With the dangers of mining in the spotlight, Gary Henson looks at the physio issues for the men who work in such conditions and speaks exclusively to the Chilean physio who helped los 33 during and after their escape
Mining has always been dangerous, because of explosions, roof cave-ins, and the difficulty of mine rescue. The tale of the successful rescue last month in Chile of 33 miners trapped for 69 days in temperatures up to 40 degrees gripped the world. But with the emphasis on psychological effects such as post-traumatic stress, what about their physical well-being? What role has physiotherapy played in their rescue and rehabilitation? Closer to home, eight miners in Britain have died in the past four years mainly through roof falls trapping them. How do physios in this country tackle the specific problems of miners? In Chile, the Ministry of Health imposed strict restrictions on the multidisciplinary health team who treated the rescued miners talking to the media. But a CSP sister organisation, the College of Physiotherapists of Chile, introduced Frontline to the physio who treated them at the local hospital. Read our exclusive interview with Aldo Rondanelli on page 23. The issues for ‘los 33’ ranged from pneumonia, silicosis, hypertension, diabetes, corneal problems and respiratory infections, and skin lesions caused by the 98 per cent humidity. For active workers an extended period of relative little physical activity can cause problems, including blood clots. Edison Pena felt very unwell after the collapse but picked himself up and ran six miles every day through the mine tunnels. He has since been invited to run the New York marathon.
Above ground a dietician supervised their diet. By a video link they were given activities and exercises to keep fit and stop them gaining weight. Tape measures were sent to keep tabs on their girth so they were thin enough to fit through the rescue shaft. The miners split into three groups, each with a leader, and worked in shifts, as they did before the accident. British National Union of Mineworkers secretary Chris Kitchen told Frontline that some form of routine ‘to take your mind off the fact that you’re trapped’ was key. ‘It is very important to be kept mobile and occupied. Seventy days is a long time especially when you have no concept of time, of day or night. ‘Before they knew of the coming rescue attempt keeping fit would be the last thing on their mind. But once they knew that help was coming, keeping themselves healthy for the rescue would be foremost.’ Meals were delivered by the supply bore holes in packages known as doves, after the role of carrier pigeons. Glucose, rehydration tablets, hydration gel, medicine and oxygen were sent down after reports of not enough air. Yonni Barrios was the most qualified of the miners to undertake medical tasks and to communicate on health issues. He made daily rounds, administering diagnostic tests, taking samples and updating patient charts, and participated in daily conference calls with the medical team above. He also vaccinated the group against tetanus, diphtheria, flu and pneumonia. Six hours before his rescue, each miner switched to a purely liquid diet, rich in sugars, minerals and potassium. They wore a girdle around the waist that monitored their blood pressure, and took an aspirin to stop blood clots forming. Conditions in the UK mining industry, which once employed over one million workers, can be as difficult as those in Chile. Rosemary Preece, curator of the National Coal Mining Museum in Wakefield, explained that historically miners suffered from vibration white finger and specific problems from stooping and bending, which were quite disabling. ‘There used to be a lot of ‘beat’ conditions such as beat knees and beat elbows with the amount of kneeling and crawling miners had to do,’ she told Frontline. ‘There were a lot of lung and eye diseases and eye strain specific to poor lighting.’ Now, better advice and protective clothing such as knee pads are available. When the industry employed over one million men, there were many rehabilitation units throughout the country. Rory Duffield worked at Talygarn House, Pontyclun, south Wales, at the start of his 30-year physiotherapy career. Now based in Pontefract, he has treated many miners with ailments including musculoskeletal, neurological and medical problems. ‘Working in damp, cold and cramped conditions leads to back and neck problems, as well as respiratory illnesses from dust inhalation, along with emphysema, COPD and bronchitis.’ Physio treatment included opening and maintaining airways, clearing secretions and trying to maintain and improve fitness levels, Rory Duffield explained.
Frontline interviews the miners’ physio
Aldo Rondanelli is the physiotherapist at Copiapo hospital where the miners spent 48 hours after being rescued. He speaks exclusively to Frontline. What physiotherapy did you give to the miners after their rescue? First there was a general inspection to find out what state they were in. Many had problems in two main areas, respiratory and musculoskeletal. The miners who were treated in bed were shown how to maintain their ventilation mechanics and avoid respiratory complications through localised exercises of the diaphragm, chest exercises, upper limb exercises, maximum inhalation, maximum expiration. They were also told to change position every two hours to keep a good perfusion-ventilation relationship. They were also taught exercises to do in bed to prevent venous stasis and muscular atrophy. They had to do exercises in a supine position [lying down with the face up], sitting and standing, which they did three times a day. There were isolated cases of osteomuscular diseases, mainly muscle cramps of the lumbar back, which were already present during the time they were in the mine, with conditions such as sacroiliac dysfunction. Others presented with symptoms after leaving the mine, due mainly to stress, which were treated with manual therapy, static stretches and electrotherapy with TENS. Treatment of respiratory complaints started in the mine with antibiotics and continued later in the hospital with respiratory physiotherapy and active breathing exercises three times a day. The miners’ good general condition was noticeable and was the product of training within the mine. This included mental health care, which lowered their anxiety level in order to achieve better intervention, and cooperation on their part, given that the social and media impact was of great importance to them. What were the environmental conditions for the trapped men? Temperatures were over 35 degrees with extreme humidity of 98 per cent, and the men were in a space of 1.8 km. Did the men have any exercise routine while underground to help keep in good health? Yes, they had an exercise routine, which one of them led, based on a pre-established model and they maintained a work schedule of eight hour shifts. Furthermore, we attempted to maintain the circadian cycle with artificial light to simulate day and night. What kind of physiotherapy will the miners require in the future? It is based primarily on joint stabilisation work and low-impact exercises, isometric contractions, thinking of joint instability and possible injuries they may have, such as arthralgia, arthrosis, tendonitis and muscle spasms. At a respiratory level, as mentioned, maintenance breathing exercises and work with Triflow spirometers [devices to help to expand the lungs]. Also, the analysis was focused on the nutritional status of the miners as they were leaving the mine, after a review by nutritionists at Copiapo hospital. As a result of the anthropometry and bioimpedanciometry, it was found that 15 of the 33 miners were overweight, that 12 (36 per cent), were found to have a normal nutritional status and that six (18 per cent) were obese. Weight loss between the usual and the current weight varied from eight to 10 kilos. So, we needed to work according to the needs of each miner.
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