ORIGINAL ARTICLE Year : 2022  |  Volume : 26  |  Issue : 4  |  Page : 255-260  

Health problems and healthcare-seeking practices of workers processing E-waste in the unorganized sector in the slums of a South Indian City: An exploratory study

Sapna Mishra, P Sankara Sarma, Rakhal Gaitonde
Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala, India

Date of Submission09-Mar-2022Date of Decision29-Apr-2022Date of Acceptance24-May-2022Date of Web Publication24-Dec-2022

Correspondence Address:
Dr. Sapna Mishra
Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Science and Technology, Thiruvananthapuram, Kerala
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/ijoem.ijoem_65_22

 

Context: The precarious nature of the work in the unorganized e-waste processing sector poses a threat to workers' health by making them vulnerable to occupational injuries as well as other work-related diseases in addition to job insecurity and related issues. Aims: To systematically explore and quantify employment and working conditions along with the occupational health problems and healthcare-seeking practices of workers processing e-waste in the slums of a south Indian city. Settings and Design: Cross-sectional study conducted in the slums of a south Indian city. Methods and Material: We used a structured interview schedule among 248 randomly selected workers. Statistical Analysis Used: Descriptive statistics were utilized to summarize the results. 95% CI was calculated for select proportions. Chi-square tests were used to determine statistical significance. Results: We found a predominance of self-employment; unclear employment relationship; no paid holidays; long working hours; unequal wages; absence of work-related social security; absent workers' organization; rented units; minimal/no use of safety equipment, no concept of good ergonomic practices. The commonest occupational health concerns were injuries (17% & 41% respectively) and musculoskeletal problems (43.5%). Private/charitable clinics were the commonest source of seeking healthcare which contributed to 'irrational' practices in the form of repeated TT injections. Conclusions: Findings suggest that the precarious work in the unorganized e-waste processing sector could not only give rise to health problems but also make workers undermine the severity of their health problems. The non-responsiveness of the local public healthcare system compels them to rely on private and charitable clinics and pay for services that are otherwise freely available in UPHCs.

Keywords: Injury, musculoskeletal problems, precarious work, private

How to cite this article:
Mishra S, Sarma P S, Gaitonde R. Health problems and healthcare-seeking practices of workers processing E-waste in the unorganized sector in the slums of a South Indian City: An exploratory study. Indian J Occup Environ Med 2022;26:255-60
How to cite this URL:
Mishra S, Sarma P S, Gaitonde R. Health problems and healthcare-seeking practices of workers processing E-waste in the unorganized sector in the slums of a South Indian City: An exploratory study. Indian J Occup Environ Med [serial online] 2022 [cited 2022 Dec 25];26:255-60. Available from: https://www.ijoem.com/text.asp?2022/26/4/255/364942   Introduction 

Electrical and electronic waste (e-waste) is one of the fastest-growing waste streams in the world with India being the third-largest producer.[1] The presence of precious and rare earth metals in e-waste makes its recycling lucrative.[2] However, the cost of recovering the metal deters its treatment in the organized sector, paving its processing under precarious conditions in the unorganized sector.[2] The precarious work in the unorganized waste processing sector, characterized by job insecurity, small or undefined workplaces, unsafe and unhealthy working conditions, low levels of skill and productivity, low or irregular income, and long working hours make workers vulnerable to occupational injuries and other work-related diseases.[3] Furthermore, the general non-recognition of occupational health and the specific context of precarity by the healthcare system compounds their existing vulnerability.[4]

Studies on workers processing e-waste have overwhelmingly utilized an environmental epidemiological lens.[5] However, a recent paradigm shift could be observed where researchers are using a sociological lens to situate workers' health in the larger context of employment and working conditions and healthcare-seeking practices.[6],[7],[8] However, such studies are limited in number as well as in scope.

Despite the well-recognized role of the unorganized sector in e-waste processing, the paucity of data on the employment and working conditions, occupational health problems, and healthcare-seeking practices limit our ability to understand the occupational health of workers and its determinants holistically. Hence, this study attempted to systematically explore and quantify these domains among workers processing e-waste in the slums of a South Indian city.

  Subjects and Methods 

Conceptual framework

We utilized the conceptual framework proposed by Muntaner et al.[9] to situate workers' health problems in the context of precarious work and the characteristics of the local healthcare systems. It assumes that precarious work—poor employment and working conditions—affects workers' health. The healthcare-seeking practices for health problems are contingent on the perceived severity of the health problem, poor employment and working conditions, and the characteristics of the local healthcare system, which in turn are determined by the macro-level determinants. However, this paper is focused on employment and working conditions, occupational health problems, and healthcare-seeking practices.

Study setting

E-waste was observed to be processed in small units which were either standalone single-room units or located on the ground floor of 2–3-storied buildings in the slums of a South Indian city. A few workers were observed working on the roadside as they did not have any permanent structure to carry out their work.

Study design

This exploratory cross-sectional survey was part of a larger case study conducted between March 2019 and March 2020.

Sample size

The sample size was estimated, assuming the prevalence of injury among workers to be 68%.[8] To obtain a 95% confidence interval (CI) of the prevalence, using Open Epi version 3.01 software, the required sample size from an expected population of 750 workers, after applying finite population correction, was estimated to be 201, which was increased to 250 anticipating nonresponses.

Sampling technique

We included all e-waste processing units in the study. The number of workers in units varied from a minimum of one to a maximum of seventeen, and therefore, sampling units would have made it difficult to reach the estimated sample size. We selected two workers from those units with two or more workers and all self-employed (units with one worker) workers. In this manner, a total of 239 adult workers were selected from 172 units. We selected 9 out of 25 workers who were working on the roadside. The simple random sampling technique following a lottery system was utilized to select the workers.

Data collection

We used a structured interview schedule, consisting of both closed and open-ended questions, to interview the selected workers. The interview schedule was developed following the qualitative study conducted in the initial phase of the study. The domains covered included socio-demographic characteristics, employment conditions, working conditions, occupational health problems, and healthcare-seeking practices. We pre-tested it on seven randomly selected workers 1 week before the final data collection period. Few modifications were done as indicated by the pre-test, and the data based on this was not included in the final analysis.

Data analysis

The data were entered into a Microsoft Excel spreadsheet and then exported to R software version 3.6.1 for further analysis. Two of the 250 workers dropped out after a few initial questions. The final analysis was done using information collected from a total of 248 workers. The results were summarized using descriptive statistics. 95% CI was calculated for select proportions. Statistical significance was determined using Chi-square tests.

Ethical considerations

The study was approved by the Institutional Ethics Committee (IEC number: 1330) of the SCTIMST, Trivandrum, to which the authors are affiliated. All data were anonymized and stored in a secured folder on the principal investigator's computer.

  Results 

This paper focuses on the findings of the currently working adult male workers who constituted the majority (247 out of 248 workers were males).

Socio-demographic characteristics

A majority (40.3%) of workers were aged 24 years or less, and almost all of them belonged to the Muslim community (99.6%). More than half (68%) had 10 or fewer years of formal schooling in vernacular medium. A small proportion (7.26%) were interstate/interdistrict migrants. Although the median number of years of processing e-waste was 7, 4% worked for more than 20 years.

Employment and working conditions

Employment conditions

A majority (98%) of the units were unregistered. 64.8% of workers owned as well as worked at units. Approximately, half of the employees (51.7%) received monthly wages ranging between 7000–12,000 INR with no provision of paid and entitled holidays. The median number of working days per week was 6; however, 14.5% worked on all days with Friday as a half-working day. Whereas the median number of working hours on a full working day is 9 hours, about one-fifth (17%) worked for 10 hours or more. No one received formal training. Only one-third (30%) of the employees received personal protective equipment (PPE) from their employers (predominantly gloves).

Whereas workers in half of the units reported storing bandages and antiseptics (57%) in units, on observation, only the bandage could be found in a negligible number of units. A majority (73.5%) reported their employers taking care of the immediate healthcare expenses in case of any serious health problems arising out of their work. A small proportion (6.5%) (all were employers) reported the presence of a welfare committee/society, of which slightly less than half (47%) had a membership.

Working conditions

Physical working conditions: All the units were rented. Whereas most workers (96.35%) were processing e-waste in units, 3.6% were found to be working on the roadside. A majority (28.5%) of the units were manned by a single person. A majority (40%) of them were involved in both dismantling as well as stripping and burning of wire, whereas a minuscule proportion (1%) reported using chemicals also. Approximately, two-thirds (65%) of them never used any PPE, and more than three-fourths (83%) believed that it was not required for processing e-waste. 31% of them used it sometimes, with gloves (61%) being the most common. However, we observed a negligible number (three or four) of workers with woolen gloves during the entire data collection period.

Ergonomic conditions: The median number of hours of continuous sitting and standing on an average working day was 3 and 2 hours, respectively. A majority (56%) reported bending and lifting heavy items at the workplace at least once on an average working day.

Occupational health problems

Injuries: 17% (95% CI: 12.5–21.8) of workers reported encountering an injury in the past 2 weeks; among them, 85% had one episode of injury. Cumulatively, 41% (95% CI: 66.2–77) of the workers reported getting injured in the past 2 years; among them, 94% had one episode of injury. Musculoskeletal problems: A little less than half (43.5%) (95% CI: 37.4–49.7) had any of the three problems: neck trouble, shoulder trouble, and lower-back trouble (LBT) in the past month. LBT was the most common (41%) problem. [Table 1] presents more information on injuries and musculoskeletal problems of workers.

Other health concerns included skin problems (13%) (95% CI: 9.4–17.8), with itching being the most commonest, eye problems (6.5%) (95% CI: 4–10.3) with watering of the eyes being the most common, and breathing difficulty (2%).

We found a statistically significant association between working hours and injury encountered in the past 2 years (P-value = 0.01). LBT was found to be statistically associated with the number of times of bending and lifting e-waste at the workplace (P-value = 0.004).

Healthcare-seeking practices

A majority (91%) (95% CI: 87–94) of workers with an injury consulted a private healthcare provider. The most common reason (34.5%) (95% CI: 25–45) for seeking care for injury in the private clinics was the “good” treatment provided by the healthcare providers. One practice that emerged as almost universal for those requiring medical care for injury was the use of tetanus toxoid (TT) injections. A majority (67.7%) (95% CI: 61.4–73) reported having a TT injection in the last 6 months, out of which 57.8% had received it at least once. The median amount charged by the healthcare providers for a TT injection was 70 INR, with the range lying between 30 and 200 INR. The most common reason cited by the workers for frequent TT injections was that it prevents the spread of infection which may arise from the injury to the rest of the body (87.3%) (95% CI: 81.4–91.6). A third of the workers (33.6%) (95% CI: 25.2–43.3) with LBT had consulted any healthcare provider, with a majority (82.3%) seeking care in private clinics. 44% (95% CI: 28.2–60.7) of workers consulted any healthcare provider for their skin problem/s, with a majority (71.4%) consulting private healthcare providers. Despite frequent health camps in the area, 15% attended in the past 6 months, with fever being the most common reason. [Table 2] presents more information on healthcare-seeking practices.

  Discussion 

While studying immediate exposures as risk factors for occupational health problems is indispensable, restricting the conceptualization of occupational health only to these exposures may decontextualize workers' health by isolating their bodies from the larger context. A recent shift in the problematization of occupational health in the context of precarity and the health system is gaining attention. This shift is underlined by the realization that workers' choices are embedded in the larger social, economic, and political context.[10] Studies on workers processing e-waste in India have either provided a qualitative account of workers' health or have quantified general health problems.[11],[12] A couple of studies focused on exploring knowledge, attitude, and practice of health-related risks and behavior of workers.[13],[14] However, we have attempted to quantify and interpret occupational health problems in the context of employment and working conditions and the health system. Whereas findings revealed the poor employment and working conditions along with an indifferent public health system that could have bearing on workers' health, we are taking forward a few selected findings to discuss in detail in the following paragraphs.

We found injury to be one of the most common health problems [Table 1]. The extant limited studies have linked poor employment and working conditions with injuries. For instance, a study from Nigeria reported that job designation, geographical location, and age contributed to injuries among workers processing e-waste in the unorganized sector.[8] We found a statistical association between working hours and injuries as well as bending and lifting heavy weights with LBT. We could not obtain a statistical association between other factors and health problems including injuries; however, we argue that this could be due to the widespread distribution of precarity in this population. This could be understood by reflecting on the use of safety equipment by the workers. Whereas safety equipment plays an indispensable role in preventing work-related injuries and diseases, neither the existing studies nor the current study found any significant statistical association between injuries and skin problems with the use/non-use of safety equipment. Although 31% of workers in the current study used it sometimes, other than two or three, no worker could be observed using it throughout the data collection period. This could have been one of the reasons for the non-significant association. We argue that workers' reluctance in using safety equipment could have been shaped by their inappropriateness in the present context of poor employment and working conditions, which is also highlighted by the existing literature.

Workers preferred private/charitable clinics despite the presence of physically accessible urban primary health centers in the vicinity. This could be indicative of the blindness of the public health system toward their occupational healthcare needs. However, it would be wrong to interpret that private/charitable clinics were sensitive to the occupational healthcare needs of the workers. This could be understood from the unjustifiable and irrational provision of frequent TT injections [Table 2]. Studies have contended that such medical practices, although unwarranted, need to be situated in the socio-cultural context,[15] and, hence, it is pertinent to locate these practices in the context of their employment and working. Workers were enrolled in the state government's health insurance scheme; however, they could not utilize it as it only covers in-patient care, whereas their health problems predominantly required out-patient care.[16] Hence, workers were forced to seek care from the private or charitable clinics, which also only provided immediate curative healthcare needs but were available at workers' convenience.

  Conclusion 

Our study attempted to locate workers' health problems in the context of precarious work and the characteristics of the healthcare system in the vicinity. The findings suggest that the precarious work and the non-responsiveness of the local public healthcare system could not only give rise to health problems but also make workers undermine their health problems. However, to further strengthen the argument, we need more explanatory studies.

Recommendations

Any policy formulation on occupational health of workers working in such sectors must consider their employment and working conditions. A detailed report prepared by the National Commission for Enterprises in the Unorganized Sector on the conditions of work and social security could provide relevant insights.A constant effort must be made to bring the occupational healthcare needs under the purview of the public healthcare system.Developing a community-based framework could be one of the possible ways of approaching the issue of occupational health among this marginalized community. This could include involving workers in the planning process and training local healthcare providers in various aspects of occupational health services from preventive to curative. Kagad Kach Patra Kashtakari Panchayat, a member-based trade union of unorganized/informal scrap collectors in Pune, represents one of the success stories of the occupational health model.

Limitations

We could not include children/adolescents in our study due to ethical constraints.We limited the scope of study to the workplace and the healthcare problems, which workers could link to their work. We excluded the details of family life, living conditions, and comorbidities, which could have further enriched our understanding of the occupational health of these workers.

Acknowledgements

We are thankful to Professor Biju Soman, Achutha Menon Centre for Health Science Studies for his valuable inputs.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

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  [Table 1], [Table 2]