Health Promotion Officer / Clinical Nurse, BreastScreen Queensland - Townsville Service, Queensland Health, P.O. Box 670, Townsville Qld 4814 sholehboyle9@hotmail.com
Development in Papua New Guinea (PNG), since independence almost 25 years ago, has been increasingly dependent on large-scale projects involving the exploitation of natural resources, principally minerals, petroleum and forests. These projects have tended to be somewhat autonomous enclaves and as such the rewards of employment and economic gain, as well as the deleterious effects on health and social fabric of the community, have been largely confined to the immediate region (Jackson, 1991).
Ok Tedi Mining Limited (OTML) is a prime example. In the late 1960s, a mountain of gold and copper ore was discovered high in the jungle-clad mountains of Papua New Guinea, near the border with the Indonesian province of Irian Jaya. An international consortium composed of the Australian firm Broken Hill Proprietary, Krupp Industries and Standard Oil of Indiana, in collaboration with the government of PNG, proposed to develop a mine and a gold and copper concentrator at this difficult site near the Tedi River, more than 500 miles upstream from the Gulf of Papua in the Fly River drainage.
For years the people of Fly River and the surrounds complained about pollution of their river, which provided livelihood for many of them, only to be bombarded with an advertising campaign denying there was a problem. When they took the multi-national BHP to court, the company took to drafting legislation for the government, which made it an offence to take action against them outside PNG.
On 11 June 1996, BHP and the plaintiffs announced a settlement of the litigation, which included monetary compensation for the damage to the environment and lifestyle of the Ok Tedi and Fly River communities (Walde, 1996). BHP announced the outcome as follows:
Despite of the above resolutions, in 1999, BHP has finally admitted that the damage Ok Tedi has caused to the environment in the Fly River area is “greater than forecast” (Hildebrand, 1999). OTML managing director, Roger Higgins (1999) admitted last month that the environmental damage so far had displaced about 4,000 people in the lower Tedi and middle Fly but the figures would eventually climb to over 9,000. BHP/OTML still continues to dump 90 million tons of mine waste each year into the Ok Tedi River causing more frequent and devastating flooding.
This is cold comfort for the people of the area whose social and physical health profiles have been, possibly irreversibly, changed. This change may be demonstrated by the comparison of epidemiological data prior to the OTML project and subsequent changes.
The spectrum of pathology has certainly changed radically in the OK Tedi region since the first clinical epidemiological study was carried out in 1978, when malaria, anemia, malnutrition and respiratory and other infectious diseases predominated and the life expectancy was low (Taukuro, et al 1980). Since 1982 to date the Department of Community Medicine of the University of PNG has been carrying out a longitudinal study on the health status of one local land owner group, the Wopkaimin. Results obtained so far indicate that infant mortality has fallen markedly from over 160/1000 to under 50/1000, and the rate of natural increase of the population has doubled over the past 10 years. However, there has also been a steady increase in adult body-mass (BMI), blood pressure, dental caries and social problems such as divorce, polygamy, promiscuity, illegitimate births, alcohol abuse domestic violence and squatter settlements.
Diseases from the adoption of a more western lifestyle and diet are now making a significant impact in this area. Stress related diseases such as heart disease are increasing: in 1995 there were at least 6 cases of myocardial infarction in relatively young patients (35 - 45 years olds who had no previous cardiac problems) amongst the 3,500 workforce at Ok Tedi and this figure is growing. The increasing incidence of stress related diseases have resulted in OTML starting a register of employees, including local Min people, with known risk factors such as hypertension, obesity, diabetes, hypercholesteraemia, tobacco and alcohol abuse. There are also an unusually high number of chronic renal disease cases coming from this region.
There seems little doubt that the change in lifestyle and diet brought about by the development has contributed significantly to the above-mentioned diseases. This is supported by a simultaneous study of villages in a similar remote environment. These villages did not experience any development and their socioeconomic and health status remained virtually unchanged over the same period (Taufa, 1996).
The typical healthy local diet of staples such as taro, sweet potato, kumu (vegetables), etc., could be incorporated in the catering contracts, which would not only replace the high fat, western diet served in Ok Tedi but would also benefit the local garden-based ‘agro-industry’ providing financial benefits to women who customarily manage them. The empowerment of women would contribute positively to the health of the families in the neighboring communities of Fly River (Dyke, 1995).
The other specter hanging over the mining industry in PNG, as in South Africa, is of course, AIDS (acquired immune deficiency syndrome). The current high rates of STDs (sexually transmitted diseases) in PNG have already prompted vigorous response on health promotion for AIDS, including at Ok Tedi mines, in an attempt to prevent the decimation of population that has already occurred in Africa, including the mining workforce and their families and communities (Flew, 1996).
OTML brought with it the first opportunity for the Wopkaimin and neighboring ethnic groups to experience modern health care in the form of a company-built health center at Tabubil which has gradually expanded to include a mobile maternal child health clinic, a network of 6 aid posts offering improved obstetrical care. The beneficial results recorded include:
The provision of simple and timely medical care and antibiotic therapy has transformed traditional life expectancy from 30 years or so (less in women) to around 45 - 50 years. Although these advances have occurred over time, it is at a significant cost that these services, which replace the government’s own responsibilities in these areas, are provided.
One unfortunate consequence of providing free or low-cost curative care, whether it be provided from the government or non-government sources, is that there is a tendency for loss of control and responsibility for one’s own health, emphasis on easy fix-it curative treatments instead of prevention of diseases, and the fostering of dependency on an outside agency for basic health care. More especially, with a liberal supply of medicines, this can develop into potentially dangerous over-medicalization of the population, and already this is a major problem with many of the health facilities run by mining ventures throughout PNG.
Another aspect that OTML prides itself is in improving the management of safety at the work site and achieving a 6-fold reduction in lost time injuries (LTIs) between 1990 and 1995 (Werner et al 1996). The safety record at OTML has achieved LTIs which are among the lowest in the world for the mining industry, at less than 1.5 LTIs per million man-hours worked. However, lost time due to illness far exceeds that due to injury (by a factor of 9:1) and in part is confirmed to be due to over medicalization of health: too many recurrent attendees with minor complaints. This begs the question: if low LTIs can be achieved for safety, why not for health?
This can happen if the right policies, personnel, motivation and political support can be found to implement the vision and goals of health promotion for the surrounding participant communities at such resource development projects as Ok Tedi. However, BHP has mined millions out of Ok Tedi, and the waste products of this have been unceremoniously dumped into the river. For such a multi-national company to continuously to proceed with such environmentally destructive action for years, even after the landowners and people in the area made claims of damages, is totally irresponsible.
For BHP to state in its website and annual reports that it is a responsible corporate citizen, with an environmental policy safeguarding the health and social well-being of Fly River inhabitants and mine workers, is a slap in the face for those people who now live in slums surrounding Fly River. In other areas of the world where BHP is engaged in mining, the company would not dare condone, let alone take part, in such disastrous action. Indeed, it has gone to great lengths in other areas of the world to ensure minimal effect on the environment. In Papua New Guinea, where the PNG government is BHP’s partner in Ok Tedi, however, due to a lack of accountability to a higher body, the company turns a blind eye to the suffering they have caused and any long-term damage inflicted.
There are broader implications of the Ok Tedi litigation that include the preservation of the cultural health of indigenous people. This is complemented by the environmental policies of the United Nations such as The United Nations Conference on Environment and Development (UNCED) and the subsequent Rio Declaration on Environment and Development. In the latter, Principle 22 states that:
“Indigenous people and their communities, and other communities have a vital role in environmental management and development because of their knowledge and traditional practices. States should recognize and duly support their identity, culture and interests and enable their effective participation in the achievement of sustainable development.”
Chapter 26 of Agenda 21 highlights the importance of cooperation with indigenous peoples and as Professor Wälde (1996) has noted:
“The balance between economic development and environmental protection may need to be defined differently.”
In the final analysis, the value of resource development projects such as Ok Tedi, to the region and the country as a whole must be viewed in the light of the permanent accruing benefits versus the permanent disadvantages. These may be highly visible, such as large holes in the ground, loss of pristine wilderness or productive land, and clogged up rivers: or hidden such as the health and social effects of acculturation to a western lifestyle. Health promotion by companies for their workforce and families, and the local communities, makes economic and moral sense and should be accorded a priority equivalent to safety and injury prevention. Companies involved in resource development projects can be put under considerable pressure from within the country, and sometimes from without (depending on their original base e.g. BHP from Australia) to act as responsible corporate citizens. In particular they can be required to adequately compensate those affected directly or indirectly by their activities, as well as to care for the health of the people and their environment as much as possible.
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