By Wanmi Sui, Jinming Qi, Yuhan Sun, Chi Zhang
Pingxiang has transformed itself from an underdeveloped and agricultural-dependent village into a relatively strong economic power. It has experienced rapid social and economic growth that once allowed Pingxiang to become a prosperous city during the mid-20th century. In the 1950s, Pingxiang exploited its mining resources to the largest extent while turning the city into a leading iron, steel, chemical, and machinery industry.  Because of the excessive favor on capital over labor, the mining sector has witnessed the rise of a severe and irreversible occupational risk——pneumoconiosis. The lucky majority of the population naturally enjoy the astonishing development; what we forget is those who truly devoted all their youth, efforts, and dedication. They are the ones that are suffering because of the prosperity; they are the epitome of Pingxiang’s broken past, the neglected minority that is doomed to be disregarded.
The low labor environment protection standards, the decentralized taxation associated with inequalities between provinces, the surplus-labor load, along the household responsibility system all contributed to the surge of pneumoconiosis . Pneumoconiosis causes the lungs to undergo progressive and irreversible fibrosis, leading to substantial morbidity and mortality in the worst-case scenario. It is undoubtedly a devastating problem that has impaired millions of Chinese miners physically and psychologically, but what is less recognized is that pneumoconiosis is more of a ‘deliberate and social disease’ than a medical problem. It is a preventable disease that was ignored, covered, and hidden by the society. Pneumoconiosis patients gave up everything for the city, but they only received callous indifference from the society in return. As we often know, a physiological sickness requires biomedicine as treatment. Similarly, a social illness needs a ‘humanitarian prescription,’ which unveils the system of three levels of prevention. In a nutshell, three levels of prevention are public health policies that focus on disease prevention through actions at primary, secondary, and tertiary levels.
Primary prevention: Raising Awareness
Primary prevention is the way to prevent the disease before it occurs. For pneumoconiosis, it aims to protect workers from direct exposure to industrial dust while mining. In the past, most of the patients worked with private enterprises that never informed them about the long-term risk of exposure to the dust. Only very few of the workers had ever heard about protection equipment such as masks. Despite workers that worked in state-owned mines had better awareness due to more exposure to information, many of them were still reluctant to keep their masks on during work because of its inconveniency. Wearing masks would lead to mild breathlessness, which can impact miners’ efficiency and thus the amount of money they earn —— their salary was counted through the volume of the coal they mined each day. To tackle this problem, the Health Commission of Luxi County successfully introduces a series of training courses to arise awareness of the disease and educate employers about self-protection while mining. Nowadays, thanks to their efforts, state-owned companies and government agencies that required workers to wear masks have done a decent job in minimizing the number of new pneumoconiosis occurrences.
Secondary prevention： The ‘Three Earlies’
Secondary prevention includes three main parts: early detection, early diagnosis, and early treatment. It aims to reduce the impact of a disease when it first occurs. Unfortunately, secondary prevention was almost absent in the past few decades. Doctor Huang at Dengjiatian village clinic stated that no one knew about pneumoconiosis 20 years ago. Instead, people with pneumoconiosis were often misdiagnosed as tuberculosis. The village clinics did not realize pneumoconiosis until a patient returned from the town with a CT film and a pneumoconiosis diagnosis certification. In addition, many pneumoconiosis patients were reluctant to go to doctors when developing symptoms in the early stages for money-saving. They would only go to hospitals when their conditions became so awful that they had to be immediately hospitalized.
“We don’t even have enough money to feed ourselves; how dare we use it for medications?” the patient’s wife claimed with tears rolling in her eyes.
Along with the elevation of social awareness and the advancement of medical technologies, health centers broadened their knowledge about pneumoconiosis. Increasing number of medical institutions are available for patients to distinguish this disease from other diseases, such as phthisis, fever, or flu. They would recommend patients with any suspicious symptoms of pneumoconiosis to make a thorough diagnosis in more professional hospitals. If they have been confirmed to have pneumoconiosis, they will be documented in pneumoconiosis health recovery centers and be recommended to further service in higher levels of hospitals. More patients are now aware of their situation in the early stage of the illness, when they may not even start to feel severe breathing difficulty. They would begin to take medicines and do several recovery exercises according to their abilities to slow down the deterioration of their conditions and thus, suffer less pain from the disease in their inevitable fibrosis development.
Tertiary prevention: Limiting Complications
Tertiary prevention aims to alleviate the exacerbation of lung function deterioration after having the chronic disease. Pneumoconiosis health recovery is the most effective existing tertiary prevention approach. It benefits patients in two major aspects: physiologically and psychologically. According to a random sampling study in the health recovery center, the physiological status of patients can be much better after performing a routine activity following the doctor’s instruction. Meanwhile, communications between pneumoconiosis patients in the rehabilitation center are reliable sources of peer support.
In the health recovery center, patients can receive physiological recovery guidance such as breath training, nutritional suggestions, and recovery exercises. Most of the patients asserted that the recovery program brought them apparent benefits on their lung function. With these programs, patients would undergo a significantly slower rate of fibrosis, causing the lung surface to soften while becoming more elastic. Statistically, the improvements in lung functions are indicated by enhanced lung volume, increased lung capacity and stable breathing rates. According to Mrs. Xiao, the chairperson of the Pingxiang sector of a non-governmental organization Love Save Pneumoconiosis, one patient who received and persisted in a professional recovery routine had improved his health so much that he had not gone to a hospital for an entire two and a half year. Prior to his involvement in the recovery program, the patient had to be hospitalized once every month and 10-15 days each time. Because of this significant reduction of hospital visits and medical expenses, the patient managed to save at least 10,000 RMB annually, thanks to the role of the health recovery program.
“The health recovery center is an alternative home to the pneumoconiosis patients.” claimed the local recovery doctor in Pingxiang health center. In this recovery center, they can find a sense of belonging and security that patients can rarely experience alone at home. They meet new people and keep in touch with the olds; they get an opportunity to socialize and communicate with people with similar experiences. In addition, in the recovery center, they can receive professional advice from psychologists to quell their fear, anxiety, and depression. This health center is a shelter full of love and kindness; it has the potential to benefit a large number of pneumoconiosis patients. They are a cold and limpid pond of water among the arid desert, a precious treasure for pneumoconiosis patients.
The effect of recovery service on pneumoconiosis provided by the recovery center is now commonly accepted by the patients who have persisted. Many patients who had not heard about these centers indicate that they are willing to go to such a place if they had known it earlier. According to Doctor Li, a pulmonary disease physician working in Pingxiang Hospital of Traditional Chinese Medicine, out of the 20,000 or more patients in Pingxiang, only about 300 of them have involved in recovery program; yet, no more than 100 patients persist in going to the recovery center every week until today. If the existence and the benefits of the recovery center can be more widely propagated to pneumoconiosis patients in the future, an increasing number of them would be able to enjoy the luxury of lung function improvement. Pneumoconiosis has never been a distant social concern; behind the name are millions of people in China who are currently suffering. Although there is no cure for pneumoconiosis, it is still more than possible to alleviate the agony of patients through the use of ‘humanitarian prescription’– the three levels of prevention. It is conceivable that if health recovery becomes widespread in the future, pneumoconiosis patients will be given the opportunity to pursue a higher quality of life and live with less anxiety. In a larger social context, all levels of prevention paved the road for a comprehensive improvement and elimination of pneumoconiosis. Despite their immense contributions to the emergence of Pingxiang’s prosperity, these patients have always been the marginalized and neglected people that have not received justified treatments. Pneumoconiosis remains a social stigma that needs to be unveiled and treated with three levels of prevention. Pneumoconiosis patients are a vulnerable group that deserves the right to health, happiness and social inclusiveness.
1. Britannica, T. Editors of Encyclopaedia (2015, January 11). Pingxiang. Encyclopedia Britannica. https://www.britannica.com/place/Pingxiang-Jiangxi-China
2. Timothy Kerswell, Zhong Deng China Review, Volume 20, Number 1, February 2020, pp. 191-224 (Article)Published by The Chinese University of Hong Kong