The facts behind hospital fatality figures uncovered

Many victims of heatstroke are not being accurately diagnosed by A&E hospital staff.

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By  Sean Cronin Published  August 7, 2005

Heat-related fatalities among construction workers in the UAE are not being officially recorded on hospital death registers. The revelation follows a two-month Construction Week investigation into the occurrence of heat-related illnesses among site workers. It found that many victims of heatstroke are not being accurately diagnosed by hospital staff, with the symptoms often being mistaken for other conditions and recorded as heart attacks. And because post-mortems are not carried out unless the police suspect foul play, official statistics may not accurately reflect the incidence of heat-related fatalities. Dr Rajeev Gupta, a cardiologist at the Ahlia Hospital in Abu Dhabi, first noticed a discrepancy in the recording of construction worker deaths last year when he examined the deaths registered at the Embassy of India — the country which supplies most foreign construction workers in the United Arab Emirates. When he went through the data he noticed that heatstroke was not mentioned as a cause of death in any of the certificates he saw. He said: “I’m sure that some of them must have died of heat stroke. We saw the data for three or four years and not one case of heat stroke. Isn’t that a little strange? “I’m not saying that all of the deaths are due to heat stroke, but is it possible that all the workers are dying of heart attacks?” Other accident and emergency doctors and consultant cardiologists contacted by Construction Week have also confirmed the link between heat stroke and cardiac arrest. Dr GY Naroo, acting head of the accident and emergency department of Rashid Hospital in Dubai, said: “Last year our initial assessment of how many heat related workers that came into the hospital was 2500 per month. “But once the secondary assessment was done inside the hospital, we realised it came out to be double. “Last year five or six patients were admitted to intensive care and one or two died. “When it comes to heat stroke, the symptoms can be quite vast. “When they come in they are often quite drowsy and sometimes aggressive and the fever is very high. So if one is not an expert in heat emergency, it is very easy to think something else is wrong with them.” According to Dr Naroo, heat emergency can also lead to cardiac arrest. He said: “Yes, it does affect the heart. We’ve got some cases where it doesn’t show. “The patient complains that his whole body is paining and we think that it is due to salt deficiency and treat it in a normal way. “Last time two patients were admitted into the cardiac unit and were having an acute myocardial infarction. “The blood becomes thick, the blood vessels of the heart clot and the sluggish flow causes the damage. “That is primarily the mechanism — heat stroke and then heart attack. Primarily it is due to the heat, but the end result is a heart attack.” This occurs with worrying frequency during the summer months when site temperatures can top 50 degrees celcius. “Today there was one guy who said he had muscle cramps, so we gave him the usual treatment and I don’t know why it came to mind to do an electrocardiogram. ‘It was showing a heart attack situation. And the strange thing is he had absolutely no chest pain and no symptoms that would have led us to see that. He was 45 years old and no symptoms at all — just muscle cramps in his legs.” Despite recent moves by the UAE government to initially ban outdoor working between 12.30 pm and 4.30 pm and subsequently allow outdoor working during these times ‘in the shade’, Dr Naroo points out that humidity and not just exposure to direct sunlight, can induce heat-related illnesses. He said: “The humidity is a very big factor. It’s not just the heat or direct sunlight. Heat emergency doesn’t only happen when one is working under direct sunlight. ‘Today we had two cases that were working in warehouses — in many places there is no air conditioning.” While heat emergencies are prolific in the construction sector, the harsh working conditions endured by many site workers also leaves them vulnerable to developing other illnesses and is thought to be one factor in the high mortality rate within the group. Mujtaba Rizwan, first secretary of labour at the Bangladesh Consulate, said: “They don’t mention it on the death certificate, but we hear from the relatives that someone has been working all day outside or whatever,” he said. Dubai-based social worker Rashid Noushad said: “There is a reason why the death rate [among construction workers] shows such a high number of ‘natural causes’. “The workers in this part of the world are made to work exceptionally hard. “While normal people work an eight hour shift, these people work at least 12 hours plus two hours for transport from their camps and back — so that is 14 hours in total. “Physically they are deteriorating and getting tired. Then they are low paid and have a lot of responsibilities on their shoulders like supporting their families back home. “In the long run it is affecting their health.” The Ministry of Health was unavailable for comment.

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