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ACTIVITY REPORT No ACTIVITY REPORT No. 45 Summary of Activities in Zlatna, Romania, 1994–1997: A Cross-Sectoral Approach to Environmental and Occupational Health Improvements January 1998 by Patricia Billig Prepared for the USAID Mission to Romania under EHP Activity No. 224-RC Environmental Health Project Contract No. HRN-Q-03-93-00037-03, Project No. 936-5994 is sponsored by the Bureau for Global Programs, Field Support and Research Office of Health and Nutrition U.S. Agency for International Development Washington, DC 20523 CONTENTS ACKNOWLEDGMENTS ................................................................... iii ABOUT THE TEAM ....................................................................... v ACRONYMS .............................................................................. ix EXECUTIVE SUMMARY ................................................................... xi MAP OF ZLATNA, ROMANIA ............................................................. xv 1 BACKGROUND ................................................................. 1 2 GOALS AND STRATEGY ........................................................... 3 2.1 Topics of Concern ............................................................ 3 2.2 Initial Survey, Stakeholder Identification, and Information Dissemination ............... 4 2.3 Goal Development ............................................................ 7 2.4 Strategy for Achieving Each Goal ................................................ 8 2.4.1 Reducing the Exposure of Young Children to Lead .......................... 9 2.4.2 Improve Air Monitoring Capacity and Data Management .................... 14 2.4.3 Improve Occupational Health and Safety ................................. 14 3 CRITICAL SUCCESS FACTORS ..................................................... 16 3.1 Commodity Provision Combined with Technical Assistance ......................... 16 3.2 A Comprehensive Cross-Sector Stakeholder Identification Process .................... 16 3.3 Collaborative Goal Identification and Strategy Development ......................... 18 3.4 Baseline and Follow-Up Assessments ............................................ 18 3.5 Leadership Development/Mentoring Key Counterparts ............................ 19 3.6 Maintenance of Program Flexibility ............................................. 19 4 RESULTS ......................................................................... 20 4.1 Reducing the Exposure of Young Children to Lead ................................ 20 4.1.1 Reduction of Blood Lead Levels ......................................... 20 4.1.2 Changes in Knowledge, Attitude, and Practice ............................. 20 4.1.3 Collaborative Community Effort to Improve Kindergarten Hygiene ........... 24 4.2 Improve Air Monitoring and Data Management ................................... 24 4.2.1 Installation, Operation, and Maintenance of Air Quality Monitoring System .................................................... 24 4.2.2 Management and Analysis of Air Quality Data ............................. 29 4.3 Improve Occupational Health and Safety ......................................... 29 4.3.1 Acquisition, Operation, and Maintenance of OHS Equipment ................ 29 4.3.2 Increased Capacity and Improved Focus of OHS Staff ...................... 29 4.3.3 Reductions in Blood Lead Levels and Improvements in Knowledge and Practices of Workers .................................................. 32 4.4 Participant Evaluations ........................................................ 32 i 5 PROSPECTS FOR SUSTAINABILITY ................................................ 36 5.1 Plans for the Lead Working Group .............................................. 36 5.2 Plans for the Air Working Group ............................................... 36 5.3 Plans for the OHS Working Group ............................................. 36 6 POTENTIAL NEXT STEPS FOR USAID ............................................. 38 6.1 Emission Reductions at the Plant ............................................... 38 6.2 Air Monitoring .............................................................. 38 6.3 Scale-Up ................................................................... 38 PHOTOS .............................................................................. 40-44 APPENDICES A List of EHP Reports ................................................................. 45 B Scope of Work for Each Goal ......................................................... 47 C Family Counseling Brochure .......................................................... 49 D Commodities Provided ............................................................... 67 FIGURES 2-1 Changes in Blood Lead Levels of Concern for Children # Six Years ........................... 4 2-2 Blood Lead Levels Associated with Adverse Health Effects .................................. 5 2-3 Links between Industrial Restructuring and Environmental Health Interventions ................ 6 2-4 Lead Concentrations in Washed and Unwashed Locally Grown Produce ...................... 11 2-5 Family Counseling Messages to Accompany Blood Lead Testing Results ...................... 12 3-1 Lead Working Group Cross-Sector Collaboration to Achieve Results ......................... 17 4-1 Distribution of Child Blood Lead Levels in 1995 and 1997 .................................. 21 4-2 Comparative Blood Lead Levels for Children Who Participated in 1995 and 1997 Surveys ........ 22 4-3 Changes in Knowledge about Lead Poisoning and How to Avoid Exposure ................... 23 4-4 Sources of Information about Lead Poisoning Prevention .................................. 25 4-5 Examples of Improved Hygiene Behaviors .............................................. 26 4-6 Contributions to Collaborative Effort to Improve Hygiene at Zlatna Kindergarten .............. 27 4-7 Air Sampling Station Schematic ........................................................ 28 4-8 Monthly Variations in Air Lead Concentrations in Zlatna and Patrengeni in 1996 ............... 30 4-9 Pollution Rose Analysis for 1996 Sulfur Dioxide Concentrations ............................. 31 4-10 Changes in Worker Blood Lead Values between 1996 and 1997 .............................. 33 4-11 Correlations between Workplace Air Lead Concentrations and Blood Lead Concentrations in 1996 and 1997 for Workers Using Respirators ............................. 34 ii ACKNOWLEDGMENTS Many people contributed to the success of this Niciu, Dr. Alin Sinca, Mrs. Ecaterina Bodor, and project from the original vision, to programmatic Dr. Dana Farian. planning, to implementation and overall At the Judet level, the Prefect’s office was accomplishments. The original vision and program very supportive in providing meeting space and support came from USAID’s Europe and Newly guidance, and the Sanitary Police and Judet EPA Independent States (ENI) Bureau. Recognizing the provided needed technical support and special circumstances and needs in Eastern Europe, collaboration with the working groups. Although the ENI Bureau understood and supported the the membership of the three working groups need for major commodities assistance along with changed somewhat over time, the following technical support. Richard Hough and Mary Ann individuals provided much of the local leadership Micka, at USAID/Romania during most of this to ensure the accomplishments of their group: activity, provided networking support with key Child Lead Exposure Reduction (Dr. Romanian health and environment ministry Vultur/Zlatna Hospital; Mrs. Puiulet and Mrs. personnel and, more importantly, critical guidance Prata/Kindergarten Directors; Mr. Ponoran/Zlatna and support to EHP. They contributed Mayor; Dr. Candrea/Sanitary Police), Air substantially to the success of the activity. Monitoring (Mr. Clepan, Mrs. Stoica, Mrs. The implementation of this activity Maier/Aba Judet EPA; Mr. Dreghiciu/Ampellum involved numerous EHP team members, listed on Plant) and OHS (Mr. Filimon, Ms. Szakas, Mr. the following pages, in collaboration with many Montean, Dr. Chiorean/Ampellum OHS staff). Romanian counterparts. Some team members were Many members of a local NGO, involved for only a short time while others Albamont, led by Ms. Marioara Puscas, provided provided periodic support throughout the life of invaluable logistical support and guidance on the activity. All are committed professionals who, several important issues, from assisting with uniformly, were impressed by the dedication and environmental sampling to working with local commitment of their Romanian counterparts and newspapers and radio stations. supported their success in many formal and Finally, EHP’s local coordinators, Liviu informal ways. Cindy Becnel and Ralph Moltzau Ionescu during the first year and Mihai were especially dedicated to coaching and Maracineanu during the second two years, were supporting the OHS Working Group and the Air also critical to the success of the activity. They Working Group, respectively. provided not only superb translation services, The overall accomplishments of the including late night informal discussions with activity would not have been possible without the participants, but also invaluable coaching of EHP cooperation, support and enthusiasm of the partner staff, which markedly increased the effectiveness of institutions. These included the Ministry of the activity. They were also very helpful in Industry, Ministry of Environ-ment, and Ministry problem-solving, as various difficulties arose. of Health.
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