Occupational therapy students help to construct safe and healthy work practices at CRP's Mirpur construction site

CRP is currently in the final stages of construction of a new 13-storey sub-centre in Mirpur, Dhaka. Construction sites are notoriously hazardous places the world over. Many countries have strict occupational safety and health standards to help prevent accidents and promote health and safety at construction sites. However, there are no such enforceable standards in Bangladesh. Through anecdotal evidence (such as the stories of our patients, our own everyday observations and experiences) we realise that construction sites in Bangladesh represent very dangerous places for workers and many workers are in danger of suffering spinal cord or other types of injuries.

One of our problems in addressing occupational safety issues is that we are not entirely sure what the problems are or what causes workers to have accidents. In order to address these problems a group of very ambitious and keen occupational therapy students, supervised by an occupational therapist, have decided to undertake a worksite analysis to identify the occupational safety and health issues at the construction site. This provides us with an excellent opportunity to develop our skills and knowledge because at the Mirpur site CRP is able to exert relatively more control and influence, an opportunity we might not have again.

The students conducted their first visit on the 13th of February 2002. For most of us this was our first visit to a construction site so our major aim was to familiarise ourselves with the types of activities that the various construction workers do. We watched the workers perform their duties and we also spoke to them about the nature of work on a construction site, as well as asking some questions about what they perceived to be the hazardous parts of their work. Interestingly, many of them did not seem to feel there were any dangers at all-despite the fact that we could see people leaning off the edge of the 11th storey with no harnesses attached!

We also conducted a general environmental assessment to identify some of the hazards caused by the physical objects and the overall condition of construction site.

The visit opened our eyes to some of the potential challenges in promoting health and safety in construction sites. We plan to visit the site again after the Eid holidays to investigate more closely some of the issues we have already identified. In particular, we hope to identify:
Environmental issues related to occupational safety and health (including hazards in the physical, social and political environment)
Occupational issues related to the safety of work practices
Workers' awareness of the hazards and risks at the worksite, worker's willingness to engage in risks and reasons for this, and any preventive strategies employed

Our team will also conduct a feasibility study of alternative methods of manual handling at the worksite. Presently, workers carry most of their loads through the traditional method of placing the load on the top of their head (such as concrete and bricks). This places the worker at risk of spinal cord injury should the load shift or should the worker fall. CRP has equipment available that would support the introduction of two alternative methods: (a) the wheelbarrow, and (b) the hod. However, the risks associated with these alternative methods are unknown, and the viability of these two methods at the construction site is also unknown.

The overall outcomes of our visits will be:
Development of a workplace checklist for use at construction sites
Development of an interview protocol for use in conducting interviews with workers to identify hazard awareness
Development of a manual handling assessment protocol for use in assessing manual handling procedures at other worksites
Clarification of environmental hazards at Mirpur construction site and recommendations for elimination of these hazards Clarification of hazards related to the nature of the work (work practices) and recommendations for elimination of these hazards
Identification and comparison of the relative strengths, weaknesses and hazards associated with three methods of manual handling (i.e., carrying on head, wheelbarrow)
Clarification of workers' awareness of risks and hazards and strategies to increase their awareness

Credit must be given to the students for undertaking such an ambitious and difficult task. This is a very complicated field to work in. Our task is made more complex by the fact that there really are no other people with skill or expertise in this area (at least that we are aware of) in Bangladesh. We will keep you informed as our findings are analysed!