1. OCCUPATIONAL MEDICINE PRACTICE & DIAGNOSTIC CHALLENGES DR. D. MOYO MBChB (UZ), MFOM (RCPI); MOHS, MAppMgnt-(Australia), CIME (US) Community Physician – Occupational Medicine ZIMA CONGRESS 2015

2. OUTLINE Definition Global & regional Perspective of OHS access & practice OM practice in Zimbabwe Principles of OH practice & OD diagnostics

3. OCCUPATONAL MEDICINE Definition ILO/WHO – all occupations Evolution -Hippocratic times 2500 years Occupational Medicine – 18th century Ind med./factory Med. OM OH

4. GLOBAL STATISTICS I LO Globally, 15% access to OH 2 M work related deaths, 300M non fatal occupational accidents 4% of global GDP 50% of world’ population - workforce Ivanov. I. D 2009. & ILO

5. REGIONALY OH Services in MOH -NIOH RSA – multiple, Bots, Zam; Z’bwe, Human Resources – OM RSA – 31, Rest of Africa Training RSA – 5 universities M.Med. Fellowship, Zimbabwe & rest of S. Africa – none Moyo, D, Kgalamono, S, Mwila M, Zungu, M (2015)

6. FUNCTIONS OF OM Preventive Function Occupational health surveillance FFD decisions Impairment “Disability” evaluations, OD diagnostics Occupational travellers HRA - OREP

7. WORK & HEALTH WORK HEALTH IDDM, EPILEPSY, MONOCULAR VISION

8. CHALLENGES IN ZIMBABWE OH Concept OH standards – FFD, Impairments Training Ex- RSA, RAF/MVAF, Mining & Agriculture – Hg, Pb, Cn, Regulatory framework

9. CURRENT ISSUES Organizational Sick Bays Light duty -Indefinite sick level- Retirement Redeployment HCW vs Occupational drivers & accidents Safety Sensitive Work – IDDM, Epilepsy Impairment Evaluations – variances: 6 th Ed. AMA Cost effectiveness: Food handlers

10. Risk Based Medical Surveillance Directly linked to the occupational risk exposure profile (OREPS) Job placement & medical tests vs OREPs Noise – Hearing test Dust – Chest X Ray; lung function Test Chemicals – Lung function Test Different from a general medical exam (CXR & PE)

11. Example case 85 year old peasant farmer. Last worked in 1964 49 years later, Insidious onset of dyspnoea & cough. TB inx. HIV, - Asbestosis No employment records available No compensation – back kumusha 68 yrs ex- miner, 28 years drill operator. SOB over 2 years. AAFBs, HIV, CXR, CT scan, Lung Biopsy etc. Silico-tuberculosis

12. DIAGNOSTIC CHALLENGES Occupational hygiene & Legal compliance Lack of OH standards Access to Occupational Health services vs BOHS Financial issues Diagnosis/Establishing causality Regulatory frame work

13. OCCUPATIONAL DISEASE DIAGNOSIS Minimum intensity of exposure Minimum duration of exposure Maximum latent period Induction period Bradford Hill Criteria

14. OD DIAGNOSTICS & FFD DECISIONS Occupational Risk Exposure Profiling (OREP) - diagnostic Essential Job Functions (EJFs) Precautionary Principle Apportionment: TLV- TWA, STEL, Ceiling

15. 3/16/201615 RETURN TO WORK Light duty, indefinite, boarding Likely date of return to work Full duties or modified duties The date of the next appointment Residual impairment Regular & efficient service Limitations & restrictions

16. 3/16/201616 TAKE HOME POINTS Safety sensitive Positions – objective & scientific practice Light duty – meaningless term Fitness for duty – OREP, EJF & PA Objective & cost effective practice Fitness for duty for Doctors