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 Table of Contents  
ORIGINAL ARTICLE
Year : 2016  |  Volume : 28  |  Issue : 2  |  Page : 120-124

Ocular open globe injuries at workplace among domestic migrant laborers in the Angamaly–Perumbavoor belt of Kerala


Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala, India

Date of Web Publication20-Mar-2017

Correspondence Address:
Sanitha Sathyan
Department of Ophthalmology, Little Flower Hospital and Research Centre, Angamaly, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_1_17

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  Abstract 


Aim: To analyze the pattern of workplace ocular open globe injuries affecting domestic migrant laborers (DML) in the Angamaly–Perumbavoor belt of Ernakulam district.
Materials and Methods: Retrospective analysis of medical records of migrant laborers who suffered from ocular open globe injuries sustained at workplace and treated at a tertiary care ophthalmic hospital during the period June 2011 to June 2016 was performed.
Results: Fifty eyes of 48 DML in the Angamaly–Perumbavoor belt, with ocular open globe injuries sustained at workplace were included in the study. Mean age of the participants was 27.18 ± 8.5 years. Fifteen (30%) patients belonged to the 18–22 age group; 13 (26%) belonged to the 22–26 age group. Most common mode of open globe injury was injury with flying metal piece (46%) followed by injury with stone (36%). Thirty-eight (74%) had rupture of globe, 10 (20%) had penetrating injury, 2 (4%) patients had intraocular foreign body, and 1 (2%) had perforating injury. According to the Ocular Trauma Score Classification, 30 (61%) had Zone 1 injuries, 14 (29%) had Zone 2 injuries, and 5 (10%) had Zone 3 injuries. Grade 3 injuries accounted for 23 (46%) cases, followed by Grade 4 injuries in 16 (32%). The follow-up data and long-term visual outcomes of ocular globe injury in DML could not be analyzed as there was a high percentage of patients who were lost to follow up. Twenty-nine (58%) were of patients who were lost to follow-up after 1 month post surgery, 16 (32%) patients were lost to follow-up after 3 months, and follow up records beyond 6 months were available only for 5 (10%) patients.
Conclusion: The prevalence of open globe injuries among migrant labourers in Kerala is high. The clinical findings indicate that most of them are serious sight threatening injuries. Socioeconomic and legal factors involved in these cases need to be addressed.

Keywords: Kerala, migrant laborers, workplace ocular injuries


How to cite this article:
Sathyan S, Davis D. Ocular open globe injuries at workplace among domestic migrant laborers in the Angamaly–Perumbavoor belt of Kerala. Kerala J Ophthalmol 2016;28:120-4

How to cite this URL:
Sathyan S, Davis D. Ocular open globe injuries at workplace among domestic migrant laborers in the Angamaly–Perumbavoor belt of Kerala. Kerala J Ophthalmol [serial online] 2016 [cited 2019 Aug 22];28:120-4. Available from: http://www.kjophthal.com/text.asp?2016/28/2/120/202466




  Introduction Top


According to the data published in 2011, there were over 25 lakh domestic migrant laborers (DML) in Kerala who migrated from other states of India, as well as from Bangladesh and Nepal.[1] In 2016, this figure was over 40 lakhs with an annual arrival rate of 2.35 lakhs with a sum of Rs. 25000 crores going outside the state each year as wages to the migrant workers. The flow of DML to Kerala is expected to rise as high as 48 lakhs by 2023.[2]

Up to the last decade, the largest number of migrant workers in Kerala was from Tamil Nadu. However, now, the trend in domestic migration has witnessed some changes. According to the study in 2013, 75% of the migrant workers in Kerala come from five states –West Bengal, Bihar, Assam, Uttar Pradesh, and Odisha. In addition, a large number consist of workers from Jharkhand, Chhattisgarh, Madhya Pradesh, Rajasthan, Gujarat, Haryana, Uttarakhand, and Manipur.[2] Kerala is a favored destination by migrant laborers due to the high demand for unskilled labor, higher wages compared to other states in India, and better living conditions.

The district-wise breakup of this population shows the highest number of DML in the district of Ernakulam, with approximately 80000 laborers. Angamaly–Perumbavoor belt in Ernakulam district has the most densely populated domestic migrant workforce in Kerala.[2]

A notable aspect of the DML in Kerala is that they seem to engage in almost all occupations and sectors of the economy.[3] Although exact figures are not available, 60% of them work in the construction sector. They also work in the furniture industry, hotels, manufacturing units, quarries, brick kilns, trade and agriculture sectors, and as unskilled manual laborers. They also include skilled carpenters, masons, electricians, etc., They now constitute approximately 65% of several private enterprises, and their daily wages range from Rs. 400 to Rs. 900.[3]

Kerala is the first state in the country to enact a social security scheme for migrant workers and the state is the first to provide benefits to job-seekers from outside the state, with the Kerala migrant workers welfare scheme set up in 2010.[4] Introduction of health cards was also proposed due to the presence of diseases eradicated by the state in migrant workers and because of the introduction of new diseases; a proposal to screen all the migrant workers is proposed under the “Safe Kerala” campaign.

Concerns regarding working conditions and long working hours of migrant laborers in Kerala came to the forefront in regard to the plywood industry in Perumbavoor.[5] It was noted that these migrant laborers are often engaged in hazardous jobs without proper safety measures and are often victims to workplace injuries. In addition, access to healthcare and health seeking behavior of this population is distinct, and the incidence of self medication and delayed attendance to the treatment facility has been noted in previous studies conducted in this area.[4]

These migrants are more prone to ocular injuries at workplace because of the inherent hazardous nature of their jobs as well as the casual way of dealing with the safety precautions both by the employers and the workers. This arises from ignorance and vulnerability on the part of the laborers, procurement of cheap physical labor without concerns about their safety at workplace by the employers, and the failure of the government machinery to enact and execute laws and norms for workplace security for these “outsiders.”

Hence, this study was conducted to analyze the ocular health status and sequelae of open globe injuries in this population. The study was conducted at a tertiary care ophthalmic hospital in central Kerala. This hospital is the major health provider in the area and caters to almost all the serious eye injuries among the migrant workers.

Aim

To analyze the pattern of workplace ocular open globe injuries affecting DML in the Angamaly–Perumbavoor belt of Ernakulam district.


  Materials and Methods Top


Retrospective analysis of medical records of migrant laborers who suffered from ocular open globe injuries sustained at workplace and treated at a tertiary care ophthalmic hospital in central Kerala from June 2011 to June 2016 was conducted. Data regarding the demographical characteristics, mode of injury, clinical characteristics, treatment, pre and postoperative visual acuity, and ocular anatomical status were collected from case records. Data regarding clinical characteristics was analyzed according to the Ocular Trauma Classification System.[6]


  Results Top


This study included 50 eyes of 48 DML in the Angamaly–Perumbavoor belt, with ocular open globe injuries sustained at workplace and who were treated at a tertiary care ophthalmic hospital in central Kerala from June 2011 to June 2016. Mean age of the population was 27.18 ± 8.5 years. Fifteen (30%) patients belonged to the 18–22 age group; 13 (26%) belonged to the 22–26 age group; 7 (14%) belonged to the 26–30 age group; 7 (14%) belonged to the 30–34 age group; and 8 (16%) belonged to more than 34 years age group. Right eye was involved in 19 (38%) and left eye in 31 (62%) of the casescases. Age distribution of the population is given in [Table 1].
Table 1: Age distribution of the population

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The most common mode of open globe injury was injury with flying metal piece (46%) followed by injury with stone (36%). Modes of open globe injuries are shown in [Table 2] and [Figure 1].
Table 2: Mode of open globe injury

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Figure 1: Pie chart showing mode of open globe injury

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Of the total patients, 38 (74%) had rupture of globe, and 10 (20%) had penetrating injury. There were 2 (4%) patients with intraocular foreign body, and 1 (2%) had a perforating injury. Type of open globe injuries is shown in [Figure 2].
Figure 2: Type of open globe injuries according to the Ocular Trauma Score Classification

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According to the Ocular Trauma Score Classification, 30 (61%) had Zone 1 injuries, 14 (29%) had Zone 2 injuries, and 5 (10%) had Zone 3 injuries. Grade 3 injuries accounted for 23 (46%) cases, followed by Grade 4 injuries in 16 (32%). Zone of involvement is shown in [Figure 3].
Figure 3: Zone of involvement according to the Ocular Trauma Score Classification

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Grade of open globe injury is shown in [Figure 4]. The follow-up data and long-term visual outcomes of ocular globe injury in DML could not be analyzed as there was a high percentage of patients who were lost to follow up. Twenty-nine (58%) patients were lost to follow-up 1 month post surgery, 16 (32%) patients were lost to follow-up after 3 months, and follow-up records beyond 6 months were available only for 5 (10%) of the patients. Follow-up period after the surgical management of ocular globe injury is shown in [Figure 5].
Figure 4: Grade of open globe injury according to the Ocular Trauma Score Classification

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Figure 5: Follow-up period after the surgical management of ocular globe injury

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  Discussion Top


Our study indicates that the prevalence of ocular globe injury at workplace is high among the migrant laborers in the Angamaly–Perumbavoor belt of Kerala. As per the chart review, the prevalence of DML reporting to the hospital with workplace ocular globe injury was 5.6 times higher than that of locals from the same area during the study period. There are no previous reports regarding the prevalence and outcomes of ocular trauma in this population. It is assumed that this group has high chances of developing such injuries because of the nature of jobs they perform, their inherent risky nature, deficiency/lack of safety equipments at workplace, improper execution of labor laws and ignorance due to poor education, and lack of integration in to the local social fabric.

Majority (30%) of the population belonged to the 18–22 age group, and 26% belonged to the 22–26 age group. In a previous study on occupational eye injuries in Coimbatore, Biradar et al.,[7] had observed that the majority affected by workplace injuries belonged to the 21–30 age group. Ocular injuries occurring at the prime of lives of those involved have crucial social and economic implications in terms of loss of wages, abstinence from work, disability adjusted life years, and economic burden on the community. In addition, this could be a major reason for quitting their job in Kerala and returning to their native states by many workers.

Our study population comprised exclusively of males. Previous studies on occupational eye injuries also state a preponderance of males.[7],[8] It has been noted that the DML of Kerala are a work force consisting almost entirely of single males aged between 18 and 35 years who are highly mobile within Kerala.[2] The migrant females who work in Kerala are mostly engaged as domestic helps are at a lesser risk of developing ocular injuries.

The most common mode of open globe injury was injury with flying metal piece (46%) followed by injury with stone (36%). Previous reports on ocular workplace injuries also report similar modes of injuries.[7],[8],[9],[10],[11] However, we could not analyze the relationship between the mode of injury and the nature of employment as the medical records were incomplete regarding the type of employment of the patients involved.

Of the total patients, 74% had rupture of globe and 20% had penetrating injury. There were 4% of patients with intraocular foreign body and 2% with perforating injury. Furthermore, 61% had Zone 1 injuries, 29% had Zone 2 injuries, and 10% had Zone 3 injuries, with a higher frequency of Grade 3 (46%) and Grade 4 injuries (32%). This indicates that there was a preponderance of serious sight threatening ocular injuries in this population, as agreed upon by previous authors.[7],[8]

It was also noted that the prevalence of open globe injuries among DML was 5.8 times higher than those of the local workers, as per the surgical records during the same period. Moreover, the rate of discontinuation of treatment/failure to turn up for follow up was also high among DML than the local population. This may be because of a number of socioeconomic factors. Compared to the migrant workers, the local workers are well organized and succeed in getting decent wages and better working conditions. However, the living conditions, sanitation, access to health care, and health care demands of the DML are poorly met. A study conducted in Thrissur district in 2011 observed that the highest educational status of the domestic migrant population was till 4th standard.[12] This is in stark contrast to the high literacy rate and the human developmental index of Kerala. This may have contributed to the lack of safety practices at workplace and poor adherence to treatment following ocular surgery observed in this population. Furthermore, there is a huge barrier in terms of language, culture, and paying capacity between the natives and the migrant workforce.[12] This prevents them from effectively integrating with the local society and makes them more vulnerable to the impacts of economic and social barriers brought about by serious ocular injuries at workplace.

Majority of the patients (58%) were lost to follow-up after 3 months, as shown in [Figure 5]. Hence, we could not analyze follow-up data and long-term visual outcomes of ocular globe injury in this population. Although we tried to contact them through telephone, only 12 patients were available for telephonic interviews. Out of the 12, 8 had quit their jobs in Kerala and had returned to their native places due to loss of employment and financial reasons, and 4 were continuing their jobs in Kerala. Although there are legislations and labor laws favoring the cause of DML in Kerala, the ground realities are different. The poor economic status, ignorance, and nonavailability of health related schemes/reimbursement, which are readily available to the locals are often denied to these migrants. It is commonly observed that the employers are also not keen to attend to their health related issues and demands, and most of them are forced to quit their jobs after the injury and are pressurized to return to their native place.

One of the merits of our study is that accurate clinical details could be obtained from the case files, and demographic data obtained are also satisfactory. Limitations of our study include its retrospective nature, incomplete details regarding the nature of employment, access to safety equipments during work, visual outcomes after management of ocular ocular globe injuries, and therefore, the inability to analyze the socioeconomic factors involved.

A report submitted to the Government of Kerala on the DML by the Gulati Institute of Finance and Taxation in 2013 has recommended that the government should take steps to improve their housing and living conditions.[2] Our study is a one of its kind study conducted among DML in Kerala and calls for greater attention towards prevention and management of ocular open globe injuries as well as ensuring legal and health rights in this relatively underserved population.


  Conclusion Top


The prevalence of open globe injuries among migrant labourers in Kerala is high. The clinical findings indicate that most of them are serious sight threatening injuries. Socioeconomic and legal factors involved in these cases needs to be addressed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ocular open globe injuries at workplace among domestic migrant laborers in the Angamaly–Perumbavoor belt of Kerala. Available from: http://www.census2011.co.in/census/state/kerala.html. accessed on 2016 Nov 11].  Back to cited text no. 1
    
2.
Joseph MP, Narayana D, Venkiteswaran CS. Study of Domestic Migrant Labour in Kerala. Gulati Institiute of Finance and Taxation. Submitted to Labour and Rehabilitation Department Government of Kerala; February, 2013.  Back to cited text no. 2
    
3.
Haseena VA. Welfare Scheme for Domestic Migrant Workers in the Analysis of Kerala. Public Policy Administration Res 2015;5:100-3.  Back to cited text no. 3
    
4.
Kerala Migrant workers welfare scheme of 2010. KURVN/12POO9-2011(March 29, 2010).  Back to cited text no. 4
    
5.
Hiran Unnikrishnan. Exploitation at Perumbavoor's plywood units. The Hindu. 2015 Sep 15.  Back to cited text no. 5
    
6.
Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G. A Standardized Classification of Ocular Trauma. Ophthalmology 1996;103:240-3.  Back to cited text no. 6
    
7.
Biradar SP, Arvind H. A Study on Industrial Eye. Injuries. J Clin Diagn Res 2011;5:1076-81.  Back to cited text no. 7
    
8.
Klopfer J, Tielsch JM. Ocular Trauma in the U.S: Eye injuries resulting in Hospitalisation. Arch Ophthal 1992;110:838-42.  Back to cited text no. 8
    
9.
Jain BS, Soni SR. Ocular injuries: An analytical study in a teaching general hospital. Indian J Ophthalmol 1987;35:112.  Back to cited text no. 9
    
10.
Koval R, Teller J, Belkin M, Romem M, Yanko L, Savir H. The Israeli ocular injury study. Arch Ophthalmol 1988;106:776-79.  Back to cited text no. 10
    
11.
Wong TY, Lincoln A, Tielsch JM, Baker SP. The epidemiology of ocular injury in a major US automobile corporation. Eye 1998;12:870-4.  Back to cited text no. 11
    
12.
Kumar A. Impact of replacement migration on wages and employment on construction sector in Kerala [dissertation]. Sacred Heart College: Mahathma Gandhi University; 2014.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2]



 

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