Vietnam, a country rich in mineral resources, is now in the process of rapid development. As a result, exposure to silica and to coal dust is a constant concern for labour, management and public health authorities.

Exposure to silica dust is common in many industries, including mining, foundries, the ceramic brick industry and quarries. Preliminary estimates indicate that many workers are exposed to silica. Vietnam is also rich in coal, thereby presenting coal workers/miners with the risk of pneumoconiosis induced by coal. In addition, a substantial number of other workers are potentially exposed to coal dust.

Fortunately, use of asbestos is limited in Vietnam, and no cases of asbestosis have been reported. Given the rapid industrialisation and long latency between exposure and development of asbestos-related respiratory disease, early monitoring of asbestos use is warranted so that long-term adverse sequelae can be prevented.

Different types of pneumoconiosis, such as silicosis and coal workers' pneumoconiosis, have long been recognised. Much is now known about how mineral dusts affect the lungs and about which levels of exposure to dusts are hazardous. Methods to prevent silicosis and coal workers' pneumoconiosis have been worked out, though each approach needs to be tailored to the particular situation and country in question.

Several groups in Vietnam, with interest in occupational health, have therefore begun to coordinate efforts in order to prevent silicosis and coal workers' pneumoconiosis. This step has yielded initiatives aiming to prevent silicosis and coal workers' pneumoconiosis. Described below are a series of steps directed at preventing pneumoconioses in Vietnam.

Recognition is the first step towards control of any hazard. Once the hazards presented by silica or coal dust have been recognised, the best available means for their control can be determined. Hazard recognition, however, must be linked with effective surveillance programmes and competent prevention efforts.

In order to promote occupational health, for the past two years several Vietnamese governmental agencies have been collaborating to form the National Occupational Safety and Health Information Network in Vietnam. An agreement on the organisation and activities of the National Occupational Safety and Health Information Network in Vietnam was formally signed on 12 February 1996 by the three principal agencies: the National Institute of Labour Protection of the Vietnam General Confederation of Labour; the Department of Labour of the Ministry of Labour, Invalids and Social Affairs; and the National Institute of Occupational and Environmental Health of the Ministry of Health.

The ultimate purpose of the Network is, in general, to strengthen the organisations dealing with occupational safety and health by pooling information on their resources, expertise and experience. If the Network is successful, its member agencies will work together and will coordinate national efforts and activities in the sphere of occupational safety and health. An important activity of the Network is to assemble data and to prepare a country profile of the occupational safety and health risks occurring in Vietnam.

Alongside establishment of the Network, the International Labour Organisation, FINNIDA and the Finnish Institute of Occupational Health have been providing assistance. Representatives of the US National Institute for Occupational Safety and Health have also recently visited Vietnam and are holding discussions with governmental agencies as to how the American organisation can best assist Vietnam in promoting occupational safety and health.

This broad spectrum of occupational health expertise and authority has also endorsed development of a sub-network focused on the prevention of silicosis and coal workers' pneumoconiosis. In parallel, the International Labour Organisation and the World Health Organization are working to make the elimination of silicosis a global priority (1). In addition, the University of Washington with support from the National Institute for Occupational Safety and Health has been working closely with the Vietnamese National Institute of Occupational and Environmental Health and the Finnish Institute of Occupational Health to conduct a course on the primary and secondary prevention of silicosis in Vietnam.

These groups consider that a programme having three major components needs to be implemented if occurrences of silicosis and coal workers' pneumoconiosis are to be reduced and eventually eradicated. Many of the steps involved can be taken in parallel.

Central to control and eventual eradication of pneumoconiosis is the control of dust exposures. All countries and industries are faced with limited resources. In order to prioritise ideal utilisation of the available resources, the profile of the exposure to silica and other mineral dusts needs to be determined. Important elements of the survey conducted for determining this profile include description of: 1) the types of industries and industrial activities resulting in exposure to silica or coal dust; 2) the number of workers exposed; 3) estimated dust levels; 4) the dust control methods currently in use (e.g. ventilation, isolation, dust suppression, personal protective equipment); 5) the facilities available to monitor dust levels (respirable dust, silica content); 6) the medical facilities for surveillance (chest radiographs, spirometry, occupational epidemiology); and 7) the number of workers with silicosis or coal workers' pneumoconiosis.

Initial steps were taken to collect these data from the regional representatives who attended the course entitled Primary and Secondary Prevention of Silicosis. Furthermore, an intensive survey to determine exposure to silica and the occurrence of silicosis is planned for a province having a number of quarries and from which cases of acute silicosis have been reported. Key challenges in this area are the need to develop a good database on occupational risks and the need to insure that all components of a good surveillance system (assessment of exposure including measurements of the respirable silica dust levels health assessments, occupational epidemiology, and centralised database with easy access both centrally and from the provinces) are available.

Needs assessment was done in conjunction with the course on Primary and Secondary Prevention of Silicosis that was held recently at the National Institute of Occupational and Environmental Health. The course itself followed, and built upon, an earlier International Labour Organisation Workshop on Pneumoconiosis that was given at the same Institute in 1995. Thirty physicians working in the field of occupational health attended the latest course. These physicians, who came from throughout Vietnam, had a very high level of knowledge. The course thus focused on building expertise in use of the ILO System to Classify Pneumoconioses and on integrating clinical and public health skills so that the course participants are equipped to conduct risk surveys and to make recommendations for prevention.

A second course is now in the planning stages (2). Efforts are also being made to ensure that important elements of any pneumoconiosis prevention system, such as occupational epidemiological expertise and the capacity to measure the levels of respirable silica dust, are widely available.

Pivotal to the reduction and eradication of silicosis and coal workers' pneumoconiosis is dust control. During the course on Primary and Secondary Prevention of Silicosis, Dr. Le van Trung outlined important steps and obstacles to prevention of silicosis. These include Components 1 and 2 above. In addition, however, the collaboration of industry, labour unions, and governmental agencies is necessary if success is to be achieved. Through such collaboration, methods of dust and hazard control including ventilation, dust suppression (wet grinding/wet drilling/wet cutting), and use of personal protective equipment such as mask respirators can be instituted. A key element of this component is follow-up of each intervention in order to determine whether it has been effective in reducing the workers' risk of pneumoconiosis. Activities of this type are described in greater detail elsewhere in this issue of the Newsletter, in the article by Dr. Erkki K„hk"nen and Ms. Nancy Beaudet.

Silicosis and coal workers' pneumoconiosis are recognised problems in Vietnam. With a view to developing a systematic approach for controlling and eradicating silicosis and coal workers' pneumoconiosis, a sub-network of the National Occupational Safety and Health Network in Vietnam has been established. This sub-network focuses on three initiatives, or components: Component 1) Hazard Identification; Component 2) Training and Infrastructure; and Component 3) Dust Control. During the coming year, the sub-network and its member agencies hope to construct a detailed country profile of the risks posed by silica and coal dusts, to conduct an in-depth risk survey into quarry operations, and to hold an additional training course.

Central to these efforts is the collaboration and coordination of a broad spectrum of governmental agencies through the National Occupational Safety and Health Network. Two employers' organisations, namely the Chamber of Commerce and Industry of Vietnam and the Central Council of Cooperatives Union and Small and Medium Enterprises of Vietnam, are also being invited to participate in the National Occupational Safety and Health Information Network. These initial steps are yielding tangible progress towards control. Nonetheless, there is a substantial need for additional support from international agencies.

1. Fedotov IA. The ILO/WHO International Programme on Global Elimination of Silicosis. African Newsletter on Occupational Health and Safety, April 1997;7:1:12 3.

2. Guidelines for the Use of ILO International Classification of Radiographs of Pneumoconiosis. Occupational Safety and Health Series, International Labour Organisation, 1980; No. 22 (rev).

Le Van Trung
Director
National Institute of Occupational &
Environmental Health
Hanoi, Vietnam

Nguyen Thi Hong Tu
Deputy Director
Department of Hygiene and Epidemic Prevention
Prevention
Ministry of Health
Hanoi, Vietnam

Scott Barnhart
Director
Occupational & Environmental Medicine Program
University of Washington
Harborview Medical Center ZA-66
325 Ninth Ave
Seattle, WA 98104
USA
E-mail: sbht@u.washington.edu

Updated by PAP/SUT/TRS. Approved by BKL. Last updated on 12 February 2001

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