December 1, 1997
From treating workers exposed to a toxic chemical at an industrial plant to helping office personnel design their computer workstations, Tulane University Medical Center's new Centers for Occupational Health aim to keep the local work force healthy.
"Within the medical world, occupational health or occupational medicine is the branch of medicine that deals with injuries and illnesses of workers," says the centers' medical director, Douglas Swift, also a professor of medicine at Tulane. "It also branches out into the community, where we deal with community exposures to toxic things. That's the disease side of the spectrum."
While the Centers for Occupational Health are a new entity at Tulane, some of the parts that make up the centers already exist at the university.
"Tulane has had a number of pieces of occupational health for many years," says Swift. "My job when I came to Tulane was to tie all of these pieces together under one umbrella."
Swift, who came to Tulane from Ochsner Medical Institutions as a full-time clinician and director of the new centers last spring, cites the School of Public Health and Tropical Medicine's department of environmental science as integral to the success of the new centers. Neurologists as well as rehabilitation and sports medicine clinicians also play a role in treating occupational injuries.
"But what we lacked was clinical occupational medicine," he says. Earlier this year, Tulane began its clinical operations in occupational medicine in the former Elmwood Hospital location in Jefferson Parish and at Tulane's hospital and clinic downtown. In addition to treating workplace injuries and illnesses and addressing community exposures, a large part of occupational medicine is preventive medicine, Swift adds. What he calls primary prevention activities are those that prevent injuries from happening in the first place.
"We actually go to the workplaces and observe and look at various parameters of exposures or hazards," Swift says.
In terms of reducing toxic exposures in a chemical plant, for instance, Swift works with the company to find out whether it can find a less harmful substitute for a toxic substance or whether the company can automate an operation to avoid human exposure. The weakest plan is to require personal protective equipment or to install administrative controls, such as personnel rotations to reduce exposure, he says.
"If you are dependent upon things like personal protective equipment and safe operating procedures," he says, "you are still leaving yourself open for a lot of potential harm because that depends on every individual wearing the protection and following the rules, and we know that doesn't always happen." A type of secondary prevention is developing screening programs "to detect sub-clinical disease or injury before it becomes apparent," Swift says. "But you have to make sure you don't discriminate against people just on the basis of certain characteristics. On the other hand, you want to make sure you have a valid test where you can qualify people."
The center also deals with tertiary prevention--minimizing disability once an injury or illness has occurred. "This type of prevention also deals with things like medical surveillance, examinations to see if a certain type of work or a certain type of exposure is affecting someone's health," he says.
Swift has a medical degree from Louisiana State University and received a master's of public health from the School of Public Health and Tropical Medicine in 1984. He has been on the faculty of the public health school since his graduation and currently teaches a course in occupational health there.
The other faculty member at the center is Larry Durante, clinical assistant professor in community medicine. Staff members include a nurse practitioner, a certified occupational health nurse, registered nurses and physician assistants. Most of Swift's work occurs in the clinical setting, but he and his staff have also traveled to work sites as far as Baton Rouge. Over the telephone and computer, however, he works with physicians and companies in other states and even in other countries.
"This is a very information-intensive specialty," he says. "Wherever I go, a little laptop computer comes with me. I have all of the OSHA [Occupational Safety and Health Administration] regs and all of the NIOSH [National Institute for Occupational Safety and Health] documents. I also have a toxicology database, where I can look up zillions of chemicals."
Another factor that affects workers is ergonomics--how they interact with machines and other parts of the physical environment at their workplace, Swift says.
"We've dealt with a lot of ergonomic issues," Swift says. "One of the most common problems is a poorly designed workspace for computers. When computerization of the workplace happened, people just put computers on their desks and keyboards were the wrong height. An easy fix is to take the center desk drawer out and put in a keyboard caddie that is adjustable."
When he advises employers on ergonomic changes, Swift recommends that they involve the people who work there.
"That's the way ergonomics is," he says. "You really have to allow the people who work there to try out their workstations." Swift says the workplace is a safer place today than in the past. "In terms of measuring mortality figures, yes, the workplace is safer," he says. "But the workplace is changing and we see a lot of stress issues now. We have a lot of ergonomic issues. Asthma is probably the most common occupational disease we have to deal with." The changing nature of the field appeals to him, he says. "Occupational health is an interesting specialty. Every day is different."
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