Pioneering Medical Treatment Program in Brazil
As a result of a remarkable partnership by asbestos victims, health professionals and civil servants, an asbestos outreach initiative in São Paulo, Brazil celebrated its second anniversary in December 2019.1 Funds for this pioneering project were sourced from a court fine imposed on Brazils former asbestos giant Eternit, S.A. for non-compliance with a legal agreement made with the Federal Public Ministry of Labor (4th Region). The company had failed to inform the relevant authorities about asbestos victims who had waived their legal rights after receiving small amounts of compensation via extrajudicial agreements from the company.
The Ministry of Labor, in consultation with the Brazilian Association of the Asbestos-Exposed (ABREA), nominated the Instituto do Coração (InCor) [Heart Institute] in São Paulo State to be the recipient of a grant R$1,697,862.13 (~US$408,000) for the purchase of equipment for pulmonary function tests and the salaries of one doctor and two technicians to perform lung function tests at an outpatients clinic for high risk workers, former workers or people who had experienced environmental exposures to asbestos. The InCor facility, which is open every Thursday morning, operates from room 137 and is under the supervision of pneumonologist Dr. Urbiratan de Paula Santos; patients referred by ABREA, trade unions, doctors and other outpatient units of InCors Pulmonology Department are eligible for free screening and treatment. This program is the first of its kind in Brazil to receive funding, albeit sourced from the imposition of judicial penalties, from its intended users.
During their appointments at the asbestos outpatients clinic, patients answer questionnaires about their occupational history with a focus on possible sources of workplace asbestos exposures and overall health history including details regarding tobacco use; they are examined and undergo procedures such as chest X-rays, spirometry tests and chest computed tomography (CT) scans.
Since 2017, the clinic has identified 143 patients (the 2017 cohort) with asbestos-related diseases (ARDs) of which 92% were males; 57% had worked for Eternit (in the Osasco plant), 25% for Brasilit, 7% for Precon and 11% for other companies. According to the Assessment Report of Individuals Exposed to Asbestos Summary of Information as of December 2019:
The characteristics of the individuals seen reveal a group composed mostly of elderly people, predominantly male, with long duration and latency of asbestos exposure. The activities performed by these workers, many of whom had worked in various capacities within the industry in which they were employed, mainly involved jobs directly linked to the production line of fiber cement material, maintenance and mechanics of the machinery involved in the manufacturing processes of these products and functions related to the logistics of input and productivity of the line. In the other category of companies [whose workers had been diagnosed with ARDs] were those involved in the production of brakes and friction materials and those involved in thermal insulation or building maintenance of old manufacturing plants that used asbestos for electrical insulation, hot water supply networks, ovens and boilers.2
Amongst the 2017 cohort of 143 patients: 12% were smokers, 41% ex-smokers and 47% non-smokers; the percentage of smokers/former smokers/non-smokers amongst the pre-2017 cohort was similar at: 9%, 45% and 47 respectively. Of the almost 250 patients diagnosed by the clinic with ARDs since its inception, ten had lung cancer, four mesothelioma and one cancer of the larynx; other cancers were also diagnosed. All of the patients are being followed up to ensure they receive timely and appropriate medical attention, surgical interventions and palliative care.
Dr. Urbiratan de Paula Santos, Asbestos Outpatients Clinic, InCor, December 2019.
After a tour of the clinic last December (2019), ABREA President Eliezer João de Souza said:
Brazilian law requires companies to perform post-retirement medical check-ups on former employees for up to thirty years after their last occupational exposure. ABREA members and others lack confidence in the reliability and accuracy of the examinations carried out by asbestos company doctors or doctors hired by these companies. The treatment provided by the InCor clinic and the results of its tests, however, are fully trusted by ABREA members who are eager to see an expansion of this program to other hospitals so that asbestos victims in other municipalities and states will also have access to high levels of medical care. ABREAs aim is to make the impact of asbestos exposures visible by ensuring that each victim is counted. The InCor clinic not only provides first-rate treatment but also registers each case with the relevant authorities in order to build up an accurate picture of the number of Brazilian asbestos victims.
February 10, 2020
1 Parceria Incor, Abrea e MPT completa um ano e avança no atendimento às vítimas do amianto [Incor, Abrea and MPT Partnership completes one year and advances care for asbestos victims]. December 27, 2018.
2 Mizutani RF, de Paula Santos, U. The Assessment Report of Individuals Exposed to Asbestos Summary of Information as of December 2019. December 23, 2019.