Fighting for breath: Khargone’s cotton workers battle Byssinosis

Aarti works in a cotton ginning factory in Khargone, 319 km from Bhopal. For the last one week, she has been unable to work due to severe back pain, headache and fever.

On her typical workday, Aarti would start at five in the morning, cook food for her family and pack some lunch for herself before leaving for her factory job at 8 am. It is always a long day for this newly married, because by the time she returns home, it is around 8 in the night. As a worker in a cotton ginning factory, her job is to separate cotton lint from the seeds. She also has to sweep away the cotton, seeds and dust from the ginning factory

The 19-year-old shares, by the time she returns home, she is barely left with any energy, “I get so tired when I come to work that I don’t even feel like making rotis for dinner.” The family cannot afford to hire a cook due to financial constraints. 

“I have to cook food even when unwell,” Aarti adds.

Cotton ginning has caused Arti to fall sick often with complaints of severe headache, fever, difficulty in breathing and tightness in the chest. These are the symptoms of Byssinosis. A lung ailment that has been seen in people working in the cotton ginning industry. 

Aarti has lived her life in the Nimar region of Madhya Pradesh, known for its hot summers and cotton production. Cotton from Khargone's market is taken to ginning factories, where the seeds are separated from the cotton to make bales. Many workers, like Aarti, breathe in tiny cotton fibres during this process, which can cause Byssinosis, a disease that reduces lung capacity.

American poet Joseph Brodsky writes in his poem Bosnia Tune- “As your hands adjust your tie people die.” This rings true for the workers of cotton ginning factories of MP’s Khargone district, who face the deadly threat of Byssinosis. As they separate cotton from seeds in harsh conditions, their lungs are slowly crippled by the disease. The state doesnt have accurate data or a concrete plan to diagnose the diseases and treat them on time. 

Workers like Aarti are at high risk of developing Byssinosis due to prolonged exposure to cotton dust. Despite the severe health impacts, including difficulty breathing and chest tightness, many workers continue to work in hazardous conditions due to financial pressures and a lack of awareness about the disease.

What is Byssinosis?

Byssinosis is called an occupational lung disease because it occurs in people who are involved in any business related to cotton and are constantly exposed to cotton dust. This cotton dust locally called Kshari, contains very small elements like very fine plant residues, fibres, bacteria, fungi and pesticides. 

Dr Harsh Mahajan has been treating respiratory diseases in Khargone District Hospital for the last 6 years. He is also working as a District TB Officer (DTO) in Khargone District Hospital. Explaining further, he says, 

“Cotton dust particles get deposited in our lungs like a foreign element. Our body tries to expel them but they cannot dissolve in the body, so this cotton dust keeps getting deposited in the body. This reduces the ability of the lungs to send oxygen to our organs.”

Dr Mahajan explains that the workers working in cotton ginning factories are at high risk of Byssinosis because they constantly work in cotton dust without safety equipment like masks.

In a ginning factory, cotton lint (called "kakra" locally) and cotton seeds are separated from the cotton brought by farmers. The lint is dried, collected in a gin stand or tray, pressed, and made into cotton bales.

Aarti works at a local ginning factory. Half of her day is spent separating cotton lint from seeds, sweeping, and changing cotton trays. If you look around any ginning factory, it is often filled with cotton fibers, which are stuck to machines, windows, wires, and even trees.

According to Dr. Mahajan, when these fibers get collected in the lungs of an employee like Aarti through breathing, then after a period of time, her body becomes a victim of type-1 respiratory failure. In simple words, by breathing in cotton dust, their lungs lose the ability to deliver oxygen with blood. Due to this, the organs of the patient do not work properly and the risk of heart attack increases.

Byssinosis in the world

The disease is not limited to ginning workers of Khargone, it has a long history. In the 1830s, Dr. James Phillips observed its symptoms in workers at a cotton mill in England. In 1855, Elizabeth Gaskell mentioned the symptoms in her novel North and South through one of her characters.

In the novel, a 19-year-old employee Bessy Higgins dies due to a similar problem. Higgins says,

“When they are carding the cotton, tiny pieces of it fly up and fill the air until it looks like a fine white dust. This white dust swirls around the lungs, and the chest tightens constantly.”

When I go through this description of the novel, Aarti comes to mind. She says that she has been working in a ginning factory since she was only twelve years old.

Marie Nakládalová of Palacký University Olomouc in Central Europe, in a research paper written in 2000, states that the prevalence rate of byssinosis has been seen to be around 30% in Indonesia, 37% in Sudan, 40% in Ethiopia and up to 50% in India.

Byssinosis in India

This disease was first mentioned in the proceedings of the Indian Parliament on 12 December 1974. During this time, Ishak Sambhali, MP from Amroha, Uttar Pradesh, had asked whether 12% of the workers working in the textile industry suffer from byssinosis? However, while answering this, the then Union Health and Family Planning Minister Karan Singh had said that no separate data is available for this disease.

Even after 50 years of debate, the central government does not have any separate data on this disease till now. But from 2000 to 31 August 2023, more than 1100 studies have been done in India on this subject. According to an article based on the analysis of these studies, about 10 to 15 million people working in textile factories in India are suffering from this disease.

Madhya Pradesh too doesn't have adequate data available about how many patients are suffering from the fatal disease in its state. However, a study conducted on 290 employees working in a 'home-based' power loom in Mominpura, Burhanpur, about 136 km from Khargone, 98% of the employees were found to be suffering from byssinosis.

There is a lack of awareness about Byssinosis. Dr. Mahajan mentions that very few people seek treatment for it. Since the disease directly affects the lungs, it is often confused with tuberculosis (TB), which is common among these patients. As a result, TB is usually treated instead. In many cases, patients are given TB medication two to three times, but this doesn't cure the disease. Instead, it can increase the patient's photosensitivity and may damage the liver. He adds that Byssinosis can be detected through a bronchoscopy test.

Dr Mahajan said that when a patient is not easily diagnosed in the Khargone district hospital can be detected through bronchoscopy. Time is crucial. The danger of delayed diagnosis can be seen in Dr. Mahajan's first Byssinosis case.

"A patient of the desease came to us around 2019 with type 1 respiratory failure and heart failure. His condition was so severe that we couldn't do much. In such cases, we advised him to use home oxygenation," says Dr. Mahajan.

Delaying diagnosis can lead to death. Dr. Mahajan says that while this disease cannot be cured, the patient's life can be extended a little by keeping him away from the environment containing cotton dust.

Is it easy to avoid Byssinosis?

But it is very difficult for Aarti to maintain this distance. Aarti lives in the Kundanpura area of ​​Khargone. Her house is a row of quarters with tin shed roofs. These houses have been given to her by the gin owners. If Aarti does not go to work for a week due to illness, she might lose her home too.  

"If you do not go to work for a week, the owners start saying that you are living in the factory quarters and do not come to work. In such a situation, they start threatening us to vacate the place."  

In such a situation, how does she protect herself from byssinosis?-- she questions.

Aarti works all day with a cloth tied around her mouth. It becomes difficult to do this during the summer, but removing the cloth from the mouth means getting sick. Like Aarti, Ranu also works 12 hours in a ginning factory. For this, she gets a wage of Rs. 250 per day. If Ranu, who works in a ginning factory from 8 am, wants to leave at 6 pm, she will get only Rs 200 per day.

In the increasing heat, Ranu can only keep the cloth tied around her mouth for half an hour to one hour. She has to go out during this interval when she feels suffocated.

“When the owner is not there, we come out and take off the cloth.”

What happens by breathing in Kshari? Responding to this, Ranu says that if she does not tie the cloth, she starts getting cold and fever. But even in such a situation, she has to 'take medicine and work'.

Dr Mahajan says that tying a cloth is not very effective in preventing this disease because there are gaps in it through which cotton dust can enter. He says that wearing a mask is the most effective way to avoid this. But many employees of the ginning factory tell us that they are not even given these masks.

Kailash Agrawal, the state vice-president of the Federation of MP Chambers of Commerce and Industry (FMPCCI), while presenting the traders' side on this, says, 

"The traders here want to provide all these facilities to their workers. But due to the high interest and tax imposed by the government, their cost increases due to which they are unable to pay attention to it." 

Whether it is Aarti or Ranu or other employees working in ginning factories like them, everyone is at risk of getting byssinosis. Most of the workers working in these factories are tribals and landless. There are some workers like Aarti whose family has very little land, so working in the Kshari of the ginning factory is their compulsion to earn a living. In such a situation, it is important to provide them facilities like masks to protect them from Byssinosis, and it is also important that they get medical checkups from time to time. For this, it is also very important to be aware of the disease.

Edited by Diwash Gahatraj 

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