Experiencias y vivencias de marmolistas diagnosticados de silicosis tras el mecanizado de aglomerados artificiales de cuarzo - life experiences of marble workers diagnosed with artificial stone silicosis

Abstract

Introduction: Silicosis resurfaces in our country with the machining of Artificial Stone (AS). The highest concentration of marble workers affected by Artificial Stone Silicosis (ASS) known in Spain, and probably in Europe is in Chiclana de la Frontera. However, new cases are appearing gradually inside and outside our country, though not at the extend presented in our area. In Chiclana de la Frontera five marble workers have died so far, two of them took their own lives. Despite being a preventable exposure in its beginnings, we are currently facing a relevant public and occupational health problem. The unknown process of how the disease will evolve is associated with serious complications over time and the suspicion of facing a more aggressive form than the classic silicosis. Since the disease affects young males after short but more intense exposure, this fact deserves deepen testimonies from those marble workers affected. Their personal and collective stories that are a true reflection of their perceptions, beliefs, behaviors, and emotions will help understand the inherent qualities of this grouping of cases that present a rare health phenomenon associated in time and space, where the commercialization of an innovative material, the countertops of AS, seems to be the origin of this silicosis resurface. Objectives: The general objective of this doctoral thesis consisted in delving into the experiences lived by marble workers diagnosed with silicosis after the exposure to silica during the manipulation of AS. Specific objectives included: 1) Identifying the origin of ASS in the province of Cádiz: exploring the working conditions of AS marble workers before developing the disease, to identify the exposure risks during the fabrication and the home installation of countertops; 2) Knowing the impact of ASS on affected marble workers: analyzing the impact the disease has had on the Quality of Life (QoL) and mental health of marble workers specializing in the machining of AS, as well as the consequences on their personal, familiar, socioeconomic and work environment; and 3) Detect the unmet needs of marble workers with ASS: collecting proposals for improvement that empower marble workers with ASS, to develop recommendations to strengthen the care and services received during the evolution of the disease. Methodology: A phenomenological qualitative study was conducted based on Heidegger's interpretative methodology. Between June 2016 and January 2017, 10 semistructured open-type interviews were conducted with male marble workers diagnosed with silicosis at the University Hospital of Puerto Real (Cádiz) after machining AS countertops and affiliated with the National Association of Patients Affected by Silicosis (ANAES for its acronym in Spanish) of Chiclana de la Frontera (Cádiz), Spain. The duration of the interviews was 60 up to 120 minutes with open-ended questions, digitally recorded and transcribed questions in full and verbatim providing anonymity and respecting the confidentiality of the participants. The interviews, once transcribed, were imported into the Nudist-Vivo 10 program to facilitate the coding process and the interpretation was continued manually. The profiles of the interviewees were established according to the following segmentation variables collected at the time of the interview: employment seniority, diagnosis, recognition of occupational disease, and employment situation. The data analysis was based on the methodology proposed by Taylor and Bogdan. Relevant areas delimited in units of meaning and coded in a preliminary list were identified, resulting in definitive codes grouped later into categories and subcategories, reflecting the content of the interviews. Both, the data collection, and the preliminary analysis of the study, was carried out by the main researcher, for which an external evaluation was carried out by an expert in qualitative methodology for the process of analysis of information, data and results, giving way to triangulation. The transferability of the results was strengthened with an adequate selection of participants chosen for their ability to provide relevant information and in sufficient numbers to achieve saturation of the information. Results: The participants had a mean age at diagnosis of 34,6 years and a working seniority in the ornamental stonemasonry guild of 11 years. At the time of the interview, 40% were diagnosed with complicated chronic silicosis, 30% did not have no recognized occupational disease and 50% did not working. Testimonials of marble workers affected by ASS revealed five main themes in response to the study objectives. When trying to identify the origin of ASS, three main themes emerged where two relevant subthemes were identified for each topic: 1) Heavy exposure while doing piecework were associated both with the boom in construction in deregulated environment labor, and the high demand for kitchen countertops due to the success and innovation of AS; 2) Poor working conditions in the workshops were reflected in the dry machining of AS without adequate personal protective equipment (PPE), the risk of exposure was even greater during the home installation of countertops and; 3) Concatenated legal transgressions, related to insufficient preventive measures and occupational health practices: deficiencies in prevention and health surveillance without safety conditions for the correct handling of AS. To assess the impact of silicosis, a main theme was detected: 4) the unseen disease, where five subthemes were identified: biographical rupture with loss of family role; personality conditioned by learned behaviors and social isolation; the stigma behind an invisible disease in its early stages; the greatest mental impairment in less advanced stages of the disease; and family dramas accompanied by death. To detect unmet needs, a main theme was identified: 5) The complaints after the homelessness, where four subthemes of interest were identified: job reinsertion was difficult by the crisis and the lack of knowledge of risk-free work activities; economic and labour problems aggravated by lack of institutional support; the polarity of mutual support not monitored by mental health services; and the medical-legal obstacles identified in the face of an emerging occupational disease. Conclusions: The results of this thesis demonstrate irregular procedures involving key stakeholders in the process of developing and marketing AS. As long as the laws that support these workers are not updated, marble workers diagnosed with silicosis will be immersed in legal proceedings against manufacturers, entrepreneurs, Occupational Risk Prevention Service (SPRL, for its acronym in Spanish), Mutual Work Accidents and Occupational Social Security Diseases (MATEPSS, for its acronym in Spanish) and Technical Social Security Inspections (ITSS, for its acronym in Spanish), to recognize their rights. The confrontation with an emerging occupational disease, ASS, forces efforts to achieve rigorous compliance with health surveillance, the prevention and protection of these workers and occupational safety and hygiene to avoid new cases and facilitate the diagnosis of sick marble workers who continue to work in the guild. The early detection of cases with early monitoring by mental health since marble workers are diagnosed with ASS, together with work facilities and economic benefits which may prevent unexpected deaths in the ornamental stonemasonry, hit by the commercialization of a material that should be banned for its toxicity, but is contradictorily rewarded for its quality and sustainability. This is the reason for the urgent need to establish strong control measures related to the risks of exposure to free crystalline silica detected during the handling of AS by marble workers to transform these small family businesses into safe and healthy work environments. In the meantime, routine inspections should be strengthened to ensure both the compliance and the protection of health survillance, not only in the workshops but also during home installation of countertops. In addition, there should be an investment in both intellectual and financial resources to promote synergies with the scientific community interested in investigating the natural evolution of the disease and concerned with discovering a curative treatment.