priority is the health and safety of mine workers and the resources sector is committed to their protection,” he said.
“Queensland coal mines have a rigorous and transparent system of compliance with standards for dust levels and industry will continue to work closely with the department to ensure compliance.”
In February former Department of Mines inspector Kevin Clough said in an interview with The Daily Mercury that he was not surprised by new reports of the disease in the industry, and that he had been “expecting it for years”.
Clough said that during his time as a mining manager at mines in NSW and Queensland, he knew of some workers who did not wear appropriate personal protective equipment to protect against inhaling coal dust.
“You could tell them to wear the mask, and they’d wear them while you were there but then they’d take it off,” he said.
“Through the years, you’d have a downright argument with the boys – ‘you wear the mask’; ‘I don’t want to wear it.'”
“Ninety per cent of them did [wear dust masks], but you’d always get one or two that would say ‘I’m fine, I’m bulletproof’.”
Clough said it was that type of refusal to wear PPE that had contributed to the re-emergence of black lung in the industry, but that workers were not the only ones to blame.
“The workers contributed to it, the companies contributed to it and the supervisory staff contributed to it,” he said.
Clough, a 42-year veteran of the coal mining industry, said that in his early days he had been made aware of the risks by experienced colleagues.
“If it was too dusty (in an area of the mine), the old fellas would haul you back,” he said.
However, Clough suggested that during the 1980s many experienced miners left the industry, and an influx of inexperienced labour were unaware of the risks of coal dust.