Dr. Med. G. Rimdeika
Sapiega Hospital, Chernobyl Medical Centre
Chernobyl and Lithuania
Four years after the Chernobyl NPP accident, in1990 the Chernobyl Medical Centre was opened in Lithuania. The centre started to collect information about almost 7000 clean-up workers. Their registry was constructed, and the system of medical care in Lithuania was created; also prophylactic and medical care programs were started. At present the experience of ten years, concentrated in Chernobyl Medical Centre, allows us to make some conclusions from these observations.
The annual conference "Chernobyl and Lithuania" was organised by Chernobyl Medical Centre of Sapiega Hospital and Centre of Radiation Security on 26 April 2000. The material of the conference was published in the magazine Environment of Health, supplement to No.3. It is well known that the Ignalina Nuclear Plant is operating in Lithuania. The plant question and the gradual closing of its first and second blocks became especially urgent when Lithuania started negotiations with the Europe Union. This and this year's conference with its large number of participants and their reports has shown the topicality of radiation and the radiation security problem in Lithuania.
The reports of the representatives from the Physics, Biology, Biography, and Botany institutes; Vilnius University; Ministry of Environment Protection; Department of Civil Security; Centre of Radiation Security and Chernobyl Medical Centre were read out at the conference. Speakers investigated radioactive contamination of food, surface water, the Baltic Sea, plants and soil and also analysed the control of extreme situations in regard to civil security. A special session was devoted to the investigation of Chernobyl clean-up workers' medical problems.
According to the data of the psychiatry department of Sapiega Hospital one fifth of almost 300 deceased committed suicide. To compare the number of suicides of non exposed Lithuanian male population with that of the Chernobyl clean-up workers: the latter was 3 times higher in 1988 and 2.4 times higher in 1990. It is important to notice that since 1994 the suicides have been decreasing and presently the number is lower among the clean-up workers than that of the Lithuanian male population. This decrease could be accounted for by improved medical and also psychiatric/ psychological care in Lithuania.
This cohort of patients has other peculiarities. While in the in-patient department, they are apt to stand out from the rest, and communicate only among themselves. It is always the case with them that they are inclined to relate their somatic and mental health problems, also their social and marital problems as well, with the clean-up work at Chernobyl. Most of them claim that they had not had such problems before the work at Chernobyl and think themselves to be "the condemned" because they have been affected by the radiation. All these facts show that taking part in the clean-up activities at Chernobyl has assumed a very meaningful place in the life and mind of these people.
In their anamnesis most of them, especially those who worked during 1986-1987, stress compulsion of military structures for them. Clean-up workers used to be given imprecise and misleading information. They were instructed that alcohol reduced the effect of radiation, that they would feel weakness, headache and dizziness from ionizing radiation. Therefore these complaints occurred in such neurotic surroundings and the clean-up workers were imbued with the thought that they had been affected by radiation and it damaged their state of health.
Therefore each fourth clean-up worker is diagnosed with permanent personality disorder after clean-up activities at Chernobyl and each eighth with post-trauma stress disorder. It should be born in mind that post-trauma stress disorders after clean-up operations occurred among most of the clean-up workers, but they were compensated later in the above-mentioned ratio.
The investigation of clean-up workers, using psychological tests, identifies them as having serious emotional problems; as well as difficulties in interpersonal relations, which could explain why they tend to gather into groups.
As the investigation in our hospital shows, and research from other countries confirms, the effect of the Chernobyl catastrophe on mental health is identified in almost all Chernobyl clean-up workers. Therefore they need psychological/psychiatric help and, assessing their specific health problems, it is expedient to provide this help in specialized medical centres.
As these diseases are the majority in morbidity of the clean-up workers this review started with psychic disorders.
In second place, according to morbidity frequency, are somatic-internal diseases: that is cardiovascular diseases, digestive disorders and respiratory diseases. Primary arterial hypertension is predominant in this group of diseases. One of the factors that might cause primary arterial hypertension is acute and chronic stress, which is so characteristic of Chernobyl clean-up workers. Prolonged anxiety and stress have an influence on heart activity and as a result it develops disorders of heart activity and coronal artery function, and in some time these functional disorders might turn into injuries of organs.
Disorders of the digestive system in the group of somatic diseases take the second place - these are ulcers with localization in the stomach and duodenum. Treatment did not cause bigger problems but a complex approach and help of psychiatrists was needed also.
In third place according to frequency, are diseases of the respiratory system. After the Chernobyl NPP accident rapidly-decaying Iodine131 radionuclides escaped into the atmosphere.
Since iodine is necessary for normal thyroid gland activity and after the accident the concentration of Iodine131 in the environment had grown considerably, then the possibility arose for it to get into the human organism. The thyroid gland is not capable of separating residual iodine from radioactive iodine; therefore radioactive iodine accumulating in the thyroid gland irradiates the whole organism, but especially the thyroid gland itself. Even a small dose of thyroid irradiation (0.1 cGy) increases the risk of getting ill with thyroid nodularity diseases. Large doses cause thyroid follicular edema, vasculitis, necrosis and might cause radiation thyroiditis.
That is why such considerable attention is being paid to this group of diseases in investigations into the health of Chernobyl clean-up workers. Our observations assert that each fourth clean-up worker has diffusive struma, each tenth nodosa struma. Thyroid cancer (4 cases) permits us to say that the risk of thyroid cancer is still high, though it might partly be explained as a consequence of the improvement of diagnostic and medical control.
Estimating thyroid diseases it is necessary to continue actively the observation of patients, and the dynamics of their illnesses.
According to the data of the Lithuanian Oncology Centre, 131 clean-up workers had oncological diseases. Of these, 74 cases were malignant tumors. However the authors noted that their cause was related to smoking and alcohol use (lung cancer, mouth cavity, pancreas cancer, etc.). As the authors note during 1990-1999 the risk of cancer has a tendency to decrease but it is necessary to carry on these observations.
The Republican Expert Commission functioning at Chernobyl Medical Centre deals with medical-social problems -They established the connection between clean-up workers' death, the cause and acute condition of diseases and the workers' participation in the clean-up activities at Chernobyl. If the commission establishes this connection, a clean-up worker gets a special allowance.
1872 cases have been presented, 1663 (88.8%) of which were related to the participation in Chernobyl clean-up operations. According to the data of the commission, most of the related cases were psychic and mental disorders (17.%), hypertension diseases (15.3%), nodosa struma (13.1%), autonomous solar system diseases (12.2%), etc.
Estimating the factor of age, it must be noted, that mostly sufferers are young people. 82.7% of related diseases were in the group of age 25-44. Psychic and mental disorders are predominant in the group of age 25-34, while hypertension diseases are predominant in the group of age 35-44. Therefore the analysis has shown that those who suffered (around 40% of the total), irrespective of their age, worked at Chernobyl in 1986.
Our experience permits us to make some conclusions: that it is difficult to separate the influence of ionisation from the influence of mental trauma on the health of Chernobyl clean-up workers; therefore the information to society about the influence of radiation must be provided in a reliable way and based on scientific research.
Estimating that the morbidity of Chernobyl clean-up workers after 14 years from the accident is slightly different from that of the similar Lithuanian population, it is necessary to continue the investigation on the state of health of this contingent and fix it.
Since Chernobyl clean-up workers have specific health problems, it is
expedient to provide health care for them in specialised medical centres.
Certainly more considerable attention from the government and Chernobyl
public organisations is necessary for solving social security problems
of clean-up workers.
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