Raju Ahmed has a lung of sand.
Every day, he fed hundreds of kilograms of limestone into a giant crushing machine. And every day, he inhaled volumes of silica dust that the ear-piercing machine emitted. In three years of this hazardous job, the 25-year-old inhaled enough silica that gave him consumptive lungs. Doctors call him a silicosis patient.
Silicosis is an incurable lung disease caused by inhalation of silica dust. Silica is the main element of sand, and an intense exposure to silica dust can cause silicosis in a few years or even months, depending on the lung condition of the patient.
"I always feel shortness of breath. It intensifies when the temperature falls in winter or whenever I try to do any physical work," says the Lalmonirhat boy. His health is fast deteriorating.
He worked at a stone crushing factory in Lalmonirhat between 2001 and 2004 and then left the job once he started having difficulty breathing.
After local doctors failed to determine what was wrong with him, he came to the National Institute of Diseases of the Chest and Hospital (NIDCH) in the capital early this year where he learnt about the deadly nature of the job.
But this knowledge came a few years too late. At his stage of silicosis, doctors cannot help much.
In Lalmonirhat's Burimari land port under Patgram upazila, where Raju lives and where poverty and unemployment are chronic, there are over 30 stone grinding factories.
The labourers, mostly young men, work in these factories from dawn to dusk for Tk 200 to Tk 250 a day.
In and around the factories, a dense fog of white dust, produced while crushing limestone, hangs in the air. The dust makes the men look like white apparitions.
Over the past few years, more than a thousand people worked in these factories, facing the risk of contracting silicosis, says Afzal Kabir Khan, research officer of Bangladesh Institute of Labour Studies (BILS).
He adds he has already found 386 workers with severe respiratory problems in the area. “We had 65 workers tested and found 53 of them had silicosis.”
Limestone is crushed to make lime powder to be used as poultry feed. Manufacturers of poultry feed from across the country buy lime powders from the grinding factories in the area. Various types of uncrushed stones come to Burimari from India, Nepal and Bhutan.
Owners of these factories are mostly from other districts and are hard to reach for comments.
Contacted over the phone, Kamal Uddin, owner of JK Agrovit Industry, said: "If it is harmful to people, how the chicken can eat limestone all the time?"
During a visit to the factory in November last year, about 20 men were seen working doggedly around a grinding machine. Except for their bloodshot eyes, everything else about these men is white.
Some of these workers said they felt shortness of breath while working there.
“Excessive exposure to silica dust that these workers are being subjected to is causing many of them to suffer from silicosis,” says Prof Rashidul Hassan, director of NIDCH.
Some of the workers have acute silicosis and their condition would never improve even if they stop inhaling silica.
Prof Rashidul, who has been seeing patients with silicosis from the area, explains that once the silica dust is inhaled into the lungs, it can never be taken out. Silica also makes the patients particularly vulnerable to tuberculosis.
However, the disease is easily preventable and not contagious.
“Putting on masks and using propelled fans to blow the dust away can easily lower the amount of exposure and the risk of silicosis,” the professor adds.
BILS researcher Afzal Kabir said setting up the factory in a building specially designed to drive the dust away and the use of professional masks would make the occupation less hazardous.
Dr Md Shahen, who participated in a health camp organised by BILS, says the disease is called "simple silicosis" in the primary stage. If the patient is not further exposed after this stage, the disease does not get worse. However, if the disease goes to the next stage, the patient's condition gets only worse with time. So it is very important that the worker stops coming in contact with dust as soon as he is diagnosed with "simple silicosis".
Most of the workers, however, do not know the danger of their occupation. The few that know do not have a choice. In this Monga-prone northern district of the country, work is scarce.
"Agricultural work is seasonal and there isn't enough work for everyone. This [factory work] is the only work available all the year round that can feed a family," says Azanur, a worker, who has been diagnosed with complex silicosis.
In his mid-twenties, Azanur has become a father recently.
"I cannot breathe properly and have to miss work when my condition worsens. The owner deducts my wage if I take a leave," he adds.
Under Section 53 (1) of the Bangladesh Labour Act 2006, "In every establishment in which, by reason of any manufacturing process carried on, there is given off any dust or fume or other impurity of such a nature and to such an extent as is likely to be injurious or offensive to the workers employed therein, effective measures shall be taken to prevent its accumulation in any work-room…. and if any exhaust appliance is necessary for this purpose, it shall he applied as near as possible to the point of origin of the dust…."
Section 150 of the same law says if a worker, while in service, contracts any disease specified as an occupational disease peculiar to that employment, it shall be deemed to have arisen out of and in the course of the employment. And the worker is entitled to get compensation in that case.
But compensations are difficult to realise because owners recruit workers verbally, often without any formal papers, said Kabir Hossain, coordinator of a BILS project.
Even after several awareness campaigns organised by BILS, the owners have not improved the working condition, let alone compensating the workers.
According to a BILS estimate, 16 workers died of complex silicosis over the last four years in the area.