Marianne Levitsky, MES, CIH, ROH, FAIHA, and Mary O'Reilly, PhD, CIH, CPE, FAIHA, first met over the phone while planning a session for AIHA’s annual conference, AIHce. The two later met in person at AIHce 2010 in Denver, Colo., where they bonded over their mutual interest in improving occupational health worldwide, especially in developing countries. Levitsky went on to lead a new organization called Workplace Health Without Borders (WHWB), a volunteer-run nonprofit organization dedicated to preventing occupational disease around the world. She currently serves as secretary on the WHWB board of directors. O’Reilly serves as vice president of WHWB and as president emeritas of WHWB-US, an independent branch of WHWB that focuses on preventing occupational disease in underserved populations in the U.S. and raising awareness of the need for worker health. Both WHWB and WHWB-US are spreading the word to help get personal protective equipment (PPE) and other needed occupational health supplies and equipment to Puerto Rico, which was recently devastated by Hurricane Maria. The WHWB-US Puerto Rico PPE fund was created to channel tax-free monetary donations to get supplies to Puerto Rico. WHWB-US will purchase needed supplies and coordinate shipments so that the right mix of requested supplies gets to the University of Puerto Rico School of Public Health as quickly as possible. Further information is available on the organizations’ websites, and , as well as on . The Synergist: How are WHWB and WHWB-US related?

TS: What are some of the major occupational health issues in the developing world?

MO: We noticed problems with exposure to silica from different types of operations around the world, and that has become a focus for us. When I was in college, I worked in Mexico giving smallpox vaccinations. I remember going to an open mine and noticing that it was really dusty and that a lot of the people who worked there put handkerchiefs over their mouths to try to protect themselves. We worked with some of the Mexican doctors, and they said that most of the people there didn’t live to be very old because of their exposure to dust. At that time, I was not aware of industrial hygiene as a profession—much less the problems of occupational exposures—but I did understand the effect of silica on lungs. That is one of the things that has evolved into a focus for WHWB. Many occupational health issues have their roots in social and economic conditions, and I think this is why it is so difficult to design effective workplace interventions and we have difficulty getting people involved with WHWB for the long haul. When you look at medical effects, like Doctors Without Borders, you can narrow the focus. But when you start looking at occupational health effects, very quickly you get into economic and social conditions, which are more difficult to address. It’s more difficult to formulate effective occupational health interventions because those interventions often depend very much on the social, economic, and cultural values that exist in the various countries. It’s a much more complicated issue that WHWB is trying to address, and at times it can be frustrating. It really takes patience and perseverance to be able to tackle a problem like that. ML: Mary’s right; there are two ways of looking at this question. We can talk about specific exposures—and obviously silica is a major one—and then we can talk about more systemic problems. In developed countries, we think of work as people going away someplace. They go out of their homes, they work somewhere, and then they come home. There’s a separation, except in some cases where workers are bringing toxic stuff home on their clothes, which is relatively rare. Usually what’s at work stays at work and you don’t have to worry so much about exposure of families and children. But in the informal work force in developing countries, people may be working in their homes in cottage industries or they may be working in some other informal setting without childcare, so they’re bringing their children with them. We have many pictures of children in brick plants, for example. They’re not necessarily there because they’re working; they’re there because there’s no other childcare. They hang around with their parents and are exposed to many safety hazards as well as hazardous materials—certainly a lot of silica. That’s a very big issue in developing countries. The general lack of expertise and resources for controls taps into the economic issues that Mary mentioned. One thing we’re dedicated to addressing is the lack of industrial hygiene knowledge and expertise, as well as resources for controls. It’s been a big eye-opener for us to try to go to places and think that we can apply the kind of control measures we’ve been taught to apply here, like local exhaust ventilation and respirators, which are very impractical in these situations. There’s the affordability of the material itself, and then there’s the power needed to run the control measures. Respirators are extremely impractical to wear in hot climates, not to mention expensive. In addition, beards are very traditional in many places, and we know that respirators don’t function well with a beard. We’ve learned that there are many barriers to instituting the kinds of controls that we have been taught, and it calls for a lot of imagination and creativity to develop new solutions. One example from early on in our history is when we were approached by an organization in India. One of the things they wanted to do was set up a daycare center, and my gut reaction was, “Well, that’s very good, but we do occupational health—not education, not schools.” But as we worked more in India, we learned that a big problem is children being with their parents while they’re working and that daycare is in fact an industrial hygiene measure. It’s an administrative control to remove children from exposure. I’d never thought of it that way.