EDITORIAL

Training of Physicians in Occupational and Industrial Health:Present Position and Challenges

DR. ALOK VAJPAYEE

Chief Editor
Dean, Director-Professor & Head
Department of Occupational Health
All India Institute of Hygiene and Public Health, Kolkata
E-mail: dralokvajpayee@hotmail.com


I think there is nothing more challenging in the field of medical education than to train doctors in the field of Occupational & Industrial Health. The training programme and the curriculum are designed, keeping in view the aim of Occupational health, which is,”Promotion and maintenance of the highest degree of physical, mental and social well being of workers in all occupations.” A comprehensive training programme has to take into consideration preventive, promotive and curative health services and physical, psychological and social effects of health hazards in all the occupations. Occupational Health has a very vast field ; there are innumerable number of occupations posing a large number of physical, chemical, mechanical, biological, social and psychological hazards to the persons employed in these occupations, for example if we just consider chemical hazards, their list is ever expanding. Every day many new chemicals areintroduced in the industrial processes somewhere in the world.

Need for continuous review:
The industrial scenario is ever changing. New industrial processes are introduced and old ones become outdated. New process may bring new health hazards. This necessitates regular review of teaching curriculum in the field of Occupational Health.

Multidisciplinary teaching faculty:
Only in Occupational Health Department of a teaching medical institution we can find a public health expert, a toxicologist or biochemist, a safety engineer, a psychologist, a psychiatrist, a physiologist and an expert in the field of industrial legislation working together as a team. In no other medical teaching department we can find this much of variety. It is in true sense a multi-disciplinary field.

To mobilize such a faculty is also a challenging task. In India only All India Institute of Hygiene and Public Health(AIIH&PH) was having a complete range of experts needed for the teaching and training in Occupational Health. Unfortunately, at present most of these posts are vacant.

Instruments and other infrastructure:
In additional to a multi-disciplinary faculty a wide range of laboratory and mobile field investigation equipments are needed to train the physicians in this field. At AIIH&PH, we have fully equipped toxicology, industrial physiology and ergonomics laboratories and a display gallery for showing safety devices. A wide range of highly sensitive hazards detection equipments and psychiatric assessment tools are also available.

Teaching should not be limited to classrooms & laboratories only:
Without several visits to different types of industrial and non-industrial workplaces, training in Occupational Health is incomplete. First-hand knowledge at the site gives a very strong and lasting visual impression which no classroom teaching can provide.

Specially trained doctors are really needed:
It is really very unfortunate that in most of the industries (including the industries involving hazardous processes) a physician especially trained in Occupational and Industrial Health is not available. For many industrial managers employing an expert in the field of Occupational Health is a wasteful expenditure. Only an expert in the field of Occupational Health by virtue of his teaching and training is able to plan, execute and manage a comprehensive preventive, promotive and curative Occupational Health Services for an Industry, especially if the industry involves some hazardous process. A big curative hospital is not a substitute for comprehensive Occupational Health services.

Loopholes in legislations:
Loopholes in the legislations give enough scope to the industrialists for not employing a specialist in the field of Occupational Health. West Bengal Factories Rules, 1958 ( under sections 41 B, 41C & 112 ) , for example, empowers Chief Inspector of Factories to give exemption from employing an expert in the field of Occupational Health to even the factories involving hazardous processes, if a suitable candidate is not available for appointment. These loopholes need to be effectively plugged.At the same time there is an urgent need to strengthen existing Occupational Health departments and to open new such departments in different medical teaching institutions in the country. At present Occupational Health Department of All India Institute of Hygiene & Public Health (AIIH&PH) is the only teaching and training department in this field. Because of insufficient faculty, admission to Diploma in Industrial Health (DIH) course at AIIH&PH has been suspended for last several years. As a result, there is no supply of trained manpower in this field.

3 months’ short training vs. 2 years’ comprehensive course:
The field of Occupational Health is so wide that 3 months training is grossly insufficient to train a medical graduate in this field, but since doctors with DIH qualifications are not available and Factories Rules permit a doctor with just 3 months training in lieu of a DIH expert, most of the industries including those involving hazardous processes are forced to recruit occupational health physicians with just 3 months’ training.

AIIH&PH played leading role in manpower development:
Recruiting a multi-disciplinary faculty, maintaining ergonomics, toxicology and industrial physiology laboratories, organizing field visits and above all having a planned and updated curriculum and maintaining a good standard of teaching is really a very difficult task, that is why from 1951 till 2013 only the Occupational Health Department of AIIH&PH was able to provide an uninterrupted stream of qualified DIH physicians, holding Medical Council recognized diplomas.

Future:
With India opening its market and entry of multi-nationals, there is increased competition. The industrial scenario is changing very rapidly. New better manufacturing processes are rapidly introduced and old industries which are unable to compete are going to be wiped out. Old health hazards may be replaced by newer ones.Because of lack of social security, unemployment and lock-outs give more psychological stress to our workers than in the developed countries. We need a large number of expert Occupational Health physicians to prevent and control emerging health problems.

Mangers must be educated:
Mangers in the industries must also be educated about the importance of having Occupational Health Services. Although an Occupational Health Specialist directly does not produce anything but their indirect effect on production (through better health & productivity of the worker) is not less than that of a good industrial manager.

Conclusion

India having a vast industrial setup, needs a large number of well trained and competent Occupational Health experts to control and prevent occupation related diseases and to manage Occupational Health Services in the industries. At present we do not have any post-graduate degree or diploma course in this field. There is an urgent need to start post-graduate (preferablyMD)courses in this field as short courses cannot serve the purpose. Institutes like All India Institute of Hygiene and Public Health, Kolkata should be supported and strengthened by the Government to start such courses.