In a chance encounter, Saleh Samreen, a radiology technician at the Department of Chest Diseases and Tuberculosis at Al-Bashir Hospital, discovered that he had developed thyroid cancer. He had met a doctor working on a thyroid study that gave him a medical examination and asked him to perform additional checks and scans.
Samreen confirms that "the department was suffering from a surplus of referrals (approximately 300 to 400 per day)” which exposes technicians to more radiation. This is in contravention of the standard radiation level limit system recommended by the International Radiological Protection Association.
According to the hospital’s Director Dr. Mahmoud Zureikat, 86 radiologists work at the Al-Bashir Government Hospital. The hospital usually receives 1,200 to 1,600 referrals a day. Further, those technicians are sometimes re-assigned to work at other hospitals to fill any shortages of technicians.
Samreen was devastated to find out that cancer is not included in the list of diseases eligible for retirement and compensation; such as heart diseases and back injuries. Despite being subjected to three catheter operations, eight spinal fractures, curvature in his back leading to a change in height (he is now 158cm down from 171cm), and extreme weight loss (24kg), Samreen was not entitled to an increase in his pension because cancer is not considered a “liability”.
Samreen's application for early retirement, after 26 years of employment at the Ministry of Health, was initially denied. Samreen was then forced to submit medical reports with the help of the head of the Radiology Department to help him retire in order to avoid exposure to more health risks given his condition.
Dr. Khaled Rababaa indicates that the ideal work cycle for radiology technicians ranges between 10-15 years and should not exceed that in order to avoid cumulative exposure to radiation. Further, Dr. Rababaa considers this to be a dangerous profession when taking into account the age of the radiology technicians.
Ibrahim Shehadeh had worked in the radiology department of Al-Bashir hospital for 25 years before his passing after being diagnosed with thyroid cancer in 2011.
Shehadeh’s work was marred by many difficulties and problems as reported by his son Ahmed. His father suffered from long working hours, and radiation leaks due to poor maintenance of devices and facilities.
He said that his father contacted the Ministry of Health as well as the head of his department about those issues more than once. However, none of the relevant parties listened to his complaints or concerns.
In terms of radiation exposure, Shehadeh's son confirms that his father's radiological scans (which were examined by the investigators) exceeded 50 millisievert. This is the highest permissible limit of radiation according to the International Committee for Radiation Protection (ICRP).
Ibrahim's story did not end there however, as Ibrahim's mother stated that the Ministry of Health did not consider his illness a work injury and therefore did not provide any financial compensation. She stressed that the pension received does not cover his wife and five children’s financial needs.
Based on the previous cases, a question may be raised surrounding the extent to which the hospitals associated with the Ministry of Health adhere to the appropriate treatment and health protocols, specifically radiological safety requirements. Further, one may question the adequacy of the provisions made by the Ministry for the general safety requirements for the employees.
Interviewees from the radiology department indicated that there are various issues surrounding the safety requirements, the most important of which is the absence of periodic examinations of the facility and checks for levels of radioactive contamination.
Omar Al-Radayda says, "throughout my year of tenure at the hospital, I would hear that tests and checks have been carried out on the equipment, but during that whole time I had not seen anyone conduct a single test (unless we report a faulty device or a problem with the equipment)".
According to Article 13 of the insurance regulations for social security, institutions have an obligation to uphold the adequate occupational health and safety standards, and regulation compliant tools at the workplace. Further, they are required to identify, mitigate and prevent occupational hazards by implementing adequate control measures.
According to the Ministry of Health, there are no official records documenting the number of radiologists whose work has caused them diseases or health issues. The Ministry of Health confirmed through official correspondence the presence of radiation protection measures in hospitals and health centres.
Additionally, they have denied that x-ray devices that do not conform to the required specifications and standards exist, they have denied also that their technicians are at risk of excess exposure (above the Ministry’s standards) to harmful materials. Further, the ministry reiterated its commitment that all technicians follow the appropriate radiation health and safety protection methods.
Dr. Rababaa comments on the dispute between Shehadeh’s (the radiology technician) son and the Ministry of Health. He suggests that the Ministry is playing a role in keeping technicians safe, however this falls short of what is required. He adds that the current number of employees is “insufficient” and “many more should be hired to protect the existing workers against excess exposure by reducing their working hours.”
Another issue identified by radiologist Basil Al-Wazani since the beginning of his employment in the radiology department, is the non-authoritative and limited role of control officers. He indicates that their role is limited to the regulatory side and the issuance of reports without any executive powers, resulting in meaningless template like reports.
Al-Wazzani added that he developed asthma and chronic chest infections during his work in radiology: “From 1990 to 2005 we processed and developed the photographic films manually due to the absence of specialised employees and any routine maintenance and inspections of the equipment. Additionally, the equipment and their viability were not inspected and harmful exposure was left undetected. We were thus exposed to harmful fumes for extended periods of time due to the shift’s long working hours especially after the removal of the 14 day break period that was previously granted to workers.”
Dr. Rababaa finds that reducing the radiation dose requires reducing the dose exposure time, increasing the distance between the radiation source and the radiologist, and narrowing the radiation beam. Also, thermo-luminescent dosimeters are required for radiologists to measure the amount of exposure they receive on a monthly or annual basis.