Inside Story

Battling asbestos, one step at a time

Recent events have revealed the power of the asbestos industry – and, in Indonesia, a powerful determination to fight it

Tom Greenwell 11 May 2017 2475 words

Trying to break the habit: Wira Ginting from Indonesia’s Local Initiative for Occupational Health and Safety Network (left) and former asbestos worker Siti Kristina. Tom Greenwell

When the 157 signatory countries to the Rotterdam Convention on Hazardous Chemicals and Pesticides met in Geneva last week, delegates heard from Siti Kristina, who worked with asbestos in Indonesia for twenty-three years. Before Siti left Jakarta, I asked her what she intended to say. “I just want to say that I have asbestos-related disease,” she told me. “I want to share that with the meeting in Geneva. I have experienced it. So it is not a myth. Asbestos causes disease. Don’t hide it.”

The global asbestos industry’s stratagem to conceal the reality of Siti’s situation – and obscure the fact that asbestos causes disease – was on show as the meeting in Geneva unfolded. Once a hazardous material is listed under the Rotterdam Convention, a member country must grant formal consent before the material is imported into its territory. Listing asbestos would be a small but significant step in reducing the harm it causes, but would stop well short of bringing the deadly global industry to a halt. And yet a small rump of countries succeeded in resisting even this moderate measure.

Exploiting the fact that unanimity is required for changes under the convention, three asbestos-mining countries – Russia, Kazakhstan and Kyrgyzstan – stubbornly held out. As if to emphasise the nature of their opposition, they were joined this year by the government of Syria. It is hard to find any reasonable basis for their stance. Attempts to foster doubt about whether chrysotile, or white asbestos, is as dangerous as other types were dealt with categorically by a World Health Organization expert, who testified that “all forms of asbestos, including chrysotile, are carcinogenic to humans, and cause mesothelioma and cancer of the lung, larynx and ovary. The evidence that chrysotile is carcinogenic is conclusive and overwhelming, and it has continued to strengthen over time.” Even an effort by a group of African countries to remove the asbestos-mining countries’ veto over the listing process was deferred until the next biennial conference of parties.

“Failure to list chrysotile asbestos on Annex III once again is an absolute disgrace,” said Andrew Dettmer, national president of the Australian Manufacturing Workers’ Union and an NGO delegate at the Geneva conference. His emotional response was surely apt in the circumstances. “While they dither, hundreds of thousands of people will die from asbestos-related diseases.” And yet, as correct as Dettmer is, the outcome in Geneva didn’t occur in isolation. It reflects the fact that the extraction, manufacture and consumption of asbestos continues to be commonplace throughout the Global South.

I met Siti Kristina not far from the asbestos textile factory in southern Jakarta where she worked for more than two decades. Production of asbestos-containing products occurs on a massive scale in Indonesia. Each year, the country imports over 100,000 tons of raw asbestos from mines in Russia, Brazil and China, without placing so much as a tariff in the way. Factories dotted throughout Java and Sumatra use the carcinogenic fibres in wall and ceiling boards, insulation, rope, gaskets, brakes and clutches. But mostly, Indonesia uses asbestos in cement roofing.

As her grandson climbed over her and we ate fried rice, Bu Siti described her job. Her employer, Jeil Fajar, had moved from Japan to South Korea in the eighties in pursuit of lower wages and lighter regulation; in the nineties it left Korea for China and Indonesia, where Bu Siti joined the company in 1991. In the factory, sacks of raw asbestos would be mixed with polyester to create asbestos thread, which was twisted and woven into cloth for industrial insulation. At each stage of the process, deadly asbestos fibres permeated the room, and found their way into each breath of air Siti and her co-workers inhaled.

After a decade working in the Jeil Fajar factory, Siti started to experience the dry, heavy coughing fits known so well by asbestos victims. Usually these episodes would last around a week. Medication prescribed by doctors sometimes helped her recover temporarily but a few days later the coughing would start again. Siti told me how she experienced a bout of dry coughing that endured for more than a month. She lost her appetite entirely and her weight dropped dramatically.

In 2008, a joint research team from Japan, South Korea and Indonesia came to the Jeil Fajar factory to conduct medical examinations on the workers. Siti – disconcerted by her deteriorating health – volunteered to take part. When the result of the CT scan eventually came back, she discovered she had been diagnosed with early onset asbestosis. Asbestosis results from fibres inserting themselves into the lining of the lungs, causing inflammation and scarring that retards our capacity to breathe. Sufferers of asbestosis are at increased risk of developing multiple forms of cancer. 

The local doctors – who happened to be associated with Jeil Fajar – disagreed. They told her she was just experiencing minor irregularities, gave her pills and sent her away. She was suffering from asbestosis according to doctors in Japan and Korea, but not according to her local medics. Dr Anna Suraya is the head of the Scientific Development Unit of the Occupational Doctors Association of Indonesia. “Mostly doctors here, if they see a lung problem, their focus is on tuberculosis,” she told me. “The first thing they look for is tuberculosis.” The resulting tendency, in Suraya’s view, is for doctors to wonder why cases of tuberculosis have an unusual appearance in scans and turn out to be drug-resistant, when in fact they’re dealing with asbestosis. 

Reorientation needed: Anna Suraya from the Occupational Doctors Association. Tom Greenwell

This is the nub of the problem. Officially, Indonesia has never had a case of asbestos-related disease. Accordingly, there has been no successful claim for workers’ compensation that acknowledges the link between asbestos-related disease and occupational exposure to asbestos.

Wira Ginting heads up an NGO, the Local Initiative for Occupational Health and Safety Network, or LION, that supports asbestos workers and victims in Indonesia. LION is part of a network of organisations campaigning for a ban on asbestos in Indonesia, and supported Siti Kristina’s travel to Geneva. For Ginting and his colleagues, Indonesia’s relationship to asbestos is a bit like the addict’s to his habit: the problem needs to be acknowledged before it can be solved. Ginting told me that the absence of any diagnosis of asbestos-related disease in Indonesia is “the gap” in dealing with the problem. “There is huge, massive consumption of asbestos,” he says. “But on the ground, there is no case of asbestos-related disease. For some people, it provides proof in support of the asbestos lobby’s position.” Asbestos is strong, flexible, heat-resistant and, above all, cheap. Why tighten regulation – let alone consider a ban – if nobody is getting sick? 

Ginting took me to meet Subono in Karawang, seventy kilometres east of Jakarta, where the factories making everything from semiconductors to sanitary items meet the rice paddies of subsistence agriculture. Subono worked with asbestos for fifteen years before he found out it could kill him. At a factory that made fibro roof sheets, he operated a machine that ground scrap material into powder, pumping out plumes of dust containing long, curly asbestos fibres. With little in the way of protective equipment and no ventilation, he was constantly exposed. Even on breaks, he would join other workers in a room near the factory floor, where they ate, drank coffee and napped as asbestos fibres floated through the air. He would take his uniform home to wash it, carrying the poisonous particles with him. 

That factory is owned by a company called Siam-Indo. The Siam half of the operation, back in Thailand, has already replaced asbestos with substitute materials. They might be more expensive, but only very marginally, and certainly less than the value of a human life. It’s hard to argue with Subono when he says, “It’s a double standard for the company. Why do they stop using asbestos in their home country but not here? It’s clear it’s possible.”Like Siti Kristina, Subono started experiencing acute coughing fits after years of working with asbestos. It was the same kind of cough, one that never really went away. When he lay down to sleep, he experienced tightness around his chest. And then his skin started to itch intensely. Subono told me that many of his friends experienced similar problems. But they lacked access to a medical explanation that connected their symptoms with asbestos.

Double standard: former asbestos worker Subono (right) with colleagues at the manufacturing union SERBUK. Tom Greenwell

Subono first learnt about asbestos-related disease when LION extended its work into Karawang in 2013. At a meeting organised for workers in his factory, it was explained that the hazard from asbestos occurs when the fibres are dispersed into the air and breathed in. They stick in the lining of the lung, and our bodies are unable to remove them. Sustained exposure to intense concentrations of asbestos dust places a person at acute risk. For Subono, who had been handling, drilling and grinding the material his whole working life, his symptoms suddenly made sense – and his blood began to boil. When he first confronted his manager, he was given the standard industry lines about how asbestos can be used safely. Then he was told that “chicken shit” isn’t pleasant either; that’s why chicken farmers don’t hold it up to their nose. In a follow-up to LION’s information seminar, Subono undertook a medical assessment. He was diagnosed with lung abnormalities.

Then his sister-in-law, who lived close to the factory like many residents of Karawang, died of lung disease. Reeling from the death and his own diagnosis, Subono felt distressed every time he walked through the factory gates. One day he pointed out all the asbestos dust lying around to his manager. The retort came back that there was nothing to worry about. Furious, Subono swept up fistfuls of the stuff from the floor and shook them in his boss’s face, demanding to know if he really believed it was harmless. As his boss backed away, Subono saw clearly that the manager knew the dangers Subono and his co-workers were being exposed to.

Not long after, Subono resigned.

Over coffee in the two-century-old Bogor botanical gardens, Wira Ginting stepped me through the strategy to establish, in official terms, that Indonesians are suffering from asbestosis, mesothelioma and lung cancer as a direct consequence of the country’s asbestos industry. As we talked, president Joko Widodo’s convoy left the adjacent presidential palace and passed by. It was election day in Jakarta and Ahok, Widodo’s successor as governor of Jakarta, would lose a contest mired in religious and ethnic tension.

Ginting described to me how LION had organised an independent medical examination of twenty workers in asbestos factories in 2015. “This time,” he said, “Indonesian doctors were the ones who did the diagnosis.” Anna Suraya, the occupational diseases specialist, supervised the project, ensuring that the doctors and hospitals involved would place the study’s results beyond question. Nine of the twenty workers tested were found to have asbestos-related disease.

The next step was to submit a workers’ compensation claim to the state social security agency, BPJS Employment. Ginting explains that “the BPJS decision will determine their position on asbestos-related disease. If they grant compensation, whatever the value actually, it will recognise asbestos-related disease and then it will become the responsibility of the workers’ compensation system to cover victims.” Its value as a test case is not just the precedent for other workers’ compensation claims. A successful claim would constitute an official recognition of the danger of asbestos, which would in turn form the basis for pushing for comprehensive and vigorously enforced regulation – and, ultimately, a ban. Prior to the state social security agency’s assessment of the compensation claim, it had to be endorsed by the Ministry of Manpower. That endorsement was granted in March.

In 2014, Subono left the factory where he had worked his whole life. At first, he tried his hand selling birds in Jakarta. But he was soon lured back to Karawang to work for SERBUK, the local union representing workers in the manufacturing sector, including his old comrades at the Siam-Indo factory. He told me about the improvements the union has won: warning signs, quarantined areas and a rest room outside the factory proper. The company provides proper masks, although only for workers in high-risk areas. It says it’s too expensive to provide masks for all employees.

Before I Ieft Karawang, Subono showed me a photo of himself and seven friends from the factory in 1999. They are on a holiday and the photo is taken in front of a waterfall. Subono would have been eighteen at the time. A guitar sits in his lap. He points to three men in the photo, standing behind him. Like him, they have been diagnosed with lung disease. Then he gestures to the man sitting beside him. He died last year. 

Siti Kristina ended up losing her job at Jeil Fajar. As an export-oriented company, its asbestos products increasingly fell out of favour and Siti and her friends were laid off. She opened a small store selling fried snacks but now faces the medical legacy of working with asbestos, combined with a lower income. Yet she continues to speak out about what she and others are going through. As she told the delegates in Geneva, “In Indonesia, many people still do not know about the dangers of asbestos. There are many of my friends that do not have the opportunity to participate in a medical examination. It is very possible that they have asbestos-related disease too.”

After I left Jakarta, Anna Suraya emailed me. News had come through that BJPS Employment had approved the workers’ compensation claim that followed from the 2015 study. It is a huge breakthrough, an official recognition of the reality of asbestos-related disease. It will be difficult to disown and will likely lead to a further reckoning with the true costs of asbestos in Indonesia. I sent a message to Wira Ginting, who has been working towards this moment for years. His matter-of-fact reply reflects his sober determination, a resolve at least equal to those who succeeded in blocking progress in Geneva: “Yup, one step at a time.” •