In the September edition of Medical Forum, we delved into the issue of silicosis, the deadly group of lung diseases that has recently re-emerged and have the potential to be a major public health concern. As a result of that report, we have had the opportunity to speak to someone who has been diagnosed with the disease and speak to regulators in more depth about the threats posed to public health through exposure to silica-based products, such as engineered stone.
Garry Moratti is a 51-year-old stonemason who worked in the sector for over 33 years, starting at the age of 15 years.
Garry recalled the day of his diagnosis.
“It was about three years ago and just a day before my birthday, on 22 May, 2017. I started to feel funny and I collapsed at work and they took me to the hospital and that’s when I learnt I had silicosis.”
The diagnosis has drastically changed Garry’s life.
“I haven’t been back to work since because I just can’t do anything. It’s affected my family. It’s affected me, I suffer from depression and anxiety and, for me, there’s only one cure – a lung transplant.”
“I’ve got about 30% of my lung covered in silicosis – I am actually one of the lucky ones. I don’t know how I got out of it so easy, to be honest.”
Garry blames the engineered stone, which entered the industry around 20 years ago, as the culprit, and he wants to raise awareness of the dangers of the working with these high-silica compound products.
“I’ve got silicosis and there’s not much I can do about it, but I want to get a point across to those people working in the industry how dangerous working with engineered stone can be.”
The cruellest cut
Silica dust is created by the cutting of engineered stone and Garry says there was no awareness of its dangers when it began being imported into Australia. Workers were using the same dust masks as for marble and granite when specia ldust masks were apparently required.
Engineered stone has become prolific in the Australian marketplace because it is cheaper than actual stone products such as marble and granite, which have a much lower silica content (marble ~ 2%, granite ~ 30%, engineered stone ~ 90%).
Garry believes the real cost is being paid by the workers exposed to the respirable silica dust.
“You shouldn’t really even get this stuff on your skin. Even if you’re cutting wet, you get wet all day with the dust. Soon as you dry out a bit, the dust is flying around. It’s ridiculous.”
In Garry’s most recent job, his workplace attempted to minimise the risk to their employees by implementing dust control protocols, yet these were insufficient for just the types of circumstances described by Garry.
“[The owner of the company] didn’t like dust, which is good, but we weren’t aware that it was so fine that you had to have a special dust mask for this engineered stone, and 90% of the work is with engineered stone,” he said.
“The owner bought the best dust masks for working with marble and granite but we weren’t awaware that we should also be suited up to prevent it getting on our skin. And this employer was the type of person who would say to you every afternoon if he knew you’d been working with the stone, he’d say, ‘you have a shower before you go home, before you leave the place.’ But we still weren’t aware of the dangers.”
Know the risks
Garry has a message for those working with engineered stone: “Do your own research and find out what sort of dust mask you really need. And if the boss has a problem with it, it’s not worth working. People have got silicosis and no one knows about it yet, especially young people in the industry.”
Medical Forum also spoke with Robert Vojakovic of the Asbestos Diseases Society of Australia. Robert has been a passionate campaigner for victims of exposure to occupational carcinogens, and most prominently led the awareness campaign of the dangers of asbestos.
As there are emerging parallels between engineered stone and asbestos, Robert’s perspective on the two provides some interesting historical context. His opinion on occupational exposure to crystalline silica dust is unwavering.
“It’s worse than asbestos. You don’t get tuberculosis from asbestos. We have to worry because someone can live with silicosis for a number of years without symptoms. Silica is most likely to give you tuberculosis at some stage in your life and that’s what I’m worried to see.”
Asbestos and engineered stone with high silica content are similar in so much as they are benign until agitated or worked with, such as stonemasons cutting stone.
Robert says it’s the cutting that is problematic and the controls in place in workshops and on-sites are inadequate.
Strict protocols needed
“P2 masks (the current recommended particulate respirator) can no longer be relied upon in the workplace. Complete hermetic isolation is required. Workers who cut engineered stone should then go into a contamination unit when they finish. That’s the only way to stop it,” he said.
When asked what action he thought should be taken to control the incidence of silicosis in Western Australia, Robert urged WorkSafe, to immediately decree that all employers must have their staff scanned on a six-monthly basis.
Robert believes there is a strong case to ban engineered stone, similar to that of asbestos.
“How would you like carcinogen in your room? We have got to do it ASAP,” he said.
However, while Robert holds these strong personal views on engineered stone with high silica content, he believes the wider population needs to take note and to pressure politicians, similar to how he campaigned for asbestosis victims.
Robert’ urges GPs with patients working in industries that may produce occupational crystalline silica dust to, “immediately ask workers, even their bosses, to have a check-up, and to ask questions such as how many years have they worked in the industry” to identify if these people at in the at-risk cohort.
We asked WorkSafe Commissioner Darren Kavanagh if the recommended standard of 0.05mg/m3 would be sufficient.
“Halving of an exposure standard might be interpreted as a reflection of the importance of the risks around silica,” he said.
“There also has been a range of new equipment, new technologies, new sampling equipment that measure the concentrations of silica. So that’s provided information, new information, to form a view about the recommended level.”
In regards to the current standard and the compliance of WA workplaces he said:
“What we have found through some proactive campaigns with the agency that there are controls in some places. So, some places are striving to work to appropriate controls. But there is definitely a number of workplaces that aren’t applying proper practices, proper safety controls. So, there’s still a bit of work to do there.”
Although measuring crystalline silica dust exposure is a relatively easy task in workshops, it’s the installation aspect that is difficult to measure, simply because engineered stone products are being installed in houses, apartments and workplaces on a daily basis.
This means the number of workplaces with crystalline silica dust exposure is changing on a day-to-day basis. With regards to the risks faced by workers installing engineered stone products, Darren holds a balanced view.
“I think there’s an anecdotal view about the risks associated with the installation side of it, but I don’t think we’ve got enough information yet to prove categorically that the risks we see in the workshop are the same as the ones we see out in the work sites”.
Darren has found a genuine concern about the risks of engineered stone from the industry stakeholders whom he sees are “genuinely interested in trying to make sure that people aren’t being exposed.”
With regards to the potential for WA to see the increase in the number of silicosis diagnoses in-line with the eastern states, Darren says WA has not experienced the same increase in cases.
“But that’s not to suggest that we’ve got the perfect working environment. I think there’s enough evidence to suggest that we’ve got lots of improvement to do.”
So far, WorkCover has accepted two silicosis claims and 141 workers have gone through health surveillance programs, with 36 workplace audits taking place since July 2018 and all of the audited workplaces receiving at least one non-compliance notice. Of the 36 workplaces audited, 292 improvement notices and two prohibition notices have been issued.
While Darren doesn’t underplay the potential harm of working with engineered stone, he stops short of a comparison with asbestos.
“I understand why people are making that comparison as there are some similarities between the two materials. But based on the volume of material that has been produced in the past, and I’m referring to a comparison to the engineered stone bench tops, I’m not sure we can get to those same levels as asbestos,” he said.
“We’re talking about thousands and thousands of people having been exposed to asbestos over the years and we’re not near those numbers for engineered stone. I don’t say that to be dismissive or challenge the concerns that people have. I think a bit of balance is required.”
Whatever regulations may do to shape the future exposure to silicosis, it doesn’t change the grim outlook for Garry Moratti and workers like him.
It is these personal stories that will eventually write the narrative of engineered stone and silicosis in Australia.
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