BASIC OCCUPATIONAL HEALTH FOR MEDICAL OFFICERS

Training course for regional medical officers

organized by the World Health Organization

at the request of the Ministry of Health and Social Services of Namibia

LESSON PLAN

Swakopmund, 14 - 25 February, 2011

2

TARGET GROUP

Regional and district medical officers in Namibia

ASSUMPTIONS

Participants

- are medical officers from public healthcare facilities in Namibia. They have excellent clinical skills and experience, but no previous training in occupational health

GOALS and OBJECTIVES

Introduce participants to concepts, paradigms and approaches in Occ Health

Explain foundations on the important and common occupational and work-related diseases

Underline importance of multi-disciplinary approaches to diagnosis, exposure and preventive action

Underline the role and importance of long-term, sub-acute exposures in disease and disability development

Enable participants to reconstruct historic exposures in disease cases

Enable participants to understand reports on occupational health risk assessment

TEACHING METHODS

Use participants' experience and stories as much as possible to keep content concrete and relevant

Visualize a lot, work with films clips, and photos as much as possible

Keep lectures open for discussions and questions

TRAINING TEAM

Dr Ali El Sherif - Chief Medical Officer for Occupational Health, Ministry of Health and Social Services - course coordinator

Mr Thebe Pule - Regional Adviser, WHO Regional Office for Africa, Brazzaville - occupatiuonal hygiene

Dr Norbert Wagner, Program Director "International Program in Occupational Health Practice", School of Public Health, University of Illinois at Chicago (UIC), United States - occupatiuonal medicine

Professor Tony Cantrell - former head of Information Section, National Institute of Occupational Health, Johannesburg, South Africa - occupèational hygiene

Dr Ivan D. Ivanov, Scientist, Occupational Health, World Health Organization, Headquarters, Geneva, occupational medicine

3

FIRST WEEK: INTRODUCTION TO OCCUPATIONAL MEDICINE

DAY 1, MONDAY, 14 FEBRUARY 2011

Start Time

End Time

Durati

on

(min)

Activity/Content Topic

Training techniqu

e

Trainee activity

Aids required

Lecturer

8.30 9.30 60 Introduction and Course Overview Introduction of lecturers Introduction of participants: Introduction to Course Objectives, Format, and Materials

Describe known cases of occ diseases

Whiteboard or flipchart

Dr Ali and T. Pule

9.30 10.15 45 Introduction to occupational health Occupational Health - scope, issues and challenges Occupational health in Namibia - main problems Legislation and regulations for occupational health in Namibia (???)

lecture Copies of timetable and list of topics

Dr Ali and T. Pule

10.15 10.45 30 BREAK

10.45 11.15 30 The role of the medical officer in occupational health (Ivan) Role Responsibilities Skill mix Collaboration with occupational health experts

Lecture and discussion

Ivanov

11.15 12.00 45 Health surveillance of workers Screening Medical and exposure tests Health examinations

lecture Ivanov

12.00 13.30 90 LUNCH BREAK

13.30 14.15 45 Occupational health problems in major sectors Mining Agriculture Healthcare Small business, artisans

Lecture Ivanov

4

Start Time

End Time

Durati

on

(min)

Activity/Content Topic

Training techniqu

e

Trainee activity

Aids required

Lecturer

14.15 15.00 45 Introduction to occupational medicine (part 1) - How important are occupational diseases? - Occurrence, incidence, global burden of disease - Disease vs. accidents - Challenges in describing past and present and mixed exposures - consequences for preventive action, hierarchy of controls

Lecture Wagner

15.00 15.30 30 BREAK

15.30 16.30 30 Principles of Toxicology - exposure pathways - uptake dynamics - Metabolism and excretion - distribution, organ-specific affinity and storage

Lecture Wagner

5

DAY 2, TUESDAY, 15 FEBRUARY 2011

Start Time

End Time

Durati

on

(min)

Activity/Content Topic

Training techniqu

e

Trainee activity

Aids required

Lecturer

8.00 8.15 15 Introduction to Day 2: Common Occupational Diseases

Lecture Wagner

8.15 9.00 45 LUNG DISEASES - Physiology of respiratory tract - Overview, classification - Occurrence, incidence & prevalence

Lecture Guided discussion

Wagner

9.00 9.45 45 Occupational Asthma - pathomechanisms - occurrence, prevalence - causes, irritant vs allergic - dilemma of exposure assessment for allergic lung diseases - preventive action and control technologies

Lecture and discussion

Guided discussion

Wagner

9.45 10.15 30 Participants' presentation on lung diseases - Mapp 2001 agents old & new causing asthma OEM 354.pdf - Microorganisms in grain handling 9851_7.pdf

Presentation

LCD Wagner

10.15 10.45 30 BREAK

10.45 11.30 45 Dust-related lung diseases: Inert dusts: COPD - pathomechanisms - occurrence, prevalence - occupations Irritant dust/fumes: example Alveolitis - pathomechanisms, - inert vs., irritant vs biological substances triggering immune reaction - occupations, examples, - occurrence, prevalence

Lecture and film on dust exposures

Wagner

11.30 12.00 30 Respiratory protection with PPE - selection and use - limits and challenges

Lecture Discussion Pule

12.00 13.30 90 LUNCH BREAK

6

Start Time

End Time

Durati

on

(min)

Activity/Content Topic

Training techniqu

e

Trainee activity

Aids required

Lecturer

13.30 14.30 60 Mineral dust-related lung diseases Asbestosis and Silicosis - Causes, pathomechanisms and natural course - Occurrence and occupations - dilemmas in exposure assessment and exposure reconstruction for compensation cases (TLVs, "exposure years" concept)

Lecture Wagner

14.30 14.45 15 BREAK

14.45 15.45 60 Participants' presentation on lung diseases - COPD - USA risk assess death certif silica 122.pdf - Silica exposure assessment concepts - Asbestos exposure assessment concepts - Asbestos risk in industry

Student presentation and discussion

Wagner

15.45 16.15 30 Medical assessment of lung function and Fitness-to-work - Purpose and limits - Ethical considerations, conflicts of interest and challenges

Lecture Discussion Wagner

16.15 17.00 45 Discussion of short cases Fitness-to-work for employees with lung diseases, case discussions, dilemmas

Open full class discussion

Discussion

------------------------------------------------------------------------------------------------------------------------------------------------------------

7

DAY 3, WEDNESDAY, 16 FEBRUARY 2011

Start Time

End Time

Duration

(min) Activity/Content

Topic Training techniqu

e

Trainee activity

Aids required

Lecturer

8.00 8.15 15 Introduction to Day 3: Common Occupational Diseases

Lecture

8.15 9.00 45 Reconstructing a occupational exposure history in Occupational Health - challenge of reconstructing exposure - Mixed exposures: a challenge - Known facts about mixed exposure scenarios and their health effects, cases, literature - Challenges to measurement, description and interpretation

Lecture Guided discussion

Exposure history questionnaire

Wagner

9.00 9.30 30 Presentations of participants: SKIN DISEASES - skin diseases & infections & metal fluids 35.pdf - other article

Presentations

9.30 10.00 30 BREAK

10.00 10.45 45 SKIN DISEASES - skin physiology - common work-related skin-diseases - irritation vs allergy, definition of exposure - typical occupations - preventive action and control technologies - challenges in rehabilitation and reintegration

Lecture with pictures

Wagner

10.45 11.00 15 OCCUPATIONAL INFECTIONS Case discussions on typical occupations in working groups Exercise, discussion groups

Group work Case sheets and scenarios

11.00 11.30 30 Presentation of group work - presentation of results, discussion on occupational infections

Presentations and discussions

8

Start Time

End Time

Duration

(min) Activity/Content

Topic Training techniqu

e

Trainee activity

Aids required

Lecturer

11.30 12.00 30 Summary: Occupational Infections - typical occupations - prevention strategies, vaccination programs, - control measures, exposure pathway control (airborne, droplet, contact) - Health Care Workers

Lecture Wagner

12.00 13.30 LUNCH

13.30 14.00 30 Long-term Cumulative Effects of Selected Exposures (part 1) Health Effects of Physical Hazards Example: Noise - noise-induced hearing loss - non-aural effects of noise

Lecture Wagner

14.00 14.30 30 Example: Vibration - vibration-induced disorders and diseases - challenges in reconstructing past exposures

Lecture Wagner

14.30 15.00 30 Medical Surveillance Techniques reg Physical Hazards - role of audiometric testing vs. prevention - neurological testing, limits and value

Lecture Wagner

15.00 15.30 BREAK

15.30 16.15 45 Long-term Cumulative Effects of Selected Exposures (part 2) Example: SOLVENTS Presentations of Participants: - Case study toluene.pdf - Case study trichlorethylene.pdf - Encephalopathy overview - NEJM425.pdf

Presentations and discussions

16.15 17.00 45 Summary of Health Effects of Solvents - health effects nervous system - other organs: reproductive system, cancer, liver, kidney, heart - Medical Surveillance: biomarkers, reliability, limits and use

Lecture Wagner

9

DAY 4, THURSDAY, 17 FEBRUARY 2011

Start Time

End Time

Duration

(min)

Activity/Content Topic

Training techniqu

e

Trainee activity

Aids required

Lecturer

8.00 8.15 15 Introduction to Day 4: Long-term Cumulative Effects of Selected Exposures (part 3)

Lecture

8.15 9.00 45 Example: OCCUPATIONAL CANCER - theories of effect - assumptions and orders of magnitude of effects (Global burden of disease, WHO) - Typical occupational cancers and occupations - Challenges to prevention, concepts of risk and risk assessment - Classification of carcinogenicity of substances

Lecture Copies of categories

Wagner

9.00 9.30 30 Presentation of participants on Occup Cancer Two Articles TBD

Presentations and discussions

9.30 10.00 30 CLINICAL OCCUPATIONAL HEALTH Heavy Metals - clinical picture, symptoms - Occurrence, importance - Prevention and treatment options

Lecture Examples of Guidelines for medical surveillance

Wagner

10.00 10.30 BREAK

10.30 11.00 30 Long-term Cumulative Effects of Selected Exposures (part 4) ERGONOMIC WORK DESIGN Introduction: Discussion on qualitative and semi-qualitative exposure assessment challenges of work load

Guided discussion

Guided discussion

10

11.00 12.00 45 Example: MUSCULOSKELETAL DISORDERS - occurrence and importance - common causes, genetic, environmental/home and occupational - upper limb disorders, carpal tunnel, shoulder, elbow - back disorders

Lecture Wagner

12.00 13.30 LUNCH

13.30 14.15 45 MENTAL HEALTH Stress and Work Organization - Stress concepts, effects and strain, - demand & control, social support systems - consequences for work organisation - employee support systems in companies - effect of management & organisation styles

Lecture Discussion Wagner

14.15 15.00 45 CHRONICALLY ILL EMPLOYEES AT WORK Example: The mental health patient as employee - occurrence and importance - fitness-for-work considerations and ethical dilemmas - consequences for organisations - roles & responsibilities in the supervising and care team

Case presentation

Discussion

15.00 15.30 30 BREAK

16.00 17.00 60 Case Studies on chronically ill or performance-reduced employees (rehabilitation and re-employment) - diabetes - epilepsy - vision impairment - old age (medical aspects, ethical and social aspects, case management options in company)

Case presentation

Open discussion

----------------------------------------------------------------------------------------------------------------------------- -------------------------------

11

DAY 5, FRIDAY, 18 FEBURARY 2011

Start Time

End Time

Duratio

n (min) Activity/Content

Topic Training techniqu

e

Trainee activity

Aids required

Lecturer

8.00 9.00 60 ??????? requested ??????? TEST on Day 1 through 4 MCQs and essay questions

Lecture Discussion

9.00 9.30 30 BREAK Lecture

9.30 10.30 60 Occupational health information on the Internet Introduction, presentation of websites

Wagner

10.30 12.00 90 Practical Exercises in Information Sources IF internet access is available on site: work on internet If NOT: work with CDs from NIOSH and ATSDR

CD copies

12.00 12.30 30 Feedback and Questions

12.30 14.00 90 LUNCH

14.00 END

12

SECOND WEEK: BASICS OF OCCUPATIONAL HYGIENE

DAY 6, MONDAY, 21 FEBRUARY 2011

Start Time

End Time

Duratio

n (min) Activity/Content

Topic Training

technique Trainee activity

Aids required

Lecturer

8.00 9.00 60 Introduction to occupational hygiene - assessment and control of occupational health risks

Lecture Discussion Cantrell

9.00 9.30 30 BREAK

9.30 10.30 60 Physical hazards - health effects, assessment and

prevention

Noise

Vibration

Atmospheric pressure (diving)

Lecture Cantrell

10.30 12.00 90 Physical hazards - health effects, assessment and

prevention (cont'd) a. ionizing and non-ionizing radiation b. thermal conditions c. illumination

Cantrell

12.00 13.30 30 LUNCH

13.30 15.00 90 Discussion - how to use exposure data on physical risks for medical surveillance

noise

vibration

ionizing radiation

Discussion Ali and Cantrell

15.00 15.30 30 BREAK

15.30 17.00 90 Practical exercises Discussion Cantrell

13

DAY 7, TUESDAY, 22 FEBRUARY 2011

Start Time

End Time

Duratio

n (min) Activity/Content

Topic Training

technique Trainee activity

Aids required

Lecturer

8.00 9.30 90 Chemical hazards - health effects, assessment and prevention

Classification of chemicals

Labelling of chemicals

Chemical safety data cards

Occupational exposure limits

Lecture Cantrell

9.30 10.00 30 BREAK

10:00 12:00 120 Practical exercise

reading chemical labels

reading material safety data sheets

obtaining toxicological information about chemicals

using international chemical safety data cards

Practical exercise

Ali, Cantrell

12.00 13.30 60 LUNCH

13:30 15:00 90 Chemical hazards - health effects, assessment and prevention

Carcinogens

Allergens

mutagens

Lecture Cantrel

15.00 15:30 30 BREAK

15.30 16.30 60 Chemical hazards - health effects, assessment and prevention

pesticides

Cantrell

14

Start Time

End Time

Duratio

n (min) Activity/Content

Topic Training

technique Trainee activity

Aids required

Lecturer

16:30 17:00 30 Sound management of chemicals at the workplaces

Discussion Ali, Cantrell

15.00 16.30 60 Airborne particulates - health effects, assessment and prevention

Silica

Asbestos

Coal ???

Organic dust

Lecture Cantrell

16.30 17:00 30 Discussion - how to use exposure data on airborne particles for medical surveillance

Silica

Asbestos

Discussion Ali and Cantrell

15

DAY 8, WEDNESDAY, 23 FEBRUARY 2011

Start Time

End Time

Duratio

n (min) Activity/Content

Topic Training

technique Trainee activity

Aids required

Lecturer

8:00 9:30 90 Airborne particulates - health effects, assessment and prevention

Silica

Asbestos

Coal ???

Organic dust

Lecture Cantrell

9.30 10.00 30 BREAK

10.30 11:30 60 Discussion - how to use exposure data on airborne particles for medical surveillance

Silica

Asbestos

Discussion Ali and Cantrell

11:30 12:00 30 Overview of silicosis in South Africa

lecture Cantrell

12.00 13.30 60 LUNCH

13:30 15:00 90 Ergonomic stressors - health effects, assessment and prevention

Posture

Movements

Organization of the workplace

Handling of loads

Eye strain

Lecture Cantrell

15:00 15:30 30 Break

16

Start Time

End Time

Duratio

n (min) Activity/Content

Topic Training

technique Trainee activity

Aids required

Lecturer

15:30 17:00 90 Workplace health risk assessment - strategies and practical techniques

Walk through surveys

Use of practical tools and checklists

Preparing reports

lecture Cantrell

DAY 9, THURSDAY, 24 FEBRUARY 2011

FIELD VISIT TO WALVIS BAY

FISHING COMPANY

SANDBLASTING STATION

17

DAY 10, FRIDAY, 25 FEBRUARY 2011

Start Time

End Time

Duratio

n (min) Activity/Content

Topic Training techniqu

e

Trainee activity

Aids required

Lecturer

8.00 10:00 120 TEST on Day 6 through 9 MCQs and essay questions

test Cantrell

10:00 11:00 30 BREAK

11:00 12:00 60 Course evaluation

Evaluation of progress

Evaluation of course content, structure, lectures

questionnaires

Ali

12:00 12:30 30 Award of certificates and closure Ali

12.30 14.00 30 Lunch