International Asbestos Conference in Slovenia
The residents of Nova Gorica, Slovenia know about asbestos. For over 70 years Salonhit Anhovo (SA), the largest employer in their picturesque alpine valley and one of the most successful manufacturers in the former Yugoslavia, produced asbestos-cement pipes and sheets1. According to data collected by Dr. Metoda Dodič-Fikfak,2 between 1970-1990, the consumption of asbestos at the SA facility accounted for approximately 90% of all the asbestos used in Slovenia. Employment at SA peaked in 1980 with a workforce of more than 2,600; between 1964-1994, 600 SA employees worked directly with asbestos every year. Prior to 1986, SA did little to control the escape of dust from their facilities; this created conditions in which serious domestic and environmental exposures to asbestos took place. A report prepared in April, 1984 "clearly showed that air pollution with respirable dust was 15 percent (in some cases even 50 percent) over the allowed maximum." 3
Despite the high levels of contamination, there appeared to be a surprisingly low incidence of asbestos-related disease. Until 1998, the State of Slovenia did not recognize work-related asbestos diseases. Why? In a paper presented at the Global Asbestos Congress in Osasco, Brazil, Dr. Dodič-Fikfak wrote:
"the Salonhit Anhovo company hosted and sponsored the most well-known Slovenian and foreign researchers, for example Mr. Valic4 from Croatia, an influential expert from WHO... they never found anything, not even a case of asbestosis or mesothelioma, until in mid 1980s when 7 cases of mesothelioma were discovered."
The tragic heritage of the River Soča region, where the SA plant was situated, has led to its nickname: Asbestos Valley. It was entirely appropriate, therefore, that the venue of the first international asbestos conference to be held in Slovenia was Nova Gorica5. On May 12, 2003, experts from the UK, Australia and the Netherlands joined Slovenian colleagues to hear presentations on legal and medical aspects of asbestos exposure in Slovenia and abroad. This landmark event was well-attended by asbestos victims, local people, lawyers, doctors and public health workers; it is significant, however, that not one politician chose to attend. The conference was organized by SABS, the Syndicate of Slovenian Asbestos Patients, the Medical Centre of Ljubljana and IBAS, the International Ban Asbestos Secretariat; it attracted a high level of local sponsorship and national media attention. The meeting was a success on many levels; by providing a public forum for discussion it:
publicized on-going legal, medical and social problems being faced by asbestos victims in Slovenia;
explored the part asbestos victims' groups can play in improving conditions;
examined the evolution of compensation systems in different countries;
highlighted alternative legal, health and research strategies.
Welcoming delegates to the meeting, Bojan Goljevšček, President of SABS, expressed the solidarity of Slovenian victims with asbestos victims abroad. He described the on-going struggle to get the Slovenian Government to honour its 1996 commitment to compensate victims; despite an increase in the number of those affected, the funds allocated to compensate the injured have decreased. President Goljevšček believed this meeting presented a unique opportunity to highlight the injustices experienced by asbestos victims.
Session 1: Compensation Schemes for Occupational Asbestos Exposure in Europe
During the presentation: A Comparative Review of European Asbestos Compensation, Laurie Kazan-Allen, Coordinator of IBAS, examined the positive contributions made by European asbestos victims' groups which have changed restrictive national legislation, over-turned unfavourable legal decisions, located crucial information and witnesses and improved conditions for victims in the UK, France and the Netherlands. Welcoming Slovenia to the European Union (EU), she urged conference delegates to work together in the Community to press for enforcement of EU asbestos legislation, compensation for all EU asbestos victims, appropriate medical treatment for all asbestos patients and funds for research and treatment of asbestos diseases.
Solicitor Guy Darlaston, from the UK law firm of Irwin Mitchell, discussed: Processing an Asbestos Claim in England and Wales. His step-by-step analysis of a claim proceeding through the UK system was an informative examination of how a legal system can, "in theory" award compensation to the injured. Pointing out many of the complexities which characterize asbestos litigation, Guy stressed the importance of: using an experienced legal specialist; compiling a detailed work history; obtaining relevant employment documentation and locating former workmates and potential witnesses.
The presentation Too good to be true? by Machiel van der Woude, Director of the Dutch Institute for Asbestos Victims (IAV), contained information on several progressive developments in the Netherlands. The IAV was set up three years ago after consultation with stakeholders such as victim support groups, insurers, politicians, employers and the Government to lessen the "legal agony" of asbestos victims, many of whom died before receiving compensation from the courts. It is an independent institute which mediates between workers with mesothelioma and employers on the basis of fixed amounts for damages and according to strict timetables. Between 27 January 2000 and 7 May, 2003:
1,238 applications were received by the IAV; 83% have been dealt with;
234 claimants received damages of €50,000 or more; 336 applicants received €16,000;
"the average processing time for successful mediation was a little over 8 months, and for settlement cases, a good 7 months."
As of January, 2003, Dutch mesothelioma claimants have been able to obtain an advance payment of €15,882 from the IAV if they can prove their disease was contracted through occupational exposure to asbestos. While the work done by the IAV certainly represents significant progress, currently it can only reduce "the legal agony" for certain categories of mesothelioma victims; it does not deal with claims from asbestosis or lung cancer patients.
Session 2: Legal Issues Affecting Slovenian Asbestos Compensation
In Slovenia, the law allows claims to be brought for asbestos disease caused by occupational exposure; compensation is available from the Government. Claims from individuals with mesothelioma, asbestosis, lung cancer, gastrointestinal cancer and pleural plaques are processed by one of two verification committees. The majority of claimants with verified occupationally-related asbestos diseases accept the offers made by the Government; unfortunately, due to lack of funding, many of those who have accepted the offers have not yet been paid. Claimants who do not accept Government offers can take legal action. The problem with this, said lawyer Mirijam Likar Kragelj in her presentation: Slovenian Asbestos Law and Victims' Rights is that the cost of litigation deters lawsuits. Before a court case can proceed, the plaintiff must pay 1% of the value of the claim in advance; if there is an appeal, this sum must be paid again. If the case is lost, the plaintiff has to pay the defendants' legal costs. Victims on low incomes are permitted to request that court fees are waived; it is believed that the majority of asbestos cases which proceed are in this category. Lawyer Kragelj urged delegates to lobby for an increase in the provision for asbestos compensation in the national budget so that compensation can be paid to the injured.
A lawyer for asbestos giant Salonhit Anhovo made the final presentation of the morning. He said that since the company has been under new ownership, liability for the asbestos claims is unclear: "the new law has socialised this guilt." Although the company imported asbestos, worked with it and sold asbestos products, there is "no personal guilt and no person responsible for these illnesses." According to Slovenian law, he said, "everyone is responsible for the people who worked in dangerous facilities."
Session 3: Medical Aspects of Asbestos-Related Disease
Dr. Gregory Deleuil, the Medical Adviser of the Asbestos Diseases Society of Australia, illustrated his talk on asbestos issues in Australia with a breath-taking collection of photographs depicting the reality of life in an Australian asbestos mining town. Although the Wittenoom (Crocidolite: Blue Asbestos) Mine was operational for only 23 years, it has produced an epidemic of asbestos disease in Western Australia amongst former workers, their families and town residents. Many young adults, who had lived in Wittenoom as children, have died from asbestos-related diseases in their 20s and 30s. Greg's photos of race day in Wittenoom showed horses running on a blue track made from asbestos tailings. A photograph of children competing in sack races on the same track told its own story, while the image of men competing to fill 50 pound storage drums with asbestos tailings elicited gasps of disbelief from the audience. Greg informed us that the 1st and 2nd prize winners and the judge of the asbestos shovelling contest have all died from asbestos-related disease. In recognition of the appalling human tragedy experienced by Australians, the Government set up The Asbestos Working Party in 2002 "to identify research strategies aimed at reducing the incidence of asbestos-related cancer particularly mesothelioma, or curing these diseases." 6 The budget for this program totals Aus$110 million over the next ten years. It is expected that this money will come from those with significant asbestos liabilities such as insurers, the national government and employers.
Eighty percent of all former SA workers smoked; survival of lung cancer victims in Asbestos Valley is currently a mere 11 months. According to Chest Specialist Dr. Marjeta Terčelj, in Slovenia there are three lung cancers for each case of mesothelioma. As early identification of lung cancer could lead to more effective treatment, Dr. Terčelj is working with colleagues on non-invasive methods of screening; one area of interest is the use of sputum tests to identify cell changes.
Dr. Majda Mandelc Grom's presentation focused on the work of the Slovenian Verification Committees which, since 1998, have been responsible for confirming the diagnoses of occupational asbestos-related diseases; certification from these committees is required before government compensation can be claimed. There are two committees each of which are composed of 3 members: a specialist in occupational medicine, a pneumologist and a radiologist. Since September, 1998, 1900 cases of asbestosis, pleural plaques and thickening, lung cancer and mesothelioma have been processed by these committees; 73% of them were verified. Although the committees work independently, questions from the audience suggested that many victims felt there was collusion between them.
Session 4: Preventative Health Strategies and the Human Experience of Asbestos-Related Diseases
An exciting community project was described by Sonja Valič in her talk: Health Preventative Program for Asbestos-Exposed Population. The high levels of asbestos exposure experienced in this region have led to an epidemic of lung cancer and other asbestos-related disease. Ms. Valič stressed the importance of early detection for lung cancer, stating that the one year survival rates for lung cancer, a disease which can sometimes be cured if found early enough, amongst local people was appalling. Working on a shoestring budget, the project employs a variety of means to promote:
healthy diets including the daily consumption of 4 portions of fruit or vegetables and a reduction of fat and alcohol intake;
regular physical activity to improve cardio-vascular capacity and reduce blood pressure.
Since May, 2000, hundreds of people have participated in workshops and discussion groups run to raise awareness of the importance of a healthy life-style; a phone line to provide information and support has supplemented these initiatives. Despite the obvious need for these services in the Asbestos Valley, the project is facing closure because of serious financial threats. Donations from the Health Service Center of Nova Gorcia, the Ministry of Health, the Community of Anhovo and the former asbestos company: Salonhit Anhovo are not sufficient to cover the center's costs; an application for European Union funding was rejected.
The next section of the conference consisted of important contributions from two members of SABS, the asbestos victims' group which was the prime mover of the conference.
Thirty years ago, Jožef Mugerli worked at SA for a few years. When a persistent sore throat sent him to a medical specialist, he could not believe that his condition was asbestos-related. After the recovery from his surgery, his health has improved.
Jožef Blažič, who had worked at SA from 1968-1971, was a keen cyclist until his health deteriorated; he was diagnosed with mesothelioma. After an operation and 5 bouts of chemotherapy, he is now well enough to cycle and ski. Mr. Blažič stressed the importance of early diagnosis. While this level of remission is unusual, early diagnosis becomes increasingly important as new treatment and palliative care regimes are developed.
During the discussion session, the following comments were made from the floor:
despite the use of asbestos by dozens of Slovenian companies, a diagnosis of asbestos-related disease outside the Nova Gorica region is a rarity;
the majority of asbestos workers who retire early receive no medical follow-up;
once a ruling has been made by a verification committee, no appeal is possible;
there are, according to victims, discrepancies between rulings by the two verification committees in similar medical cases;
compensation levels remain fixed and do not rise with inflation;
payment of compensation by government agencies is routinely delayed;
although invitations were sent to politicians, not one attended the conference. Their lack of interest and commitment explains why funds allocated in the Slovenian budget for 2003-2004 to compensate asbestos victims have decreased; thus, even when claims are approved, government compensation is not assured. There are currently 560 approved claims awaiting payment.
For decades, workers and residents in Asbestos Valley have paid the price for the unregulated and widespread use of asbestos, while the Government and "the experts" did nothing. Workers in Asbestos Valley have been campaigning on asbestos issues since 1983, but information is seriously lacking in many other areas of the country in which asbestos was used; it is imperative that steps are taken to begin the process of diagnosis and compensation in these areas.
With the adoption of the Asbestos Act of 1996, the Government banned the manufacture, use and transport of asbestos-cement products in Slovenia and outlined a process for assessing and paying compensation for asbestos diseases. Unfortunately, the funds needed have not been forthcoming. The lack of political support for this issue was apparent from the fact that not even one politician attended the conference. As Slovenian scientists predict that the incidence of mesothelioma and lung cancer won't peak until 2010-2025, it is clear that more must be done to help the nation's asbestos victims.
|Press Conference in Nova Gorica on May 13, 2003|
June 10, 2003
1 Dodič-Fikfak M, Kristancic Z, Rahotina L, Vidic R: Case Study: Slovenia - Asbestos Valley, New Solutions, Vol. 8(4) 469-478, 1998.
2 Dodic-Fikfak M, National Directives for Asbestos, a paper presented on February 15, 2003 at the conference: Ban on Asbestos in Europe in Monfalcone, Italy.
3 CD: Annals of the Global Asbestos Congress, Osasco. Brazil, 2000.
4 A paper entitled: The Asbestos Dilemma: 1. Assessment of Risk by Fedor Valic can be accessed on the website of the Asbestos Institute. Valic concludes: "there is no doubt that it is advisable to replace any potential carcinogen with noncarcinogenic or less carcinogenic material whenever possible. At this point, however, there are few materials of known toxicity / carcinogenic and at least equal technological performance (to chrysotile). There is a potential for the development of such materials, but their toxicological properties have not been evaluated sufficiently."
5 While a smaller bilateral meeting between Slovenian and Italian experts, trade unionists and representatives of NGOs took place previously, this was the first international gathering.
6 Document published by the Australian National Health and Medical Research Council. Asbestos Working Party.