1. BASIC OCCUPATIONAL HEALTH FOR MEDICAL
OFFICERS
Training course for regional medical officers
organized by the World Health Organization
at the request of the Ministry of Health and Social Services of Namibia
LESSON PLAN
Swakopmund, 14 - 25 February, 2011

2. TARGET GROUP
Regional and district medical officers in Namibia
ASSUMPTIONS
Participants
- are medical officers from public healthcare facilities in Namibia. They have excellent clinical skills
and experience, but no previous training in occupational health
GOALS and OBJECTIVES
 Introduce participants to concepts, paradigms and approaches in Occ Health
 Explain foundations on the important and common occupational and work-related diseases
 Underline importance of multi-disciplinary approaches to diagnosis, exposure and preventive
action
 Underline the role and importance of long-term, sub-acute exposures in disease and disability
development
 Enable participants to reconstruct historic exposures in disease cases
 Enable participants to understand reports on occupational health risk assessment
TEACHING METHODS
 Use participants' experience and stories as much as possible to keep content concrete and
relevant
 Visualize a lot, work with films clips, and photos as much as possible
 Keep lectures open for discussions and questions
TRAINING TEAM
Dr Ali El Sherif - Chief Medical Officer for Occupational Health, Ministry of Health and Social Services
- course coordinator
Mr Thebe Pule - Regional Adviser, WHO Regional Office for Africa, Brazzaville - occupatiuonal
hygiene
Dr Norbert Wagner, Program Director "International Program in Occupational Health Practice",
School of Public Health, University of Illinois at Chicago (UIC), United States - occupatiuonal
medicine
Professor Tony Cantrell - former head of Information Section, National Institute of Occupational
Health, Johannesburg, South Africa - occupèational hygiene
Dr Ivan D. Ivanov, Scientist, Occupational Health, World Health Organization, Headquarters, Geneva,
occupational medicine
2

3. FIRST WEEK: INTRODUCTION TO OCCUPATIONAL MEDICINE
DAY 1, MONDAY, 14 FEBRUARY 2011
Start End Durati Activity/Content Training Trainee Aids Lecturer
Time Time on Topic techniqu activity required
(min) e
8.30 9.30 60 Introduction and Course Overview Describe Whiteboard Dr Ali and
Introduction of lecturers known or flipchart T. Pule
Introduction of participants: cases of
Introduction to Course Objectives, Format, and Materials occ
diseases
9.30 10.15 45 Introduction to occupational health lecture Copies of Dr Ali and
Occupational Health - scope, issues and challenges timetable T. Pule
Occupational health in Namibia - main problems and list of
Legislation and regulations for occupational health in Namibia topics
(???)
10.15 10.45 30 BREAK
10.45 11.15 30 The role of the medical officer in occupational health Lecture Ivanov
(Ivan) and
Role discussio
Responsibilities n
Skill mix
Collaboration with occupational health experts
11.15 12.00 45 Health surveillance of workers lecture Ivanov
Screening
Medical and exposure tests
Health examinations
12.00 13.30 90 LUNCH BREAK
13.30 14.15 45 Occupational health problems in major sectors Lecture Ivanov
Mining
Agriculture
Healthcare
Small business, artisans
3

4. Start End Durati Activity/Content Training Trainee Aids Lecturer
Time Time on Topic techniqu activity required
(min) e
14.15 15.00 45 Introduction to occupational medicine (part 1) Lecture Wagner
- How important are occupational diseases?
- Occurrence, incidence, global burden of disease
- Disease vs. accidents
- Challenges in describing past and present and mixed
exposures
- consequences for preventive action, hierarchy of controls
15.00 15.30 30 BREAK
15.30 16.30 30 Principles of Toxicology Lecture Wagner
- exposure pathways
- uptake dynamics
- Metabolism and excretion
- distribution, organ-specific affinity and storage
4

5. DAY 2, TUESDAY, 15 FEBRUARY 2011
Start End Durati Activity/Content Training Trainee Aids Lecturer
Time Time on Topic techniqu activity required
(min) e
8.00 8.15 15 Introduction to Day 2: Lecture Wagner
Common Occupational Diseases
8.15 9.00 45 LUNG DISEASES Lecture Guided Wagner
- Physiology of respiratory tract discussion
- Overview, classification
- Occurrence, incidence & prevalence
9.00 9.45 45 Occupational Asthma Lecture Guided Wagner
- pathomechanisms and discussion
- occurrence, prevalence discussio
- causes, irritant vs allergic n
- dilemma of exposure assessment for allergic lung diseases
- preventive action and control technologies
9.45 10.15 30 Participants' presentation on lung diseases Presentatio LCD Wagner
- Mapp 2001 agents old & new causing asthma OEM 354.pdf n
- Microorganisms in grain handling 9851_7.pdf
10.15 10.45 30 BREAK
10.45 11.30 45 Dust-related lung diseases: Lecture Wagner
Inert dusts: COPD and
- pathomechanisms film on
- occurrence, prevalence dust
- occupations exposure
s
Irritant dust/fumes: example Alveolitis
- pathomechanisms, - inert vs., irritant vs biological substances
triggering immune reaction
- occupations, examples, - occurrence, prevalence
11.30 12.00 30 Respiratory protection with PPE Lecture Discussion Pule
- selection and use
- limits and challenges
12.00 13.30 90 LUNCH BREAK
5

6. Start End Durati Activity/Content Training Trainee Aids Lecturer
Time Time on Topic techniqu activity required
(min) e
13.30 14.30 60 Mineral dust-related lung diseases Lecture Wagner
Asbestosis and Silicosis
- Causes, pathomechanisms and natural course
- Occurrence and occupations
- dilemmas in exposure assessment and exposure
reconstruction for compensation cases (TLVs, "exposure
years" concept)
14.30 14.45 15 BREAK
14.45 15.45 60 Participants' presentation on lung diseases Student Wagner
- COPD presentatio
- USA risk assess death certif silica 122.pdf n and
- Silica exposure assessment concepts discussion
- Asbestos exposure assessment concepts
- Asbestos risk in industry
15.45 16.15 30 Medical assessment of lung function and Fitness-to-work Lecture Discussion Wagner
- Purpose and limits
- Ethical considerations, conflicts of interest and challenges
16.15 17.00 45 Discussion of short cases Open full Discussion
Fitness-to-work for employees with lung diseases, case class
discussions, dilemmas discussio
n
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6

7. DAY 3, WEDNESDAY, 16 FEBRUARY 2011
Start End Duration Activity/Content Training Trainee Aids Lecturer
Time Time (min) Topic techniqu activity required
e
8.00 8.15 15 Introduction to Day 3: Lecture
Common Occupational Diseases
8.15 9.00 45 Reconstructing a occupational exposure history in Lecture Guided Exposure Wagner
Occupational Health discussion history
- challenge of reconstructing exposure questionnai
- Mixed exposures: a challenge re
- Known facts about mixed exposure scenarios and their health
effects, cases, literature
- Challenges to measurement, description and interpretation
9.00 9.30 30 Presentations of participants: SKIN DISEASES Presentatio
- skin diseases & infections & metal fluids 35.pdf ns
- other article
9.30 10.00 30 BREAK
10.00 10.45 45 SKIN DISEASES Lecture Wagner
- skin physiology with
- common work-related skin-diseases pictures
- irritation vs allergy, definition of exposure
- typical occupations
- preventive action and control technologies
- challenges in rehabilitation and reintegration
10.45 11.00 15 OCCUPATIONAL INFECTIONS Group work Case
Case discussions on typical occupations in working sheets and
groups scenarios
Exercise, discussion groups
11.00 11.30 30 Presentation of group work Presentatio
- presentation of results, discussion on occupational infections ns and
discussions
7

8. Start End Duration Activity/Content Training Trainee Aids Lecturer
Time Time (min) Topic techniqu activity required
e
11.30 12.00 30 Summary: Occupational Infections Lecture Wagner
- typical occupations
- prevention strategies, vaccination programs,
- control measures, exposure pathway control (airborne,
droplet, contact)
- Health Care Workers
12.00 13.30 LUNCH
13.30 14.00 30 Long-term Cumulative Effects of Selected Exposures Lecture Wagner
(part 1)
Health Effects of Physical Hazards
Example: Noise
- noise-induced hearing loss
- non-aural effects of noise
14.00 14.30 30 Example: Vibration Lecture Wagner
- vibration-induced disorders and diseases
- challenges in reconstructing past exposures
14.30 15.00 30 Medical Surveillance Techniques reg Physical Hazards Lecture Wagner
- role of audiometric testing vs. prevention
- neurological testing, limits and value
15.00 15.30 BREAK
15.30 16.15 45 Long-term Cumulative Effects of Selected Exposures Presentatio
(part 2) ns and
discussions
Example: SOLVENTS
Presentations of Participants:
- Case study toluene.pdf
- Case study trichlorethylene.pdf
- Encephalopathy overview - NEJM425.pdf
16.15 17.00 45 Summary of Health Effects of Solvents Lecture Wagner
- health effects nervous system
- other organs: reproductive system, cancer, liver, kidney, heart
- Medical Surveillance: biomarkers, reliability, limits and use
8

9. DAY 4, THURSDAY, 17 FEBRUARY 2011
Start End Durati Activity/Content Training Trainee Aids Lecturer
Time Time on Topic techniqu activity required
(min) e
8.00 8.15 15 Introduction to Day 4: Lecture
Long-term Cumulative Effects of Selected
Exposures (part 3)
8.15 9.00 45 Example: OCCUPATIONAL CANCER Lecture Copies of Wagner
- theories of effect categories
- assumptions and orders of magnitude of effects (Global
burden of disease, WHO)
- Typical occupational cancers and occupations
- Challenges to prevention, concepts of risk and risk
assessment
- Classification of carcinogenicity of substances
9.00 9.30 30 Presentation of participants on Occup Cancer Presentatio
Two Articles TBD ns and
discussions
9.30 10.00 30 CLINICAL OCCUPATIONAL HEALTH Lecture Examples Wagner
of
Heavy Metals Guidelines
- clinical picture, symptoms for medical
- Occurrence, importance surveillance
- Prevention and treatment options
10.00 10.30 BREAK
10.30 11.00 30 Long-term Cumulative Effects of Selected Guided Guided
Exposures (part 4) discussio discussion
n
ERGONOMIC WORK DESIGN
Introduction: Discussion on qualitative and semi-qualitative
exposure assessment challenges of work load
9

10. 11.00 12.00 45 Example: MUSCULOSKELETAL DISORDERS Lecture Wagner
- occurrence and importance
- common causes, genetic, environmental/home and
occupational
- upper limb disorders, carpal tunnel, shoulder, elbow
- back disorders
12.00 13.30 LUNCH
13.30 14.15 45 MENTAL HEALTH Lecture Discussion Wagner
Stress and Work Organization
- Stress concepts, effects and strain,
- demand & control, social support systems
- consequences for work organisation
- employee support systems in companies
- effect of management & organisation styles
14.15 15.00 45 CHRONICALLY ILL EMPLOYEES AT WORK Case Discussion
presentati
Example: The mental health patient as employee on
- occurrence and importance
- fitness-for-work considerations and ethical dilemmas
- consequences for organisations
- roles & responsibilities in the supervising and care team
15.00 15.30 30 BREAK
16.00 17.00 60 Case Studies on chronically ill or performance-reduced Case Open
employees (rehabilitation and re-employment) presentati discussion
- diabetes on
- epilepsy
- vision impairment
- old age
(medical aspects, ethical and social aspects, case
management options in company)
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10

11. DAY 5, FRIDAY, 18 FEBURARY 2011
Start End Duratio Activity/Content Training Trainee Aids Lecturer
Time Time n (min) Topic techniqu activity required
e
8.00 9.00 60 ??????? requested ??????? Lecture Discussion
TEST on Day 1 through 4
MCQs and essay questions
9.00 9.30 30 BREAK Lecture
9.30 10.30 60 Occupational health information on the Internet Wagner
Introduction, presentation of websites
10.30 12.00 90 Practical Exercises in Information Sources CD copies
IF internet access is available on site: work on internet
If NOT: work with CDs from NIOSH and ATSDR
12.00 12.30 30 Feedback and Questions
12.30 14.00 90 LUNCH
14.00 END
11

12. SECOND WEEK: BASICS OF OCCUPATIONAL HYGIENE
DAY 6, MONDAY, 21 FEBRUARY 2011
Start End Duratio Activity/Content Training Trainee Aids Lecturer
Time Time n (min) Topic technique activity required
8.00 9.00 60 Introduction to occupational hygiene - Lecture Discussion Cantrell
assessment and control of occupational health
risks
9.00 9.30 30 BREAK
9.30 10.30 60 Physical hazards - health effects, assessment and Lecture Cantrell
prevention
 Noise
 Vibration
 Atmospheric pressure (diving)
10.30 12.00 90 Physical hazards - health effects, assessment and Cantrell
prevention (cont'd)
a. ionizing and non-ionizing radiation
b. thermal conditions
c. illumination
12.00 13.30 30 LUNCH
13.30 15.00 90 Discussion - how to use exposure data on physical Discussion Ali and
risks for medical surveillance Cantrell
 noise
 vibration
 ionizing radiation
15.00 15.30 30 BREAK
15.30 17.00 90 Practical exercises Discussion Cantrell
12

13. DAY 7, TUESDAY, 22 FEBRUARY 2011
Start End Duratio Activity/Content Training Trainee Aids Lecturer
Time Time n (min) Topic technique activity required
8.00 9.30 90 Chemical hazards - health effects, assessment and Lecture Cantrell
prevention
 Classification of chemicals
 Labelling of chemicals
 Chemical safety data cards
 Occupational exposure limits
9.30 10.00 30 BREAK
10:00 12:00 120 Practical Ali, Cantrell
Practical exercise
exercise
 reading chemical labels
 reading material safety data sheets
 obtaining toxicological information about
chemicals
 using international chemical safety data cards
12.00 13.30 60 LUNCH
13:30 15:00 90 Chemical hazards - health effects, assessment and Lecture Cantrel
prevention
 Carcinogens
 Allergens
 mutagens
15.00 15:30 30 BREAK
15.30 16.30 60 Chemical hazards - health effects, assessment and Cantrell
prevention
 pesticides
13

14. Start End Duratio Activity/Content Training Trainee Aids Lecturer
Time Time n (min) Topic technique activity required
16:30 17:00 30 Discussion Ali, Cantrell
Sound management of chemicals at the workplaces
15.00 16.30 60 Lecture Cantrell
Airborne particulates - health effects, assessment and
prevention
 Silica
 Asbestos
 Coal ???
 Organic dust
16.30 17:00 30 Discussion - how to use exposure data on airborne Discussion Ali and
particles for medical surveillance Cantrell
 Silica
 Asbestos
14

15. DAY 8, WEDNESDAY, 23 FEBRUARY 2011
Start End Duratio Activity/Content Training Trainee Aids Lecturer
Time Time n (min) Topic technique activity required
8:00 9:30 90 Lecture Cantrell
Airborne particulates - health effects, assessment and
prevention
 Silica
 Asbestos
 Coal ???
 Organic dust
9.30 10.00 30 BREAK
10.30 11:30 60 Discussion - how to use exposure data on airborne Discussion Ali and
particles for medical surveillance Cantrell
 Silica
 Asbestos
11:30 12:00 30 lecture Cantrell
Overview of silicosis in South Africa
12.00 13.30 60 LUNCH
13:30 15:00 90 Lecture Cantrell
Ergonomic stressors - health effects, assessment and
prevention
 Posture
 Movements
 Organization of the workplace
 Handling of loads
 Eye strain
15:00 15:30 30
Break
15

16. Start End Duratio Activity/Content Training Trainee Aids Lecturer
Time Time n (min) Topic technique activity required
15:30 17:00 90 lecture Cantrell
Workplace health risk assessment - strategies and
practical techniques
 Walk through surveys
 Use of practical tools and checklists
 Preparing reports
DAY 9, THURSDAY, 24 FEBRUARY 2011
FIELD VISIT TO WALVIS BAY
FISHING COMPANY
SANDBLASTING STATION
16

17. DAY 10, FRIDAY, 25 FEBRUARY 2011
Start End Duratio Activity/Content Training Trainee Aids Lecturer
Time Time n (min) Topic techniqu activity required
e
8.00 10:00 120 TEST on Day 6 through 9 test Cantrell
MCQs and essay questions
10:00 11:00 30 BREAK
11:00 12:00 60 questionn Ali
Course evaluation
aires
 Evaluation of progress
 Evaluation of course content, structure, lectures
12:00 12:30 30 Award of certificates and closure Ali
12.30 14.00 30 Lunch
17