Medical Practitioners Meeting in Hong Kong, October 28-29, 2013

Present By : EDWIN CHRISTIAWAN

INTRODUCTION

• Indonesia consists of :

– The largest archipelago – 17000 islands– 5 main islands– 33 governors and 360 districts– population more than 220 million

INDONESIAN WORKERS CONDITION – INDONESIA CENTRAL STATISTIC

Total 114 Million workers in Indonesia ( Feb 2013 )

Elementary School 54,6 Million / 47,9 %Junior High School 20,3 Million / 17,8 %

Diploma : 3,2 Million / 2,82 %Degree : 7,9 Million / 6,96 %

Women : 36.08% / Men : 63.92%

WORKING ACCIDENT REPORT - ( no Occ Diseases Report )On Jan 2013 from Jamsostek

Only < 48% WORKERS IN INDONESIA COVERED BY JAMSOSTEK

( GOVERNMENT HEALTH INSSURANCE )

Tahun

Working Accident Claim

JK JHT JPK

Cases IDR Kasus Nominal Kasus Nominal Kasus Nominal

2008 94.486 298.862 13.897 157.679 693.199 3.736.750 15.076.955 588.713

2009 86.224 337.568 14.557 179.851 884.930 5.789.278 14.745.849 662.193

2010 98.711 401.237 15.252 241.637 867.723 5.881.284 18.604.383 776.592

2011 99.491 213.672,07 16.738 136.555,67 904.927 6.825.013,78 10.784.906 433.557,76

2012 103.074 554.005,78 18.436 406.457,90 943.324 7.966.046,12 16.811.208 796.240,50

Total 481.986 1.805.344,85 78.880 1.122.181 4.294.103 30.198.372 76.023.301 3.257.296,26

Reported

No Reported

Indicated without symptom

Diagnosed, and not doing medical Check up

Hospitality

OD.

ICE MOUNTAIN OF OFFICIAL REPORT

No Of Occupational Diseases suspected is :1% ave / year from total accident reported = 1,952/year average

( source Jamsostek )

There is NIL data of Occ Diseases in Indonesia

INDONESIA OHS REPORTING FLOW

Employer

Man power Dept

OHS Director of Man power dept

OHS committeeCompany

Doctor Union

Env DeptHealth Dept

JamsostekWorker Insurance

BUMN Local Comp Dept

Ministry of MP

Most of problem in ground level

NATIONAL INSTITUTE OF OHS – CERTIFICATED BY GOVERNMENT

NATIONAL INSTITUTE OF OH&S

ANALYTICALDIVISION

OSH HUMAN RESOURCE DEVELOPMENT AND

PLANNING PROG. DIV.

GENERAL AFFAIR

DIVISION

SAFETYANALYTICAL

SUB DIV

INDUSTRIAL HYGIENE &

OCC. HEALTHSUB DIV

HUMAN RESOURCEDEVELOPMENT

SUB DIV

PLANNING PROGRAM SUB DIV

FINANCESUBDIV

PERSONNELSUBDIV

HOMEAFFAIRSUB DIV

OHS ISSUES AND NATIONAL ORGANIZING

Labor Union

NGOs

Government

Employers

Research

Workshop/

training

Consolidate

Communication

Communication

By NGOs, OHS issues accelerate to raise up to become serious issue

Presser

Pressure flow

International NGOs

Research

Workshop/training

Consolidate

Website, Newspaper, TV

POLICY AND LEGISLATION OF OHS IN INDONESIA – Gov Regulation Related

The main OSH legislation in Indonesia is Act no 1/1970The Act no 3/1992 on worker compensation ActLegislations related to working environment are Minister of Man Power Circular Letter no SE/01/MEN/1997 on threshold limit value for chemical in the workplace, and Minister of MP Decree no Kep 51/MEN/99 on TLV for physical aspects in the workplace Minister of Manpower, Transmigration and Cooperation regulation No Per 1/MEN/1976 on the obligation to attend training courses on OHS for company medical doctors.

Minister of Manpower and Transmigration No Per 1/MEN/1979 concerning to compulsory training in OHS for industrial medical officers Minister of Manpower and Transmigration No Per 4/MEN/1987 concerning to OSH committee the workplaceMinister of Manpower and Transmigration No Per 5/MEN/1996 concerning to OSH management system Minister of Manpower and Transmigration No Per 2/MEN/1992 concerning to designation of obligation & authorization OSH officers.

GOVERNMENT REGULATION – OCCUP DISEASES COVERED BY LAW

Daftar Penyakit Akibat Kerja Oleh: dr. Ikhwan Muhammad

Berikut adalah daftar 31 kelompok Penyakit Akibat kerja (PAK) sebagaimana yang tercantum pada Lampiran Keputusan Presiden Indonesia Nomor 22 Tahun 1993 Tentang Penyakit Yang Timbul Karena Hubungan Kerja:Pneumokonisis yang disebabkan debu mineral pembentuk jaringan parut (silikosis, antrakosilikosis, asbestosis) dan silikotuberkulosis yang silikosisnya merupakan faktor utama penyebab cacat atau kematian. Penyakit paru dan saluran pernafasan (bronkhopulmoner) yang disebabkan oleh debu logam keras. Penyakit paru dan saluran pernafasan (bronkhopulmoner) yang disebabkan oleh debu kapas, vlas, henep, dan sisal (bissinosis). Asma akibat kerja yang disebabkan oleh penyebab sensitisasi dan zat perangsang yang dikenal yang berada dalam proses pekerjaan. Alveolitis allergika yang disebabkan oleh faktor dari luar sebagai akibat penghirupan debu organik. Penyakit yang disebabkan berilium atau persenyawaannya yang beracun. Penyakit yang disebabkan cadmium atau persenyawaannya yang beracun. Penyakit yang disebabkan fosfor atau persenyawaannya yang beracun. Penyakit yang disebabkan oleh krom atau persenyawaannya yang beracun. Penyakit yang disebabkan oleh mangan atau persenyawaannya yang beracun. Penyakit yang disebabkan oleh arsen atau persenyawaannya yang beracun. Penyakit yang disebabkan oleh air raksa atau persenyawaannya yang beracun. Penyakit yang disebabkan oleh timbal atau persenyawaannya yang beracun. Penyakit yang disebabkan oleh flour atau persenyawaannya yang beracun. Penyakit yang disebabkan oleh karbon disulfide. Penyakit yang disebabkan oleh derivate halogen dari persenyawaan hidrokarbon afiliatik atau aromatic yang beracun. Penyakit yang disebabkan oleh benzene atau homolognya yang beracun. Penyakit yang disebabkan oleh derivate nitro dan amina dari benzene atau homolognya yang beracun. Penyakit yang disebabkan oleh nitrogliserin atau ester asam nitrat lainnya. Penyakit yang disebabkan oleh alcohol, glikol, atau keton. Penyakit yang disebabkan oleh gas atau uap penyebab asfiksia atau keracunan seperti karbon monoksida, hirogensianida, hidrogen sulfide, atau derivatnya yang beracun, amoniak seng, braso, dan nikel. Kelainan pendengaran yang disebabkan oleh kebisingan. Penyakit yag disebabkan oleh getaran mekanik (kelainan-kelainan otot, urat, tulang persendian, pembuluh darah tepi atau syaraf tepi). Penyakit yang disebabkan oleh pekerjaan dalam udara yang bertekanan lebih. Penyakit yang disebabkan oleh radiasi elektromagnetik dan radiasi mengion. Penyakit kulit (dermatosis) yang disebabkan oleh penyebab fisik, kimiawi, atau biologik. Kanker kulit epitelioma primer yang disebabkan oleh ter, pic, bitumen, minyak mineral, antrasena atau persenyawaan, produk atau residu dari zat tersebut. Kanker paru atau mesotelioma yang disebabkan oleh asbes. Penyakit infeksi yang disebabkan oleh virus, bakteri atau parasit yang didapat dalam suatu pekerjaan yang memiliki resiko kontaminasi khusus Penyakit yang disebabkan oleh suhu tinggi atau rendah atau panas radiasi atau kelembaban udara tinggi Penyakit yang disebabkan bahan kimia lainnya termasuk obat

31 items of Industrial Diseases

INDUSTRY IN BATAM

Bigest industrial Company located in Batam :

Muka Kuning ,Sekupang ‘Batu Ampar Batam Center,Tj Uncang

Most of them is electronic and ship yard company

FOREIGN ELECTRONIC INDUSTRY IN BATAM

Survey from 30 electronic company of FSPMI Union Worker

Electronic company investment

60%27%

10% 3%

Japan

Singapore

Europe

USA

BATAM INDUSTRIAL RELATION PROBLEM

1. Wage and welfare 55%

2. Outsourcing worker 30%

3. Safety of work 15%

Survey from 30 electronic company of FSPMI Union Worker

INDONESIA REGULATION RELATED WITH OHS – Company scope

Function of OHS committee in the factory(Permen No. Per-03/Men/1982 tentang Pelayanan Kesehatan Kerja, Pasal 2)

Annual medical check up ( general and special ) Control and reporting about working env, sanitary, chemical handling, and all related with OHS in factory . Train to related OHS committee about first aid Preventing and diagnosis for all industrial diseases .  Advising and make a plan to improve OHS condition in the factory include PPEHygiene control in factory include food and drinking water  Help and prevent Industrial accident and diseases.  Firs aid coordinator  Periodic report to government about 3 month activity in OHS related , include if any violation of law

Commitment and policy

Planning

Organizing

Excusing

Controling

Evaluating

Flow of accident report and handling in the company as government regulation

1. Report to coordinator (P2K3), that is one of Safety Health Committee.2. Report to Government and Company doctor3. Company doctor doing diagnosis and if necessary giving recommendation to specialist doctor to more deep analysisIn this case Company doctor authorize can be treated to the next process ( hospitalization or check up by specialist )

When victims felt they need further more medical treatment, they will report to P2K3Usually P2K3 there is Industrial Accident Dept

Company doctor

Workers

Employer

P2K3/OHS

Committee

Further treatment

OHS HANDLING AND RESPONSIBILITY – COMPANY SCOPE

BATAM OHS PROBLEM – Status of employee , Health assurance, and Company responsibility

1.Most of sub contractor worker did not cover by Jamsostek ( Gov medical assurance service )

Analysis :

1.Limitation of Government’s control

2.Most of them is not as LU members ( sub contractor worker )

3.Labor Union did not understand well about regulation

4.Not priority issue compare with wages and welfare

2.History of diseases for contract workers

Analysis :

Government regulation legalize contract only 3 year max contract each company

“If workers have indicated of occupational diseases, max 3 years from resignation time, they can claim to the company”

( Gov Regulation )

Not all company follow Gov Regulation to conducting annual medical check up

Analysis :

Cost consideration and not enough control from Gov

Medical check up by provider who assign by company, and not deeply diagnosis

Analysis :

No deeply check up, just to full fill Gov regulation

BATAM OHS PROBLEM – Regular Medical Check Up and Diagnosis

“ Regular medical check up have 2 categories : Special ( work cond. and age >40 year ) and General

Government regulation said that “company doctor is general doctor Not specialist doctors “

1.Company’s doctor have no capability to deeply analysis what exactly disease for worker

2.Symptom of disease is non specific, some time overlap with other illness

3.Limitation of medical device to diagnosis

BATAM OHS PROBLEM – Company doctors and Occupational diagnosis

UNION STRUGGLE IN ELECTRONIC SECTOR – PT VARTA

PT VARTA is Germany Company , doing Battery assembly that contain Lithium Battery

Established 1994 year

Number of workers about 1200 ( 70% is Female )

Working service average 8 years

Permanent employee ration : 95% permanent

Working Hours Average : 12 hours / day

UNION STRUGGLE IN ELECTRONIC SECTOR – PT VARTA

We observed together with OHS in charge in this company, included HR Manager,

1st Step :1.Identification of chemical using2.Interview worker who have working service >5 years3.Collect the data related with medical record ( annual medical record )

2nd Step :1.Line observation to know more deeply about chemical and PPE using2.Interview what their felt, and complaining and understanding about chemical

UNION STRUGGLE IN ELECTRONIC SECTOR – PT VARTA

3rd Step :1.Explain risk of abnormality process finding2.Looking for substitute of MSDS to replace with health friendly material

Gluing process – Skin, respiratory

Laser Machine – Eyes, lung , breast, Ovary , etc

Most of died members came from this process

UNION STRUGGLE IN ELECTRONIC SECTOR – PT VARTA

Another suspected base on workers claim of diseases

• Welding machine (Resistance machine and Laser).• Resistance make sparking• Radiation of laser possible to make disturbance of

nerve, reproduction, lung and cancer.

• pre discharge can make burn due to shortening between positive and negative polarity.

• Coding process can make disturbance of respiratory due to chemical

• Printing machine using paint can cause skin irritation.• Shrinking machine making risk burning if false setting and smoke can disturb lung

and heart.

UNION STRUGGLE IN ELECTRONIC SECTOR – PT VARTA

Chemical Using

• Solvent, ink• Thinner• Acetone• Extender• Silicone • Lithium• Prema bond• Super sight glue• Microcell

UNION STRUGGLE IN ELECTRONIC SECTOR – PT VARTA

4th Step :

1.Consolidate for victims representative by interview and collect medical records by raised questionnaire 2.Collect sample of workers history in suspected work place

Workers from Varta Micro Battery was death, indicated due to chemical healing to their body ( Yellow color )

VICTIMS ORGANIZING – Focusing to 2 workers medical and behavior

1.Mr Yoga ( Line Lithium )

He was working in PT Varta about 15 yearsHe working handling chemical Lithium 12 hour / day, not use any PPE in the past time

Health Complaint :He felt sputum, in his throat never lost till now, since last 3 years , cough other wise he never smoke .

2. Mr Sarno ( Laser Line )He working there since 2002 ( 11 years )

Health complaint :Always headache and he consume about 10 tablet of medicine everydayHe was worked at laser machine about 3 years, before moved to another working place

Its so serious, to more detail report, I asked to get medical report and screening record of 1 sample Mr Sarno ( attached )

We got their medical record, scanning result, and we just gave recommendation to company to cover their illness , without claim any compensation

CASE HANDLING

Base on the Varta’s case, we just only collecting data related, and recommended to the company to recover their health

Base on that, we shared problem to another factory, to raised up similar issue and discuss with employer

TASK FOR DISCUSS ( OPEN ISSUES / PLAN )

Coordinate with local OHS network to bring and check up both of victims by Volunteer OHS Doctor

Raise OHS issue becoming top issue of Indonesia Workers

Stop or replace strength chemical

Continue conducting workshop to increases awareness of workers about OHS

Continue investigating another suspected of occupational diseases