Health conditions among workers who participated in the cleanup of the Chernobyl accident Z. Kamarli a &A. Abdulina a
In Kyrgyzstan, the health status of the people who were exposed to radiation from the Chernobyl acciden t and took part in the cleanup (or "liquidation") of the site has been monitored since 1991. Clinical observation of children born in families of the cleanup workers ("liquidators") of the accident consequences after their return from the accident zone began in 1992. For the last two years medical care has been provided for all the people who were in other radiation disaster zones (Semipalatinsk, Chelyabinsk region, etc.), and a special 3-level registry has been established for these patients. In 1992, the Interdepartmental Board of Experts, a government agency, was established for the evaluation of diseases and their relation to the work done in the zone of high-level radiation, in those persons who had been subject to radiation effects after the Chernobyl accident. The staff of the Board consists of medical specialists from different fields and representatives of social security, trade unions, and the Union Chernobyl public organization. Professor Z. Kamarli was appointed Chairman of the Board. By 1 January 1995, 2 093 people including 407 children born after their parents' work in the Chernobyl accident zone, were being followed up through the registry. In addition, 24 evacuees including 7 children from the Chernobyl accident zone, 3 persons who had resided in the Techa River basin in Chelyabinsk province ("oblast") for a long time, and 3 servicemen who took part in the nuclear tests in Totski, Orenburg province, were also registered. At present the number registered is approaching 3000, mainly due to improved registration in the sonth of the republic. In Kyrgyzstan, uranium has been mined in a number of regions, and radioactive waste deposits are found around these populated areas. Moreover, some towns and villages bordering China have been subject to the effect of radioactive dust during the nuclear tests at Lob Nor. Considering these circumstances, an increase in the number of people likely to be registered can be expected. Meanwhile, there is no regular, clinical examination of the population in those regions, chiefly
a
Kyrghyz Oncology and Radiology Research Institute, Bishek, Kyrgyzstan.
because of financial difficulties and the absence of the only programme which aims to lessen the severity of radiation consequences. Nevertheless, in the current year, with the financial support of our partners from the Kansas University Medical Center (United States of America), medical examinations of the residents of Mailuu-Suu town in the south of Kyrgyzstan were carried out. Around this town there are about 20 waste deposits maintained without due precautions. Nearly 5500 people including 2100 children were examined. The preliminary results of this study showed that among people who considered themselves healthy more than 50% of the adults and 38% of the children suffered from various diseases. Medical care was provided for some of these newly discovered patients. Of 1 688 adult patients included in the registry, 1 584 (94%) have undergone a prophylactic medical examination. Of these, only 627 (39.6%) were healthy, the rest (957 or 60.4%) had various diseases and needed medical treatment. An analysis has shown that the number of patients among Chernobyl accident cleanup workers increases each year (from 54.5% in 1991 to 60.4% in 1994) and that the number of invalids among them increases in an almost geometrical progression (from 2.3% in 1991 to 20.6% in 1994). This indicates serious disorders in the organisms of people who were subjected to radiation effects while working in the accident zone. These disorders result in disability, despite the therapeutic measures applied each year. However, it cannot be denied that there are shortcomings in the medical care dispensed to these patients. Fig. 1 shows the increase in number of diseases in the followed-up population. When comparing these data with corresponding figures for the republic as a whole, it was observed that the incidence rate among the cleanup workers of the Chernobyl accident site was nearly 3 times that in the rest of the population, although the rate of increase of the morbidity rate among the cleanup workers showed a tendency to slow down. However, a significant improvement in registration, especially in the south of the republic, is likely to result in an apparent increase in the followed-up population. Fig. 2 shows the incidence rate of various disorders among the cleanup workers and a comparison
W/d h/th ststis;
quart., 49 (1996)
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Fig. 1 Increase in disease among cleanup workers after the C hernobyl accident, K yrgyzstan, 1991-1994 Augmentation des maladies chez le personnel ayant partlclpe ala remise en etat du siteapres I'accident de Tchernobyl, Kirghizistan, 1991-1994
3441
1991
942
o
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Fig. 2 Structure of morbidity in cleanup workers:comparison with averagerates per 100 000, Kyrgyzstan Struc ture delarnorblditechez lepersonnel chargede la remiseen etatdusite: comparaisonavec les taux moyens pour 100 000 personnes, Kirghizistan 45000 - . - - - - - - - - - - - - - - - , 40000 35000 30000 25000 20000 15000 10000 5000 Inc idencerateamong cleanup workers- Taux parmi lepersonnel affec te au ne ltoyagedu site
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Total incidencerate - Taux pour I'ensemble dela population
7 tim es higher than in th e rest of the population. For diseases of th e d igestive syste m , th e incide nce ra te is 5.6 tim es higher among th e clean up work ers than in th e ge neral populati on. Diso rders of th e endocrine and immune syste ms oc cu r rather ofte n in persons su bjected to irradi ation. These diso rd ers occur more th an 18 tim es more fr equently among th e cleanup wor ke rs th an in th e rest of th e Kyrgyz population. Can cer has been de tected nearly 4 times as fre q uen tly in those su bjected to irradi ation as in the population as a whole. Analysis of mortality rates (T able 1) during a 3-year period shows th at su icides were the most com m on cau se of death amon g people exposed to radiation. About a quarter of all death s were suicid es, and if we were to consider the taking of massive doses of alcohol as a type of suicide , then th is figure wou ld increase still m ore. Owing to th e im possibility of calculati ng precise, individual d oses of radiat ion , it m ay be assumed that the morbidity was caused by small d oses of ionizing radiatio n . The psychosocial stress effects, m anifestations of which are various an d latent for a long tim e , are added to that. The treatmen t has a temporary and sometimes very slight effect, m aking it n ecessary to searc h for new ways to provid e th erapy and rehabilitation for these followed-u p patients. In Kyrgyzstan, th ere is significan t ex perience in th erapy an d rehabili tation of patients using alpin e climatotherapy, a me thod known for its effectiveness. Thus, th e alpine base at Tuya-Ashu (3200 m above sea level ) was used jointly with the Institute of Card io lo gy fro m 1992 through 1995 for th e reha bilita tion of the Chernobyl acciden t cleanu p workers. The co u rse of treatment lasted for 24 days. Co nsidering that only 20 patien ts received such tr eatmen t, so far it is too early to d raw a co n clusion . H oweve r , the positive influence of high-altitude climato th erapy on the fu nc tional indi cators of the re spiratory, card iovascu lar and immune syste ms has be en observed.
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Conclusions 1. The establishment of th e registry of persons su bj ected to radiatio n co ntributes to the detection of illness am ong th em, and their timely treatment. 2. The registry data for Kyrgyzstan show that morbidity am ong the observed population is incre asing. Diseases of th e nervous system are mostfre q ue nt, followed by diseases ofthe digestive, r spira tory and en docr in e syste ms. The immune is very ofte n affected, too. 3. The m or tality rate among cleanup workers of the Ch mobyl accident site is high. Suicide is one of th e main causes of death in this population. Rapp. trimest. statist. sanit mono ; 49 (1996)
1. Diseases of the nervoussystem and mental disorders Maladiesdusysteme nerveuxet troubles mentaux 2. Diseases of the digestive system- Maladies deI'appareil digestif 3. Disorders of the endocrineand immune systems . Maladies endocriniennes ettroubles immunitaires 4. Cancer
with the average rates p er 100 000 for the population as a whole. The left ba r shows th e incide nce rate amo ng the cle an u p workers, and the one on th e right, the average rates for the who le re pu blic. For diseases of the n ervous system and m en tal d isorders, the rates among cle anup workers are 30
Table 1 Main causes of death among the Chernobyl Atomic Energy Station accident cleanup staff, 1989-1994 Tableau 1 Principales causes de ceces parmi le personnel de la centralenuclealre deTchernobyl attecte I'ac cident, 1989-1994 Cause Number ofdeaths Nombrede deces
ala remise en etat du site apres %
Suicide Cardiovascular diseases Malad ies cardio-vasculaires Alcohol poisoning - Alcoolisme Cancer ther diseases - Autres maladies O Total
16 12 10 5 26 69
23.2 17.4 14.5 7.25 37.65 100.0
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4. High-altitude climatoth erapy may become one of th e auxi liary methods for th e treatm en t and rehabilita tio n of people subjected to rad iat ion .
Resume Conditions sanitaires parmi les membres du personnel ayant participe au nettoyage apres /'accident de Tchernobyl Les pers onnes qu i ont pa rticipe la remise en etat du site ap res I'acci dent de Tchernobyl ont ete enreq istrees leur retou r au Kirghizistan dep uis 1991 et leurs enfants le sont depuis 1992. Ulterieurernent, on a inc lus, a des fins d'enreg istrement et de fourn iture de soins, les citoyens co ntarnines par les incidents de Semipalatinsk et de Chelyabinsk. Les effets des dec harqe s de dec hets nuc leaires situes dan s la reg ion de Mailuu-Suu ont ete examines avec I'assistanc e du Centre med ica l de l'Universite du Kansas des Etats-Unis d'Amerique. "
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Summary Peopl e who took pa rt in the Chernobyl acc ident cleanup have been regis tered upon their return to Kyrgyzstan since 1991, and their children sinc e 1992. Later , citizens affected by the Semipalatinsk and Chelyabinsk co ntamination incidents were inc lud ed for registration and health care purposes. The effects of the nuclear waste depositories in the Mailuu-Suu regio n were examin ed with the assistance of the Kansas University Medical Center (United States of Ameri ca) . All these investigations of affected peo p le indicate apparent increases in a number of symp toms and illnesses when compared to the rest of the population. Sampl e sizes ranged from several hundred to several thousand . Ab ove-normal rad iation levels and/or the stress and fear of living in contaminated areas can lead to significant increases in nervous d isorde rs, card iovascular diseases and othe r pro blem s. The most signif icant increase was in the suic ide rate.
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Toutes les recherches portant sur des personnes touchees indiquent un acc roissement appa rent d'un certain nombre de sympt6mes et de maladies par rapport au reste de la pop ulation. Les tailles des echantillons vont de plusieurs centaines plusieurs milliers. Des niveaux de rayonnement superieurs la normale et/ou le stresset la crainte que provoque le fait de vivre dans des zones contarninees peuvent accroitre considerablernent les troubles nerveux, les maladies cardio-vasculaires et autres. C'est le taux de suicide qui a auqrnente le plus.
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Wld hlth stsust . quart., 49 (1996)
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