lesson plan basic occupatiuonal health for medical officers in namibia full
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BASIC OCCUPATIONAL HEALTH FOR MEDICAL OFFICERS
Training course for regional medical officers
organized by the World Health Organization
at the request of the Ministry of Health and Social Services of Namibia
LESSON PLAN
Swakopmund, 14 - 25 February, 2011
2
TARGET GROUP
Regional and district medical officers in Namibia
ASSUMPTIONS
Participants
- are medical officers from public healthcare facilities in Namibia. They have excellent clinical skills and experience, but no previous training in occupational health
GOALS and OBJECTIVES
Introduce participants to concepts, paradigms and approaches in Occ Health
Explain foundations on the important and common occupational and work-related diseases
Underline importance of multi-disciplinary approaches to diagnosis, exposure and preventive action
Underline the role and importance of long-term, sub-acute exposures in disease and disability development
Enable participants to reconstruct historic exposures in disease cases
Enable participants to understand reports on occupational health risk assessment
TEACHING METHODS
Use participants' experience and stories as much as possible to keep content concrete and relevant
Visualize a lot, work with films clips, and photos as much as possible
Keep lectures open for discussions and questions
TRAINING TEAM
Dr Ali El Sherif - Chief Medical Officer for Occupational Health, Ministry of Health and Social Services - course coordinator
Mr Thebe Pule - Regional Adviser, WHO Regional Office for Africa, Brazzaville - occupatiuonal hygiene
Dr Norbert Wagner, Program Director "International Program in Occupational Health Practice", School of Public Health, University of Illinois at Chicago (UIC), United States - occupatiuonal medicine
Professor Tony Cantrell - former head of Information Section, National Institute of Occupational Health, Johannesburg, South Africa - occupèational hygiene
Dr Ivan D. Ivanov, Scientist, Occupational Health, World Health Organization, Headquarters, Geneva, occupational medicine
3
FIRST WEEK: INTRODUCTION TO OCCUPATIONAL MEDICINE
DAY 1, MONDAY, 14 FEBRUARY 2011
Start Time
End Time
Durati
on
(min)
Activity/Content Topic
Training techniqu
e
Trainee activity
Aids required
Lecturer
8.30 9.30 60 Introduction and Course Overview Introduction of lecturers Introduction of participants: Introduction to Course Objectives, Format, and Materials
Describe known cases of occ diseases
Whiteboard or flipchart
Dr Ali and T. Pule
9.30 10.15 45 Introduction to occupational health Occupational Health - scope, issues and challenges Occupational health in Namibia - main problems Legislation and regulations for occupational health in Namibia (???)
lecture Copies of timetable and list of topics
Dr Ali and T. Pule
10.15 10.45 30 BREAK
10.45 11.15 30 The role of the medical officer in occupational health (Ivan) Role Responsibilities Skill mix Collaboration with occupational health experts
Lecture and discussion
Ivanov
11.15 12.00 45 Health surveillance of workers Screening Medical and exposure tests Health examinations
lecture Ivanov
12.00 13.30 90 LUNCH BREAK
13.30 14.15 45 Occupational health problems in major sectors Mining Agriculture Healthcare Small business, artisans
Lecture Ivanov
4
Start Time
End Time
Durati
on
(min)
Activity/Content Topic
Training techniqu
e
Trainee activity
Aids required
Lecturer
14.15 15.00 45 Introduction to occupational medicine (part 1) - How important are occupational diseases? - Occurrence, incidence, global burden of disease - Disease vs. accidents - Challenges in describing past and present and mixed exposures - consequences for preventive action, hierarchy of controls
Lecture Wagner
15.00 15.30 30 BREAK
15.30 16.30 30 Principles of Toxicology - exposure pathways - uptake dynamics - Metabolism and excretion - distribution, organ-specific affinity and storage
Lecture Wagner
5
DAY 2, TUESDAY, 15 FEBRUARY 2011
Start Time
End Time
Durati
on
(min)
Activity/Content Topic
Training techniqu
e
Trainee activity
Aids required
Lecturer
8.00 8.15 15 Introduction to Day 2: Common Occupational Diseases
Lecture Wagner
8.15 9.00 45 LUNG DISEASES - Physiology of respiratory tract - Overview, classification - Occurrence, incidence & prevalence
Lecture Guided discussion
Wagner
9.00 9.45 45 Occupational Asthma - pathomechanisms - occurrence, prevalence - causes, irritant vs allergic - dilemma of exposure assessment for allergic lung diseases - preventive action and control technologies
Lecture and discussion
Guided discussion
Wagner
9.45 10.15 30 Participants' presentation on lung diseases - Mapp 2001 agents old & new causing asthma OEM 354.pdf - Microorganisms in grain handling 9851_7.pdf
Presentation
LCD Wagner
10.15 10.45 30 BREAK
10.45 11.30 45 Dust-related lung diseases: Inert dusts: COPD - pathomechanisms - occurrence, prevalence - occupations Irritant dust/fumes: example Alveolitis - pathomechanisms, - inert vs., irritant vs biological substances triggering immune reaction - occupations, examples, - occurrence, prevalence
Lecture and film on dust exposures
Wagner
11.30 12.00 30 Respiratory protection with PPE - selection and use - limits and challenges
Lecture Discussion Pule
12.00 13.30 90 LUNCH BREAK
6
Start Time
End Time
Durati
on
(min)
Activity/Content Topic
Training techniqu
e
Trainee activity
Aids required
Lecturer
13.30 14.30 60 Mineral dust-related lung diseases Asbestosis and Silicosis - Causes, pathomechanisms and natural course - Occurrence and occupations - dilemmas in exposure assessment and exposure reconstruction for compensation cases (TLVs, "exposure years" concept)
Lecture Wagner
14.30 14.45 15 BREAK
14.45 15.45 60 Participants' presentation on lung diseases - COPD - USA risk assess death certif silica 122.pdf - Silica exposure assessment concepts - Asbestos exposure assessment concepts - Asbestos risk in industry
Student presentation and discussion
Wagner
15.45 16.15 30 Medical assessment of lung function and Fitness-to-work - Purpose and limits - Ethical considerations, conflicts of interest and challenges
Lecture Discussion Wagner
16.15 17.00 45 Discussion of short cases Fitness-to-work for employees with lung diseases, case discussions, dilemmas
Open full class discussion
Discussion
------------------------------------------------------------------------------------------------------------------------------------------------------------
7
DAY 3, WEDNESDAY, 16 FEBRUARY 2011
Start Time
End Time
Duration
(min) Activity/Content
Topic Training techniqu
e
Trainee activity
Aids required
Lecturer
8.00 8.15 15 Introduction to Day 3: Common Occupational Diseases
Lecture
8.15 9.00 45 Reconstructing a occupational exposure history in Occupational Health - challenge of reconstructing exposure - Mixed exposures: a challenge - Known facts about mixed exposure scenarios and their health effects, cases, literature - Challenges to measurement, description and interpretation
Lecture Guided discussion
Exposure history questionnaire
Wagner
9.00 9.30 30 Presentations of participants: SKIN DISEASES - skin diseases & infections & metal fluids 35.pdf - other article
Presentations
9.30 10.00 30 BREAK
10.00 10.45 45 SKIN DISEASES - skin physiology - common work-related skin-diseases - irritation vs allergy, definition of exposure - typical occupations - preventive action and control technologies - challenges in rehabilitation and reintegration
Lecture with pictures
Wagner
10.45 11.00 15 OCCUPATIONAL INFECTIONS Case discussions on typical occupations in working groups Exercise, discussion groups
Group work Case sheets and scenarios
11.00 11.30 30 Presentation of group work - presentation of results, discussion on occupational infections
Presentations and discussions
8
Start Time
End Time
Duration
(min) Activity/Content
Topic Training techniqu
e
Trainee activity
Aids required
Lecturer
11.30 12.00 30 Summary: Occupational Infections - typical occupations - prevention strategies, vaccination programs, - control measures, exposure pathway control (airborne, droplet, contact) - Health Care Workers
Lecture Wagner
12.00 13.30 LUNCH
13.30 14.00 30 Long-term Cumulative Effects of Selected Exposures (part 1) Health Effects of Physical Hazards Example: Noise - noise-induced hearing loss - non-aural effects of noise
Lecture Wagner
14.00 14.30 30 Example: Vibration - vibration-induced disorders and diseases - challenges in reconstructing past exposures
Lecture Wagner
14.30 15.00 30 Medical Surveillance Techniques reg Physical Hazards - role of audiometric testing vs. prevention - neurological testing, limits and value
Lecture Wagner
15.00 15.30 BREAK
15.30 16.15 45 Long-term Cumulative Effects of Selected Exposures (part 2) Example: SOLVENTS Presentations of Participants: - Case study toluene.pdf - Case study trichlorethylene.pdf - Encephalopathy overview - NEJM425.pdf
Presentations and discussions
16.15 17.00 45 Summary of Health Effects of Solvents - health effects nervous system - other organs: reproductive system, cancer, liver, kidney, heart - Medical Surveillance: biomarkers, reliability, limits and use
Lecture Wagner
9
DAY 4, THURSDAY, 17 FEBRUARY 2011
Start Time
End Time
Duration
(min)
Activity/Content Topic
Training techniqu
e
Trainee activity
Aids required
Lecturer
8.00 8.15 15 Introduction to Day 4: Long-term Cumulative Effects of Selected Exposures (part 3)
Lecture
8.15 9.00 45 Example: OCCUPATIONAL CANCER - theories of effect - assumptions and orders of magnitude of effects (Global burden of disease, WHO) - Typical occupational cancers and occupations - Challenges to prevention, concepts of risk and risk assessment - Classification of carcinogenicity of substances
Lecture Copies of categories
Wagner
9.00 9.30 30 Presentation of participants on Occup Cancer Two Articles TBD
Presentations and discussions
9.30 10.00 30 CLINICAL OCCUPATIONAL HEALTH Heavy Metals - clinical picture, symptoms - Occurrence, importance - Prevention and treatment options
Lecture Examples of Guidelines for medical surveillance
Wagner
10.00 10.30 BREAK
10.30 11.00 30 Long-term Cumulative Effects of Selected Exposures (part 4) ERGONOMIC WORK DESIGN Introduction: Discussion on qualitative and semi-qualitative exposure assessment challenges of work load
Guided discussion
Guided discussion
10
11.00 12.00 45 Example: MUSCULOSKELETAL DISORDERS - occurrence and importance - common causes, genetic, environmental/home and occupational - upper limb disorders, carpal tunnel, shoulder, elbow - back disorders
Lecture Wagner
12.00 13.30 LUNCH
13.30 14.15 45 MENTAL HEALTH Stress and Work Organization - Stress concepts, effects and strain, - demand & control, social support systems - consequences for work organisation - employee support systems in companies - effect of management & organisation styles
Lecture Discussion Wagner
14.15 15.00 45 CHRONICALLY ILL EMPLOYEES AT WORK Example: The mental health patient as employee - occurrence and importance - fitness-for-work considerations and ethical dilemmas - consequences for organisations - roles & responsibilities in the supervising and care team
Case presentation
Discussion
15.00 15.30 30 BREAK
16.00 17.00 60 Case Studies on chronically ill or performance-reduced employees (rehabilitation and re-employment) - diabetes - epilepsy - vision impairment - old age (medical aspects, ethical and social aspects, case management options in company)
Case presentation
Open discussion
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11
DAY 5, FRIDAY, 18 FEBURARY 2011
Start Time
End Time
Duratio
n (min) Activity/Content
Topic Training techniqu
e
Trainee activity
Aids required
Lecturer
8.00 9.00 60 ??????? requested ??????? TEST on Day 1 through 4 MCQs and essay questions
Lecture Discussion
9.00 9.30 30 BREAK Lecture
9.30 10.30 60 Occupational health information on the Internet Introduction, presentation of websites
Wagner
10.30 12.00 90 Practical Exercises in Information Sources IF internet access is available on site: work on internet If NOT: work with CDs from NIOSH and ATSDR
CD copies
12.00 12.30 30 Feedback and Questions
12.30 14.00 90 LUNCH
14.00 END
12
SECOND WEEK: BASICS OF OCCUPATIONAL HYGIENE
DAY 6, MONDAY, 21 FEBRUARY 2011
Start Time
End Time
Duratio
n (min) Activity/Content
Topic Training
technique Trainee activity
Aids required
Lecturer
8.00 9.00 60 Introduction to occupational hygiene - assessment and control of occupational health risks
Lecture Discussion Cantrell
9.00 9.30 30 BREAK
9.30 10.30 60 Physical hazards - health effects, assessment and
prevention
Noise
Vibration
Atmospheric pressure (diving)
Lecture Cantrell
10.30 12.00 90 Physical hazards - health effects, assessment and
prevention (cont'd) a. ionizing and non-ionizing radiation b. thermal conditions c. illumination
Cantrell
12.00 13.30 30 LUNCH
13.30 15.00 90 Discussion - how to use exposure data on physical risks for medical surveillance
noise
vibration
ionizing radiation
Discussion Ali and Cantrell
15.00 15.30 30 BREAK
15.30 17.00 90 Practical exercises Discussion Cantrell
13
DAY 7, TUESDAY, 22 FEBRUARY 2011
Start Time
End Time
Duratio
n (min) Activity/Content
Topic Training
technique Trainee activity
Aids required
Lecturer
8.00 9.30 90 Chemical hazards - health effects, assessment and prevention
Classification of chemicals
Labelling of chemicals
Chemical safety data cards
Occupational exposure limits
Lecture Cantrell
9.30 10.00 30 BREAK
10:00 12:00 120 Practical exercise
reading chemical labels
reading material safety data sheets
obtaining toxicological information about chemicals
using international chemical safety data cards
Practical exercise
Ali, Cantrell
12.00 13.30 60 LUNCH
13:30 15:00 90 Chemical hazards - health effects, assessment and prevention
Carcinogens
Allergens
mutagens
Lecture Cantrel
15.00 15:30 30 BREAK
15.30 16.30 60 Chemical hazards - health effects, assessment and prevention
pesticides
Cantrell
14
Start Time
End Time
Duratio
n (min) Activity/Content
Topic Training
technique Trainee activity
Aids required
Lecturer
16:30 17:00 30 Sound management of chemicals at the workplaces
Discussion Ali, Cantrell
15.00 16.30 60 Airborne particulates - health effects, assessment and prevention
Silica
Asbestos
Coal ???
Organic dust
Lecture Cantrell
16.30 17:00 30 Discussion - how to use exposure data on airborne particles for medical surveillance
Silica
Asbestos
Discussion Ali and Cantrell
15
DAY 8, WEDNESDAY, 23 FEBRUARY 2011
Start Time
End Time
Duratio
n (min) Activity/Content
Topic Training
technique Trainee activity
Aids required
Lecturer
8:00 9:30 90 Airborne particulates - health effects, assessment and prevention
Silica
Asbestos
Coal ???
Organic dust
Lecture Cantrell
9.30 10.00 30 BREAK
10.30 11:30 60 Discussion - how to use exposure data on airborne particles for medical surveillance
Silica
Asbestos
Discussion Ali and Cantrell
11:30 12:00 30 Overview of silicosis in South Africa
lecture Cantrell
12.00 13.30 60 LUNCH
13:30 15:00 90 Ergonomic stressors - health effects, assessment and prevention
Posture
Movements
Organization of the workplace
Handling of loads
Eye strain
Lecture Cantrell
15:00 15:30 30 Break
16
Start Time
End Time
Duratio
n (min) Activity/Content
Topic Training
technique Trainee activity
Aids required
Lecturer
15:30 17:00 90 Workplace health risk assessment - strategies and practical techniques
Walk through surveys
Use of practical tools and checklists
Preparing reports
lecture Cantrell
DAY 9, THURSDAY, 24 FEBRUARY 2011
FIELD VISIT TO WALVIS BAY
FISHING COMPANY
SANDBLASTING STATION
17
DAY 10, FRIDAY, 25 FEBRUARY 2011
Start Time
End Time
Duratio
n (min) Activity/Content
Topic Training techniqu
e
Trainee activity
Aids required
Lecturer
8.00 10:00 120 TEST on Day 6 through 9 MCQs and essay questions
test Cantrell
10:00 11:00 30 BREAK
11:00 12:00 60 Course evaluation
Evaluation of progress
Evaluation of course content, structure, lectures
questionnaires
Ali
12:00 12:30 30 Award of certificates and closure Ali
12.30 14.00 30 Lunch