As invited by “2011 ASIAN Medical student forum” joint discussion, I was urged to talk about my BOUNTY of experience in this field. In fact, I could only share my LIMITED experience since twenty years ago- that’s the year (1991) when I completed residency training in the Internal Medicine and decided to start Public Health master program in NTU, focusing on occupational medicine and industrial hygiene and, consequently, stir my future interest –after completing master thesis about the VCM and PVC manufacturing ( The Formosan Plastic’s first petrochemical industry) workers’ exposure and health, shift to a Government research job (Institute of Occupational Safety and Health (IOSH), Taiwan).
The VCM study continued and when in 1996 August, a notice was sent to IOSH, Taiwan from DOH that six Philipino workers had been admitted into shin-chu hospital due to high fever, generalized rash and abnormal liver function test. One of them died one day before. Erythma multiforme was impressed as the diagnosis. Tracing the working history, all workers recently emigrated from various locations of the Philipines and they were working at one TV screen-making factory. Before this onset, 20 similar cases got ill two months within arrival, and two of them had been sent back to their home country. A walk through and questionnaire survey of 325 workers was then performed and 321 workers receiving the health exam. After investigation, occupational exposure such as TCE, anti-parasite medication and endemic infection may be linked to the causes, but not confirmed. However, part of my work shift to the foreign workers, and a SUDS study among Thai workers was launched during1996-1998, and we postulated hereditary, food and beverage excess or stressful work may relate to SUDS in those young, healthy immigrants.
Occupational medicine was first introduced into the bureau of labor insurance (BLI) when in 1999 the loosening of pneumoconiosis (coal miners’ lung disease) make the compensation claims skyrocketing and thus, in addition to chest medicine specialists, several occupational physicians (not officially certified then) were recruited to assist the claims jurisdiction. Meanwhile, the under-protection of occupational disease or injury draws the attention of political parties and NGOs, and 3 years later a new law -Occupational Injury Workers Protection Act, and Occupational Medicine Specialist Certification was announced since 2001. To offer proper assistance of workers after occupational injury, a first demonstration center (Which I participate the creation), named Center for Management of Occupational Injury and Disease (CMOID) was established by BLI on April, 26, 2003 in NTUH when SARS epidemics Taiwan . The HCW suffered a lot due to SARS, which later CLA promulgated infectious disease among HCW and similar occupations as occupatioanl disease list.
On February 21st 2003, the first SARS patient in Taiwan was identified. The patient had returned from traveling to Guangdong Province , mainland China , by way of Hong Kong . After April 24, due to the outbreak in Ho-Pin hospital in north of Taiwan , the Department of Health (DOH) in Taiwan decided to close the hospital. Fever screening plus a self-report questionnaire was then implemented to all the visitors at the National Taiwan University Hospital (NTUH) and other hospitals in Taiwan soon after. The emergency department at NTUH was, unfortunately, temporarily closed for two weeks after May 12th 2003 because of a possible SARS cluster among Health Care Workers (HCW) appeared. Nevertheless, the crisis was soon relaxed and the hospital restriction eased as there had been no probable SARS case reported in Taiwan since June 16th 2003, when reviewed one year after the outbreak. A questionnaire survey of 15 HCWs who had been classified as suspected, probable, excluded and confirmed SARS patients at the NTUH was carried out by an experienced physician of the CMOID in June and July 2003. The study found that the most dangerous place at a medical center was the Emergency Department(ED), nurses were at a higher risk of developing SARS than other HCWs and the most important prevention method is frequent hand washing in addition to adequate respiratory mask.
After the SARS storm, a multidisciplinary medical and paramedical team, including case manager, occupational health nurses, and occupational therapist were integrated in this center, offering occupational disease diagnosis, compensation and return to work assistance. The center initially offered clinical service on Tuesday and Thursday morning and every afternoon over weekdays, special clinics of occupational musculoskeletal disease and cardiovascular disease is offered on Thursday and Friday afternoon respectively. From 2003 to 2010, there are other 8 similar medical centers and around 54 network clinics offering more than 160 occupational medicine clinics per week and a nationwide managing and service center were established and the workers are much easier to find occupational physician.
As above mentioned, occupational medicine specialist training program were formally developed after 2003, I recalled a total of 9 (originally is 12), including 4 full time trainee and 5 part time, trainees in 2004 in NTUH. As a joint venture with OMIH, this program is sponsored by a special grant from CLA (sponsored by DOH in the previous years) for full time trainee for two years, with salary around 2,000 USD/month. Through the two years, the requirement is as follows, the listed figure is minimal:
a) Occupational medicine clinics- 10 case-reports
b) Ward/ER consultation, or occupational disease jurisdiction cases, 10 cases
c) Workers health screening, performed in clinics 60 cases
d) Workers health screening, performed in factories 30 cases
e) Training for special hazard health exam. 36 hours (e.g. NCV, PFT,PTA.)
f) Other specialty clinical training (Dermatology, Neurology, Chest, Liver, Orthopedics, Rehabilitation, ENT, choose any three)
g) Fitness for work, disability evaluation, return to work, 3 cases
h) Practice as a company occupational physician,1 factory (> 200 employees)
i) Attending company OSH board committee meeting, 4 times
j) Recognition of workplace hazard, 10 sites/reports
k) Evaluation of workplace exposure, 2 cases
l) Selection of personal protective equipment, 5 cases
m) Occupational safety and health project evaluation, 5 reports
n) Presentation of study on above topics, 5 times
o) inquiry and response, 10 cases
Though government subsidy stopped at 2005, the certified training hospitals are continuing their job at their own expenses. Now, we have 17 training hospitals and a round 270 occupational medicine specialists, and every year about 15~20 new trainees enrolled. From 2010, a new policy to train more physicians participating in basic occupational health service, plus a revised regulation (workers’ health protection act) promulgated since Jan, 2011, both combined to mandate factories and companies of different sizes offering proper preventive health service through trained physicians and nurses in the workplace, taking preventive and precautionary measures so that the employer, employee and the public may know how to protect life, health and environment.
To summarize my road to occupational physician, as my adviser (JD Wang) put it: genuine devotion to occupational medicine is the cornerstone of its quality. I am glad to have the chance to study versatile occupational health techniques and its hazards, to help concerned tri parties, to train either occupational physicians or those expected to offer occupational health services. I wish every physician serving for occupational medicine has mercy towards the vulnerable workers, keep medical ethics in their minds, and help injury or disease victims to safely return to workplace as soon as possible.