CHENNAI: Conversations around sanitation in India, unfortunately, rarely extend to the people upholding it. And when they do, they take an often surface-level, linear route. It’s been a long time coming for the struggles of sanitation workers to be highlighted and addressed. Recently, as part of Tamil Nadu Urban Sanitation Support Programme (TNUSSP) implemented by Indian Institute for Human Settlements, in association with CDD Society, Gramalaya, and Keystone Foundation took a step in this direction with their ‘First Aid Training Manual for De-sludging Workers’.

The manual was launched recently at the YMCA, preceding a panel discussion with Niladri Chakraborti, senior lead – practice, City-Wide Inclusive Sanitation (CWIS), IIHS; Jawahar Hasan, secretary, Indian Red Cross Society; Karuppaiah Raju, owner of Raju Septic Tank; Radhakrishnan, St John’s Ambulance; Dr G Chandramouli, general surgeon, RGGGH; and Kamalakannan from the Department of Industrial Safety and Health (DISH).

Background and research

Peer reviewed by members of the Indian Red Cross Society, the manual is a rather elaborate training guide with illustrations (created under supervision of subject experts), mapped out plans and step-by-step instructions to educate on the first-aid needs for desludging workers (see box) in particular. “To develop an evidence-based understanding of the occupational hazards facing desludging operators, IIHS conducted a Needs Assessment Study in 2021.

It identified the critical decision-making points, time cycle of activity, and design concerns of locations to substantiate hazards based on Hierarchy of Controls method. One of the key recommendations that emerged was the necessity of developing a first aid protocol for desludging operators. In coordination with St John Ambulance, TNUSSP conducted rounds of simulation exercises involving desludging operators in Tiruchy in September 2021 and this was fine-tuned by repeated training with desludging operators,” explained Kavita Wankhade, project director, TNUSSP.

operators to participate in the pilot training session was Karuppaiah. Over the years, he has seen his fair share of problems during operations from infections to bodily wounds. “There are many general issues while, say, opening the septic tank. If it has been shut for a long time, there could be gas build up and even if we wear masks, the smell can sometimes be a bit too much. Some have gotten fevers. Previously, during rains, a few people I have worked with have fallen as well. The training has had many advantages. It is for our safety and it has been a success for us,” he shares. It is, however, important to note that the manual in no way claims to take the place of medical attention but rather provides steps to take immediate action preceding the former.

When it comes to dissemination of the information in the manual, IIHS plans to train desludging workers in Tiruchy in coordination with St John Ambulance. The Red Cross Society has also expressed willingness in incorporating the information in their overall training package, informs Kavita. “Every year, in India, sanitation workers die while performing their duties. We hope that the first aid manual will help desludging operators in a small way to respond to health emergencies in time to stop them from turning fatal,” she adds.

Steps ahead

While the manual addresses a need for desludging workers, there is more to be explored when it comes to the issues faced by sanitation workers, it seems. According to Dr Chandramouli, the manual works better for those in the organised sector of desludging, who have some support system and transport and disposal facility. He hopes that by involving the government, issues pertaining to the informal sector of the industry can also be reviewed. “In my opinion, (working with the unorganised sector) cannot be through voluntary means. I think the government can (provide) free licences and tell the public to employ those with licences. And while giving the licence, they should ensure that the workers know first aid and understand the health consequences,” he says, adding that there is yet another major issue that still needs to be worked on asphyxiation.

“As far as doctors are concerned, this type of small bruising, fractures etc. can be managed in tertiary services. I am worried about the asphyxiation due to inhalation. Some gases smell and others don’t. Hydrogen sulphate comes with a rotten smell but carbon monoxide and methane don’t smell. The common perception which is false is that desludging operators can smell and avoid the (tank). After asphyxiation, they don’t know how to proceed further and that is where first aid comes in. I insisted (at the panel discussion) that since this is an organised sector (that the manual works best towards), they have to get a disposable oxygen tank so they can get support; most treatment for asphyxiation
is oxygen.

There are also gas monitors that can be used to find carbon monoxide before entering the tank. And workers need to get into the habit of wearing PPEs…While the manual works for largely the organised sector, it is a first step and we can always extend it towards the unorganised sector,” he explains. After hearing Dr Chandramouli’s statement at the discussion, Karuppaiah too looks forward to learning more about the oxygen cylinders and gas monitors, and hopes they could be given more information on the same.

Moving ahead, IIHS that is already working with a host of sanitation workers will be extending their services beyond desludging operators. “In Tiruchy, IIHS is closely associated with solid waste management workers, and it is understood that their challenges are considerably different from that of the desludging operators. A preliminary work around development of the training module has been initiated. IIHS puts equal emphasis on training design, keeping in mind the informal nature of sanitation work, educational limits, and a reluctance to classroom-based learning methods,” Kavita informs, adding that IIHS engages with all types of sanitation workers to ensure improved social security and access to health and alternative livelihoods.

What’s to come is yet to be seen and evaluated, but for now, one can hope that the manual makes the world of sanitation workers (or at least desludging operators) a little safer.

Describing desludging

A desludging operator is responsible for emptying, transport and disposal of faecal sludge from the septic tank/pits to desludging sites/FTSP/co-treatment plant. They have to operate a Sludge Vacuum tank with trucks, pumps, suction hoses, and other machinery/equipment to empty the septic tank.

Source: National Qualifications Register