|Guide to Health and Hygiene in Agricultural Work (ILO, 1979, 328 p.)|
|6. Organisation of occupational health services and medical inspection of labour in agriculture|
|6.2. Practical organisation of agricultural health services|
As mentioned above, agricultural health services should be organised according to local conditions and needs. The type of service provided will therefore be based on as exact a knowledge as possible of these conditions and needs and of likely future developments.
In the first place, it is essential to ascertain as precisely as possible the number of full- and part-time workers, both permanent and temporary. This figure will include women and children, as well as those doing industrial work followed or preceded on the same day or during the same week by agricultural work. Inevitably, it will be virtually impossible to arrive at an exact figure, but information that is even approximately correct will be useful. It will also be necessary to know the number of persons needing medical supervision, and where they are to be found.
In the second place, the hazards to which workers in a particular area are exposed must also be ascertained. This is a very difficult task. However, fairly reliable results may be obtained with the co-operation of the various organisations which are in a position to know these risks-for instance, the service organisations (fire, civil protection, health and first-aid) and other bodies such as insurance institutions, if any.
While serious accidents, acute poisoning or the effects of particularly adverse working conditions are likely to leave clearly visible effects from which the degree of risk can be assessed, other hazards are difficult to evaluate (chronic conditions due to noise, vibration, cumulative poisoning, and so on).
Some form of administrative organisation for the reporting of risks is indispensable. This should cover all the aspects involved and be equipped to undertake statistical analysis. However, such organisations are often lacking in one respect or another, where they exist at all.
The attention of the medical profession should be drawn to the possible existence of chronic risks, since these often escape notice and, when discovered, are not reported to a competent authority qualified to assess them.
The same is true of epidemiological information, of which there is a world-wide lack. Admittedly, some of the chief epidemic or endemic diseases have been studied; but in all countries, even those with high sanitary standards, epidemiological research has been generally neglected. Investigations should be conducted at the local, regional, national and even international levels. As well as studying pathology in man and beast, the investigators may expect to discover reservoirs of infection in man, in domestic and wild animals and in the ecological environment, together with the vectors capable of transmitting infection. These specialised investigations could either be confined to one disease and cover a fairly large area or be confined to a small area and extend to all possible diseases. Their organisation calls for considerable resources and the co-operation of all the specialists taking part, and their preparation must be psychological, administrative and technical.
The purpose of psychological preparation is to draw the attention of the public authorities and the population at large to the importance of the investigation and the need for it, to persuade the authorities to give the investigators all the help they require, and to persuade the public to submit willingly to all the questionnaires and samplings to which they will be subjected. The population should be prepared by a campaign mounted by the health services (administrators, doctors, veterinary surgeons, social assistants), by propaganda in meetings and in villages, by the regional press and radio, and by various audio-visual demonstrations presented by educational or occupational bodies.
The administrative preparation involves approaches to ministries and subordinate organisations, to prominent persons or representatives of the people, and to educational, trade union and religious authorities.
The technical preparation comprises the mobilisation of the necessary staff and equipment. In addition to a permanent secretariat, the staff will consist of permanent technical personnel (bacteriologists, virologists, parasitologists, doctors or veterinary surgeons, ecologists (mammalogists, entomologists)) and tem- porary technical personnel (botanists, pedologists, climatologists, psychosociologists, economists, accident prevention specialists, industrial hygienists).
Financial resources should be made available for the necessary research equipment (sampling apparatus, marking apparatus, travelling laboratory) and the laboratories which are to examine the samples taken. These should be chosen for their competence and geographical location.
The investigation will include a general survey of the region, classifying its geographical, geological, cadastral, demographic, economic, social and medical features. Research may be planned and the human and animal diseases of the region explored on the basis of the findings of the survey. The actual study will consist of clinical examinations of people and animals, paraclinical investigations (allergies, radiological examinations, and so on) and sample-taking from people and domestic and wild animals (a carefully completed record card should accompany each sample).
The appropriate season should be chosen for each investigation according to its nature, and provision should be made for repeating the examination if necessary.
This epidemiological investigation can serve as a model for general health, traumatic and toxological investigations.
Of course, such investigations call for sizeable resources, and not all of them can be undertaken; but they may become possible in the future, little by little, depending on the resources available in the countries concerned. Even investigations of limited scope will furnish a wealth of information.
As part of the preliminary inquiries to be made before agricultural health services are established, it will be necessary to study the labour legislation in force, as regards the possibility of extending it effectively to agricultural workers, and to provide for the amendments and additions needed for the administration of agricultural health services. It will also be necessary to draw up an inventory of all the existing medical, veterinary and health services and their activities, as well as a census of other related professional and auxiliary personnel available to deal with the problems of agricultural medicine. Naturally, none of these activities can be undertaken unless adequate financial resources are available. The scale of the activities will clearly have to be adapted to the funds at the investigators' disposal.