Gold Mining, 2015

Preface

Under the environmental and health integrated plan of fiscal year 2015 (B.E.2558) which focused on collaboration between departments in the Ministry of Public Health aimed to achieve the objectives to reduce environmental risk factors that affect public health and the illness caused from the environment. A key measure of the environmental and health integrated plan is to develop the monitoring and warning system, public communication and to contribute the environmental and health problem-solving. Due to the circumstances of the environmental pollution problems in the risk areas are likely to affect health and have caused more complaints. So, in order to solve such problems and to reduce environmental risk factors that may affect the health of the people. The Department of Health and the Department of Disease Control have co-operated the joint surveillance in the risk areas under the integrated plan. By the activity is the preparation of guidelines and manuals for environmental and health surveillance in each of the risk areas consisting of the gold mining areas, the risk areas of air pollution from biomass power plants, the risk areas of air pollution from the smoke, the risk areas of air pollution from dust, the risk areas of contagious diseases from food and water and the risk areas of electronic wastes. The purpose is to create guidelines for the public health staff to apply in surveillance, warning and public communication proper to the problems in the areas and enable to manage and solve the environmental health problems in the risk areas effectively on which it would lead to health preventing and reduce environmental risk factors that affect

1 people’s health, according to the objectives of the integrated environmental and health plan. In addition to support the implementation of environmental and health surveillance in risk areas, the Publication Team has renewed the second updated guidelines which have more completely contents and information for surveillance in the risk areas. It would be beneficial to support the implementation of the public health officers in the areas. If there are any additional suggestions, please notify the Division of Health Impact Assessment, Department of Health, Ministry of Public Health.

The Publication Team March, 2015

Table of Contents

Preface 1 Table of Contents 3 Chapter 1 Background 5 1.1 Background 5 1.2 The Objectives of this guideline: 6 1.3 Target Groups 6 1.4 The Components of the Health Surveillance Guidelines in Case of Gold Mining 6 Chapter 2 Process, Pollutions and Health Impacts 7 2.1 Gold Deposits in Thailand 7 2.2 Types of gold mining 10 2.3 Process of Gold mining 12 2.4 Chemicals used in the Gold mining process 16 2.5 Health Hazards and Health Impacts 18 Chapter 3 Guidelines for Environmental surveillance 37 Chapter 4 Procedures and Methods of Health Surveillance 47 4.1 Health Risk Assessment 66 4.2 An example of health risk assessment in case of ingested arsenic exposure. 68

Table of Contents

4.3 Treatment and Rehabilitation 72 4.4 Setting community mapping or risk mapping 72 4.5 Mental health surveillance of the community. 74 4.6 A Study on consumption behavior of the population in the surrounding areas. 75 4.7 Collection of samples of food, vegetables and fruits (Department of medical service, 2014) 76 Chapter 5 Risk Communication and Risk Management 78 Chapter 6 Laws and Regulations Relating to Mining Activities 80 6.1 Relevant Legislations 80 6.2 Health and Environmental Quality Standards 82 Bibliography 93

Chapter 1 Introduction 1.1 Background Mining is the affair defined to prepare a report on the environmental impact assessment. According to National Environmental Quality Act B.E.2535 (1992) has stated that the mining industry, smelting or foundry with a capacity since 50 tons per day to study and prepare a report on the environmental impact assessment (EIA) and has defined to gold smelting industry which feed ore into the manufacturing process since 1000 tons / day or more as a project that may cause severe impact on the environmental quality of the community, natural resources and health which must report environmental health impact assessment (EHIA) by identifying measures to prevent and mitigate environmental impacts and measures of environmental quality monitoring. The project must have been monitoring the environmental impact listed in the environmental impact assessment report after the project was done. Furthermore, the mining industry is also defined as harm to health according to the Act of Public Health B.E.2535 (1992). Various types of mining could affect both the environment and people’s health. The impacts may cover both mining sites and nearby areas. The gold mining, particularly, has been complaints from the public about the environmental and health impacts, dust causing, heavy metal contamination or pollution in the environment, such as manganese, arsenic, cyanide, etc. Environmental diseases are also chronic, and are possible long-term effects and are often caused by many factors together. So the protection and surveillance of health affected from environmental hazards, particularly gold mining, are necessary to have official systematic data storage continuously.

1.2 The Objectives of this guideline: 1) To provide knowledge and information about production process, activities, pollutions and health hazards caused by gold mining. 2) To be guidelines for the preparation of surveillance and monitoring the health impacts in the area of gold mining.

1.3 Target Groups The public health practitioners who are in charge of care and take the responsibility for gold mining areas.

1.4 The Components of the Health Surveillance Guidelines in Case of Gold Mining Chapter 1 Background Chapter 2 Process, Pollutions and Health Impacts Chapter 3 Guidelines for Environmental health surveillance Chapter 4 Procedures and Methods of Environmental Health Surveillance Chapter 5 Risk Communication and Risk Management Chapter 6 Laws and Regulations Relating to Mining Activities

Chapter 2

Process, Pollutions and Health Impacts

2.1 Gold Deposits in Thailand Genesis of gold ores, both macroscopic and microscopic, in the varieties of the strata, such as igneous rock, sedimentary rock and metamorphic rock have been found in the veins / lodes of gold bearing quartz, pyrite and sulfite the veins / lodes of gold bearing quartz can be found in igneous rock. Primary gold deposits have been discovered at Tomo in Narathiwat province, Khaw Sarm Sib in Sakhaw province, Chatree gold mine in Pichit and Petchaboon province, Doi Dhoong in Chiangrai province and Khaw Phanompha in Pichit province in Thailand. But secondary deposits are formed by decay of rock contained of gold and the alluvia that are blown form the origin and accumulated at foothills, brook or in distributary. Those are formed as pellet, sheet or small flakes. Secondary gold deposits have been found at Pa Nam Ron in Prachuabkirikhan province, Ban Na Lom, Prachinburi province, Thung Hua in Lampang province, Doi Doon in Chiangrai province and Khaw Pa Nom Pa in Pichit province in Thailand. There are 9 potential gold deposits, both primary and secondary, in the country have been investigated. (Department of mineral resources, 2001) They are: (1) Mueng Loei, Chiang Khan and Pak Chom district in Loei province, continuous to Sangkhom district in Nongkhai province and Nam Som district, Suwan Ku ha district in Udonthani province.

(2) Kabin Buri district in Prachin Buri province and Watthana Nakhon district in Sa Khaw province. (3) Long district and Wang Chin district in Phare province, continuous to Sop Prap district and Thoen district in Lampang province and Si Satchanalai district-Thung Saliam district in Sukhothai province. (4) Mueng Chiangrai district, Mae Sai district and Wiang Pa Pao district in Chiang Rai province. (5) Sanamchaikhet district in Chachoengsao province to Ban Bueng district and Bo Thong district in Chonburi province. (6) Thap Sakae District, Bang Saphan District and Bang Saphan Noi district in Prachuap Khiri Khan province. (7) Sukhirin district, Waeng district and Ra-ngae district in Narathiwat Province and southern part of Yala province. (8) Sangkhla Buri district, Thong Pha Phum district and Sai Yok district in Kanchanaburi province. (9) Mueang Phetchabun district, Wang Pong district and Lom Sak district in Phetchabun Province, Tap Khlo district in Phichit province, Tha Tako district in Nakhon Sawan province, Khok Samrong district and Ban Mi district in Lop Burin province, (10) as illustrated in figure 2.1

Gold Deposits in Thailand

Primary Gold Deposits Secondary Gold Deposits Gold Deposits Mining by Private Sectors

Figure 2.1 Gold deposits in Thailand (Department of Mineral Resources, referred in IPST, 2002)

Gold deposits that have been surveyed and developed to be gold mining industries are Chatree gold mining complex in Phichit province and Phu Thabfa gold mine in Loei province. Chatree gold mining complex is a primary resource and composes of gold and silver quartz and carbonate lode/fissure vein in volcanic rock. The average amount of gold is 2.6 grams and silver 13.3 grams per 1 ton of minerals. The gold deposits at Phu Thabfa are also primary resources and compose of gold and iron in the rocks (IPST, 2012)

2.2 Types of gold mining Gold mining is the process of mining of gold ores through several processes by which pure gold ores may be extracted from the gold rocks 1) Open-pit or open-case mining or surface mining is a mining technique by digging and opening the surface of the earth to get the gold deposits. During these processes, there are several heavy machines are used, such as ground drilling machines, excavators, backhoes, haul truck. Rock blasting is used to open pits and spiral staircases are made to reach bedrock and they will be used to transport minerals up to mineral processing (mineral technology)

Figure 2.2 Open pits or open-cast mining or surface mining

Figure 2.3 Underground mining

2) Underground mining are used to access gold ores from deep in the Earth. Small areas of the surface are needed by opening the surface and drilling the tunnel in order that heavy machine can go into the deep mineral source or tunnel or path to the deep mineral resource. When reaching the underground areas, they will be enlarged both vertically and horizontally. The rocks that were dug will be ground and transported to the surface for gold extraction processes.

2.3 Process of Gold mining Processes of gold mining : 1) Mining 2) Mineral Processing or Mineral Technology or metallury 2.3.1 Mining is the extraction of valuable ores that will be transported to metallurgy. - Rock blasting is used for opening the mine with required size and amount of ores. Mixture of ammonium nitrate and diesel or blasting equipment such as dynamite are used. - Excavation and Extracting of ores from (non-valuable) waste rocks: Drilling and extracting depend on quality of ores which are 3 types 1) Excavation and Extracting of gold with other types of valuable metals, 2) Excavation and Extracting of low quality of ores 3) Excavation and Extracting of tailings for later process. - Mine haulage Transportation of ores (gold, low quality ores and tailings) to metallurgy plant.

2.3.2 Metallury - Primary Crushing the rock fragments will be transported and sorted in a grizzly. During this process, the large fragments will retain in the grizzly, then, they will be transported and be crushed to be smaller fragments in jaw crushers. Small ores will be transported by conveyer belt to the same areas of the large fragments that are crushed to be small ones. - Grinding The ores that are processed by primary crushing will be transport by conveyer belts to the SAG mills. During this process, lime and water will be added in order to adjust acid-base balance. Then, the slurry will be transported to the grinders that have shaker screens to sort wastes and foreign bodies. The slurry that passed the shaker screens will be transported to cyanide tanks. The foreign bodies on the shaker screens will be transported to tailings area and then transported to tailing tanks. - Gold extraction A metallurgical technique for extraction gold and silver from low-grade ore through cyanide processes or gold cyanidation (A chemical equation is 4Au+8CN+O2+2H2O---

4Au (CN)2+4OH). The ores will be soaked in cyanide solution tanks so that the gold or silver will be converted to a water- soluble coordination complex. Then, the gold and silver will be extracted from the solution through a Carbon-In-Leach (CIL) process by adding activated carbon in order that gold and silver will be absorbed into the porous surface of the activated carbon. - Acid Wash and Gold Stripping Processes that hydrochloric acid solution will be added in order to strip gold from activated carbon. Another method is stripping gold from

13 activated carbon with sodium hydroxide solution and sodium cyanide solution. Sodium hydroxide will be added in gold and silver-bearing solution before removing gold and silver by electrowinning. Gold and silver are stripped from activated carbon on which they are adsorbed as cyanide complexes by subjecting the activated carbon to a stripping solution comprising as the strippant an effective amount of a compound containing the carboxylate functionality. The compound is preferably selected from benzoic and substituted benzoic acids, and polyacrylic acids of less than about 100,000 MW. - Electrowining processes of recovery of metal, such as gold and silver, from solution by passing a current through stainless bars that are anodes and through steel cathodes in the electrowinning cells. Gold and silver will be extracted while they deposit in an electroplating process onto the steel cathode, then they will be removed by water and be smelt to form solid metal compounds and sent for electrorefining to recover 99.99% gold and 99.95% silver, as illustrated in figure 2.4

Figure 2.4 Example of gold mining process flow chart Source: Health Impact Assessment from Mining by Ass.Prof. Dro. Suthep Silapanantakul and EHIA Report15 by Akara mining

2.4 Chemicals used in the Gold mining process There are 2 types of chemicals used in the gold mining process: major chemicals are used to be added in the processes such as calcium hydroxide/ quick lime, sodium cyanide, sodium hydroxide, hydrochloric acid, flocculants, Chemicals for separation, flux, other chemicals or materials to remediate cyanide such as sodium bisulfite, sulfuric acid, copper sulfate. Details of chemicals used in the processes are shown in the table 2.1 Table 2.1 Chemicals used in the processes Gold Ore Chemical Characteristic Processing Used Rock Blasting 1. Emulsion A powerful explosive used in Dynamite the form of a stick, heat-stable 2. Ammonium White crystalline solid, highly nitrate soluble in water, highly hygroscopic and causing acid soil. Fine griding 1. 1. Quicklime, White to pale yellow / brown Burnt Lime, powder, odorless, used for base Calcium Oxide control in leaching process Leaching and 1. Sodium White solid and faint almond-like absorption Cyanide (NaCN) odor. 2. Caustic Soda, It is used in large steel leach. lye or Sodium hydroxide (NaOH) 3. Sodium It is white opaque crystals, Hydroxide (NaOH) odorless, used to keep base of water more than 10.5 during cyanide mixing 4. Hydrochloric It is colorless and transparent and Acid Solution highly pungent liquid. It is used to (HCl) extract calcium from the surface of amalgam.

Gold Ore Chemical Characteristic Processing Used melting 1. Sodium Borate It is white, grey or pale green solid, process or Borax odorless, used to treat gold and silver ores from gangue. 2. Silica Sand : It is white granules, odorless used SiO2 for gold extraction or recovery from its ores 3. Sodium It is white, odorless powder, used to Carbonate or treat gold and silver ores from Soda Ash gangue 4. Sodium It is white powder or colorless, Nitrate odorless crystals, used to treat gold and silver ores from gangue. Mineral 1. Sulfamic Acid It is used to clean screens in Processing or mineral process. Mineral 2. Flocculants It is used in dewatering Technology 3. Activated It is carbon from coconut shell, carbon or Activated used for absorption of gold and Charcoal silver. Cyanide 13. Sodium It is slight sulfurous odor, Destruction Bisulphite employed with copper sulfate to (NaHSO3) convert free form of cyanide to cyanate, which is less toxic. 14. Copper It is a white or brown, odorless Sulfate crystals, employed with sodium (CuSO45H2O) bisulfite to convert free from of cyanide to cyanate, which is less toxic. 15. Sulfuric acid It is clear, colorless and odorless solution (H2SO4) solution, used to treat acid-base balance.

2.5 Health Hazards and Health Impacts Health Hazards is something that potentially harm (injury, illness, death or physical and mental health). Chemicals, equipment, radiation, energy, operating processes and environment are included. In gold mining, there are many physical and chemical issues that affect health, as illustrated in table 2.2 Table 2.2 Health Hazards and Health Impacts Chemicals / Gold ore Health Health Impact process Hazard Rock Silica Dusts - They lead to respiratory Blasting insufficiency, dyspnea(short of breath), cough, chest pain, gasp for breath, , fatigue, that are called silicosis, which is incurable and are at high risk of developing Tuberculosis. Noise -It can harm to the hearing organs, cause annoyance, stress or other severe disease. Vibration It may cause vibration sickness, which decrease effectiveness of the body and cause muscle twitching. Tailings Acid Mine Acid mine drainage is formed when Heaps Drainage sulfur-bearing waste rocks are exposed (ADM) and react with air and water to form sulfuric acid and dissolve heavy metals (arsenics, cobalt, copper, cadmium, lead, silver, zinc) in the tailings, causing environment pollutions.

Chemicals / Gold ore Health Health Impact process Hazard Arsenic -It irritate to the respiratory system/airway, skin and eyes. -It is a carcinogen, type A1 as the lists of ACGIH and NTP. -As the lists of IARC, It damages liver, kidneys, lungs, respiratory system and causes tumors. Copper -It irritates to nose, mouth and eyes and also causes headache, abdominal pain, dullness, vomiting and diarrhea. Large amount of copper intake leads to impairment of live and kidney function. -It is a cause of Wilson’s disease. Cadmium Acute symptom - Persistent nausea, vomiting and diarrhea. - Irritation of the nose, throat, bronchi and lungs, cough and dizziness Chronic symptoms - It causes softening of the bones, specialty in Itai Itai disease and is also a carcinogen. Lead - Lead has been highly influential in the classification possible carcinogens, group 2B (IARC-International Agency for Research on Cancer) and has been

Chemicals / Gold ore Health Health Impact process Hazard confirmed as an animal carcinogen, group A3 (ACGIH- The American Conference of Governmental Industrial Hygienists) -It can affect central nervous system, digestive system, kidneys, blood, heart, reproductive system, and fetal development - The prime targets to lead toxicity are eyes, stomach and intestines, central nervous system, kidneys, blood and cause a blue line along the gum with bluish black edging to the teeth. Zinc - Zinc irritates to skin and eyes. - After breathing in, sweet taste in the mouth, dry throat, cough, fatigue, fever, nausea and vomiting occur. Manganese - Acute symptoms: After breathing in, manganese can cause high fever, breathing problem, grasp for breath, metal fume fever, sore throat and cough, producing mucus. - Chronic symptoms: The prime target to chronic exposure to manganese is central nervous system, causing neurological defects.

Chemicals / Gold ore Health Health Impact process Hazard Primary Silica dusts - It cause respiratory insufficiency, Crushing dyspnea (shortness of breath, cough, chest pain, grasp for breath and fatigue that called Silicosis, which is incurable and particularly susceptible to Tuberculosis Infection (Tb) Grinding Quicklime, - It can cause irritation to skin and Processes Burnt Lime mucous membranes of the nose. - Inhaled quicklime can cause irritation to the nose, throat and upper airway. Carbon in Sodium -It can cause irritation to mucous Pulp(CIP) Cyanide membranes of respiratory and (NaCN) gastrointestinal system. -It also can be toxic to central nervous system. - It can also cause irritation to the skin since it can be absorbed through skin, causing symptoms of central nervous system: headache, dizziness, excessive sleepiness, nausea, respiratory disturbance, apnea, loss of conscious, and cardiovascular collapse. - Chronic exposure to cyanide by direct contact can result in skin rash, crusting Lichenification excoriation, headache, nausea, vertigo and allergic reaction

Chemicals / Gold ore Health Health Impact process Hazard Sodium - Sodium hydroxide can cause Hydroxide irritation to respiratory system and (NaOH) skin. Long exposure to sodium hydroxide can lead to tissue damage. - It also is corrosive to the tissues. Hydrochloric - Hydrochloric acid can cause damage Acid (HCl) to local areas (skin, eyes, mucous membranes) - It also cause severe irritation to skin, mucous membranes and eyes that may lead to loss of vision. Cyanidation Sodium -Borax can cause irritation to mucous Borate or membranes, upper respiratory tract, Borax skin and eyes. - It was reported that an infant, exposed to 5 grams of sodium borate and an adult, exposed to 5-20 grams of it can be harmful and cause death. -The prime targets of borax toxicity are eyes, respiratory system, central nervous system, kidneys and scrotums. Sodium - It leads to results in irritation to Carbonate or mucous membranes, upper respiratory Soda Ash system, skin and eyes. - It also can affects reproductive organs. Sodium - It can cause irritation to mucous Nitrate membranes and upper respiratory tract,

Chemicals / Gold ore Health Health Impact process Hazard cough, rapid breathing, sore throat and runny nose.

- Direct skin contact can be harmful to the skin, causing erythema, swelling and painful skin. - Eye exposure can cause irritation, causing erythema, swelling, watery and painful eyes. Mineral Sulfamic - It can cause irritation to respiratory Processing / Acid tract, skin and eyes because of the Mineral dusts. Technology Cyanide Sodium - It is toxic to upper respiratory tract Destruction bisulfite and causes skin and eye irritation.

(NaHSO3) - Long exposure to sodium bisulfite can damage many organs. Copper - Copper sulfate can cause irritation to Sulfate respiratory tract, skin and eyes

(CuSO45H2O) - After ingestion, it can cause diarrhea, peptic ulcer, nausea, vomiting, seizure and collapse. Sulfuric Acid - It is corrosive and causes irritation to

(H2SO4) respiratory tracts, skin and eyes. - It also cause tooth damage and coronary insufficiency.

Toxicology of poisoning and health impacts. (ATSDR, 2007; Curtis D.2007; Ministry of Labour, 2007) (1) Cyanide Properties - Cyanide or cyanide compound can be found in the form of cyanide salt such as sodium cyanide (NaCN), potassium cyanide

(KCN), calcium cyanide (Ca(CN)2) or interaction with metal such as iron and manganese. It also can be found in gas form as hydrogen cyanide (HCN) Sources - Cyanide can be found in cigarette smoke, smoke from burning food such as cassava, bamboo shoot, raw military seeds and environmental contaminations. It also can be found in raw cassava, raw soy bean, raw bamboo shoot or receiving sodium niroprusside for treatment. Toxicology - Cyanide gas and cyanide salt can rapidly be absorbed by inhalation or digestion, but slowly being absorbed by skin. - Cyanide that enters the body will be distributed to several organs in the body and is converted to thiocyanate, which has half-life of approximately 20 minutes to 1 hour in the blood. - Some of the cyanide leaves the body in the urine, and some leaves the body in the breath. - After cyanide exposure, cyanide can be measured and detectable in blood, and thiocyanate can be measured in plasma or urine.

Health Impacts Symptoms caused by cyanide exposure are: - Acute Symptoms: Cyanide can cause collapse and death because of hypoxia (lack of oxygen). - Symptoms after long-term exposure to small amount of cyanide include headache, dizziness, fatigue, tachypnea(rapid breathing), tachycardia(rapid heartbeats), nausea and vomiting. Exposure to the dusts of cyanide salt produces erythema and cherry red skin.

Cyanide level measurement in blood Cyanide binds to thiosulfate and is converted to thiocyanate by rhadonase, an endogenous enzyme. It also binds to methhemo- globein in red blood cells, then facilitates the formation of thiocyanate, a much less toxic metabolite. Since endogenous concentrations of methhemoglobin are quite low, so after exposure to high level of cyanide, it cannot totally be cleared from the body.

(2) Manganese Manganese is an essential mineral for metabolism and cell functions of a body. It also is found in many enzymes in the body and enhances enzyme activities. There are many valences of manganese in the body: Mn+2(divalent), which is common found and can be oxidized to Mn+3 (trivalent), which is toxic to the body.

Sources - Manganese intake occurs by ingestion of vegetables, nuts, beans, fruits and tea. Average daily requirement of manganese is 2-9 mg. - Workers in metallurgical industry are at risks of exposure to manganese dioxide, especially workers in steel alloy plants and electric coil plants, battery production plants, glass manufacturing plants, electrode manufacturing plants and potassium or manganese production plants. - Environmental exposure to manganese mostly is from organometallic, dithiocarbamate insecticide, mancozeb which is a dithocarbamate fungicide and drink of water contaminated with manganese. Toxicology - Approximately 1-5% of ingested manganese is normally absorbed. The manganese interactions can lead to manganese poisoning. - Manganese is excreted from a gall bladder into the small intestine and reabsorbed into the body and eliminated in stool. Biliary excretion is poorly developed in neonates, and exposure during this period may result in increased delivery of manganese into the brain and other tissues. - There are not definite evidence-based results of manganese deficiency in human beings. But low levels of manganese in the bodies of animals can result in skeletal abnormalities, stunted growth and can alter functions of the reproductive system. - Most of manganese is excreted from the body in stool, small amount of it is excreted in urine (0.1-0.2%). The manganese

26 that un-absorbable will be excreted in stool and the biological half-life of manganese in the body is about 13-37 days. It also is excreted in sweat, hair and breast milk.

Health impacts - Appropriate amount of manganese is essential for body functions, such as anti-oxidation, bone development and wound healing. Average daily requirement is 2.3 mg. for men, and 1.8 mg for women. - Long period of manganese accumulation may affect to neurological system: brain damage since brain is very susceptible to manganese. - Consumption of water contaminated manganese may affect to neurological system. - Chronic exposure to excessive level of manganese can lead to Parkinson-like symptoms that may include tremors, difficulty walking, and facial muscle spasms. - No evident-based of carcinogen. - Manganese exposure can be measured in blood and urine samples. Manganese level measured in stool is more related to the disease but it may be difficult to perform.

(3) Nickel Properties - Nickel is lustrous, metallic and silver solid powder, water- insoluble but nitric acid-soluble and partially hydrochloric-soluble and sulfuric acid-soluble.

Sources - Nickel occurs naturally in the environment, such as rocks, soil and food. It is used in battery production, chemicals, inois, catalysts, and metal materials. Toxicology - Approximately 20-35% of nickel dusts, inhaled into the lungs will be contributed to blood circulation. - 27% of water contaminating nickel can be absorbed into the body and nickel found in food (1%) can also be absorbed into the body. - Only small amount of nickel can be absorbed through skin. - After absorption into the body, nickel will not cause any reaction and be excreted in urine. The half-life of nickel that ingested into the body is 28 hours. - Exposure to nickel can be detected in serum and urine. - Normal levels of nickel are 0.2 μg/L in serum and 1-3 μg/L in urine.

Health impacts Exposure to nickel can occur by ingestion, inhalation and skin contact. - Small amount of nickel can be found in food or nickel- pigmented dishes - Polluted air from factories and tobacco smoking - Skin contact through direct contact with jewelry. - Common symptoms caused by nickel exposure are contact dermatitis (rash). The most common sites are the earlobes (from earrings), fingers and arms)

Exposures to nickel via inhalation can cause lung diseases. Nickel allergy is one of the most common causes of contact allergic most common sites for nickel dermatitis are the earlobes (from earrings), No evident-based of carcinogen. - Exposure to nickel can be measured in blood and urine samples.

(4) Arsenic Arsenic is a carcinogen and very toxic agent. Inorganic arsenic can be found in the form of trivalence (AsIII) and pentavalence (AS V) in the environment. Organic arsenic, trivalence (AsIII) that is common found are arsenic trioxide and sodium arsenite, but organic arsenic, pentavalence (AsV) are sodium arsenate, arsenic pentaoxide and arsenic acid. Properties - Arsenic can be found in soils, rocks and other minerals such as gold. It also can be found in the form of organic compound in animals. Source - The dominant basis of arsenic poisoning is via drinking water that naturally contains arsenic. - During mining processes, arsenopyrite, which is stable will be converted to arsenic oxide, which is water-soluble (Arsenopyrite and Asenite(ASIII) - Arsenic can be found in groundwater that naturally contains arsenic. The arsenic is also a composition of insecticide.

- It also can be found in burning of charcoal, which contains arsenic or chemicals for preservation of wood that contains arsenic. - Oral exposure to organic arsenic called “arsenobetaine” can occur through seafood ingestion. Toxicology - 89-90% of organic arsenic can be absorbed into the body through gastrointestinal system and be distributed to every parts of the body, then most of it will be excreted in urine. The half-life of arsenic through ingestion is about 10-30 hours. Approximately 50-80% of the amount of arsenic will be excreted in urine in 3 days or more than that and also excreted in sweat. Arsenic exposure can be detected in nails and hairs because some arsenic remains at nails and hairs. When the arsenic enters the body, the arsenic AS (V) can be reduced to As (III) arsenic, which has severe toxicity that can inhibit the functions of enzymes and proteins. - Arsenite (As III) binds to sulhydryl group (SH), thus reacts with a variety of proteins and essential enzymes, which are important for DNA formation in cells and leads to changes of chromozomes and chromatids and may leads to carcinoma(s).

Health Effects Acute toxicity - Ingestion of large amount of organic arsenic (70-80 mg) can cause death. Symptoms of acute arsenic toxicity are fever, anorexia, hepatomegaly, melanosis, arrhythmia (irregular heartbeats), heart failure and death. It sometimes causes irritation of digestive

30 system and peripheral neuropathy. These can occur 1-2 weeks after exposure to high level of arsenic. Chronic toxicity - Long-term exposures to arsenic can lead to skin changes (darkening or discoloration), the discoloration can occur in 6 months to 3 years, then hard patches can appear on the palms of hands and may lead to skin cancers. Exposure to arsenic can also affect abdominal pain, jaundice, liver damage and liver cancer. Long-term exposures to arsenic at the lower level than toxic level can lead to peripheral nerves defects. Sensory nerve defects, such as numbness at hands and feet and tinkling can develop. The association between arsenic exposures through water consumption and cardiovascular disease are documented. - Arsenic can be accumulated in many organs in the body, such as fingernails, bones, hairs and lungs. - Arsenic is harmful to fetus. - Arsenic is classified as a carcinogen. - Arsenic level in the body can be measured in blood, urine, hairs and fingernails samples.

(5) Lead Properties Lead is a bright and silvery metal with a slight shade of blue in the soil, rock, water, plants, air and water, especially in groundwater, lakes and rivers. Lead compounds are used widely in paint industry and paste, batteries and submarines. Besides, lead oxide is used in cosmetics.

Sources - People can accidentally be exposed to lead by ingestion and consumption of water contaminated lead, soil and in oils - Lead can be contaminated in drinking water that flow through water pipe lines and enter the body. Container contained lead can leach the metal into food. - Lead is a composition of hair dye and some cosmetics. Toxicology - Approximately 95% of inorganic lead inhaled can be absorbed into the body. Absorption rates depend on the individual bodies and species of lead compounds. - Lead can be absorbed in children (40-50%) more than in adult (3-10%). In case of full stomach, lead absorption may decrease. - Approximately 94% of lead can be found in bones and teeth in adults and 73% in children, respectively. - The half-life of inorganic lead in blood and bones is 30 days and 27 years, respectively. - Lead can be excreted in urine and stool - Lead level can be measured in blood sample. Health effects Generally, lead can enter the body by oral consumption of food and lead-contaminated water and through inhalation. Mostly, skin exposures to lead can occur in the people who work with lead, especially organic lead that can be easily absorbed through skin. After entering the body, lead will be absorbed into the circulatory system and bound with red blood cells in place of ferrous (Fe+2), which is essential for red blood cell formation and cause anemia and abnormal increase of ferrous level. Some lead

32 will deposit in bones. Lead (Pb+2) will replace calcium (Ca+2), which is essential for bone and tooth formation and lead to joint pain, osteoporosis and easily broken. A blue line along the gum with bluish black edging to the teeth, sometimes called lead line can occur. The teeth may be easily loss. A research has found that lead can have been deposited in the bones of the body for 32 years and been deposited in fat, nervous system, brain and lymphatic system, liver and kidneys. Common chronic symptoms include symptoms of digestive system that are abdominal pain, weight loss, loss of appetite, nausea, vomiting, constipation, neurological and brain poisoning that lead to gait imbalance, hallucination, stupor, seizure, hands and feet drops, paralysis, loss of conscious and death.

(6) Cadmium Properties - Cadmium may be presented in the environment from natural source. It occurs as a component of other minerals such as zinc, lead and copper and also in the solution in the sea. Sources - Generally, exposure to cadmium can be found in food, drinking water, air and by smoking. - Cadmium enter the food chain through cadmium contamination in soil, container contained cadmium. - High level exposure to lead can be found in vegetables such as, spinach, cauliflower, cabbage, peanut and cereals. - Exposures to cadmium can be found in workers in alloy plants, battery production plants, plastic plants, smelteries.

Toxicology - 25% of inhaled cadmium is absorbed, about 1-10% of ingested cadmium may be absorbed and 1% of cadmium is absorbed through skin. - Absorption of cadmium is greatest for small particles, such as the particles in cigarette smoke and least for large particles. Typically, the persons with lower iron status, are believed to be at risk for greater absorption of cadmium. - Absorbed cadmium is eliminated from the body in urine and stool. - The biological half-life of cadmium in human body is more than 26 years. Health Effects - Kidneys and bones are very susceptible to cadmium exposure through ingestion. Exposure to cadmium leads to kidney problems and osteomalacia (The bones become soft and become weaker.) - Inhaled cadmium dust leads to be carcinogenic. (IARC) - Exposure to cadmium can be measured in blood and urine.

(7) Mercury Properties Mercury can occur naturally and can be found in many forms: 1) metallic mercury, which is odorless and silvery-white liquid that expands as it is heated. 2) inorganic mercury or mercury salt, which is white powder or crystals and is the combination between mercury and other minerals, such as chlorine, sulfur and oxygen. 3) organic mercury compounds that occur when mercury

34 binds to carbon. Methyl mercury caused by reactions between microorganisms in soils and water is common found. Sources - Emission of the inorganic mercury to the atmosphere caused by mining, burning coal and garbage that contained mercury from the industries. - Soil and water contaminated mercury can occur in the nature, garbage and lava extruded from a volcano cools - Metallic mercury can be found in soil and water through bacterial reaction and bioaccumulation in long-lived and big fish, which contain higher concentrations of mercury than others. - Using mercury in dentistry and medical treatment. - Inorganic mercury, such as mercuric oxide is used in battery production, chemical synthesis and cosmetics.

Toxicology - Mercury exposure occur through inhalation of mercury fume. The mercury will be converted to inorganic mercury. In first contact or enter the body, the half-life of mercury in the human whole body is 1-3 days and may vary within the range of 1-3 weeks. Then, the mercury will be eliminated from the body via kidneys in urine. - Approximately 15% of ingested inorganic mercury can be absorbed, then it will be eliminated by kidneys and in faeces. - Approximately 95% of ingested methylmercury can be absorbed and distributed to brains and other tissues in the body. The half-life of methymercury is 50 days, then the methylmercury will be eliminated in faeces. Some mercury accumulates in hairs.

- Both organic mercury and methylmercury can accumulate in breast milk. - Level of exposure to methylmercury and organic mercury in the human body can be measured in blood and urine. - Exposure to methylmercury can also be measured in blood and new hairs.

Health Effects - Inhaled exposure to large amount of mercury leads to lung damage, nausea, vomiting, hypertension and tachycardia. - Neurological system is very susceptible to mercury, especially the vaporized mercury and methylmercury, which enter the brain and cause more health effects than other types of mercury. - Exposure to metal mercury, organic mercury or organic mercury can result in brain and kidney damage and lead to fetal development defects. The symptoms of brain damage can be visual problems, hearing loss, decreased cognitive functions and tremors. - Exposure to mercury in a pregnant woman and through breast milk can harm the infant whose brain is shown to be very sensitive to mercury and result in brain damage, decrease brain development, blind and seizure.

Chapter 3 Guideline for Environmental Surveillance

Surveillance is a system for continuous monitoring, observation, consideration of changes of epidemiology or public health problems, including factors that cause those changes. The surveillance is the continuous, systemic collection, consolidation, analysis, interpretation of health-related data and providing the information to the users in order to plan, formulate policies, implement and evaluate preventive system rapidly and effectively (Department of Disease Control, 2012) In the surveillance of health impacts of gold mining on surrounding communities, there is concern about chemicals or environmental pollutions caused by industrial activities in the areas such as activities of factories, chemicals used in gold extraction process and other activities that cause environmental pollutions. The scope of environmental health surveillance must be defined to monitor environmental contamination, since the data of environmental contamination can indicate human exposure to the environmental chemicals. Data source are classified into primary and secondary data. The primary data is the data collecting from measuring environmental quality. And the secondary data is data collecting of data base from other sources. In case the values exceed the standard values, the information of risk must be disseminated to the people and stakeholder organizations. The environmental data are useful for health risk assessment by public health officer in order to find out human exposure to the environmental contamination or health risks. If there are any risks,

the information must be disseminated to the people in the surrounding areas and the risks must be managed. In case the values of environmental pollutants exceed the standard values or the people are at high risks, beside of dissemination to the people, it is also responsibilities of public health officer to continuously monitor health impact in people of risks. Health impact surveillance can be conducted by both passive surveillance and active surveillance. Passive surveillance can be conducted by collecting data from the routine report of the people who come for healthcare service. And active surveillance can be conducted by actively searching for the patients or people at risk in order to get epidemiological data. If patients are found by either method, the public health officers need to manage in order that those patients can be diagnosed, threated and rehabilitated as the details in figure 3.1

Risk Communication and Risk Management

Health surveillance Diagnosis, Management Risk Risk - Active Impacts Treatment Assessment surveillance and - Passive Rehabilitation surveillance Environmental Surveillance exceed -Primary standard -Secondary values

Link environmental data

Figure 3.1 Environmental Surveillance

The Steps of surveillance: 1) Data collection: In this step, data of environmental impacts, illness and disease must be defined, then the data of hazards and environmental factors must be collected 2) Data Analysis : In this step, the data will be analyzed and modelled statistically and are used for risk evaluation in order to manifest environmental conditions: water pollutions, air pollutions, soil pollutions, food chain and epidemiology of diseases, epidemiological trends and people at risk. 3) Data Reporting: The analyzed information will be reported to the stakeholder organization that are responsible for policy formulation and to the people at risks. 4) Problem Solving or Prevention : To solve or prevent the problems, the information will be used to develop plans or activities that appropriate for each group of prospects. In order to find out whether the problems can be solved or prevented or not, monitoring must be the first step, including controlling and evaluating effectiveness of controlled or preventive measurement. An environmental surveillance is a continuous system of data collection, data analysis, interpretation, and dissemination the information to the stakeholder organizations that are responsible for disease control and prevention. The environmental surveillance includes data collection from environmental monitoring, biological monitoring, and the results from survey and screening. The environmental surveillance of gold mining defines data need to be collected and data source. Primary source of surveillance information

39 of environmental contaminated sites, especially consumption water, surface water, stream water, rivers and swamps, water supply, groundwater and food chain is collected in order to define scope of contaminated areas that must be conducted for environmental surveillance. Secondary data sources The public health officers can coordinate and ask for The Environmental Quality Reports in mining from authorized state agency (Provincial Industrial Office, Office of Primary Industries and Mine, Department of Primary Industries and Mines) and stakeholder organizations such as Regional Environmental Office and Provincial Environmental Office. A annual environmental annual report must be reported to authorized agency and stakeholder organizations by a mining entrepreneur every 6 months. The parameters are defined in the appendix of the Environmental Impact Assessment, such as total suspended particles (TSP) per 24 hours, tiny dust smaller than 10 micron, hydrogen gas, cyanide, noise level, results of water quality analysis in an observation well, surface water and underground water quality, such as acid- base balance, BOD (biochemical oxygen demand),COD(chemical oxygen demand), color, odor, total suspended particles, dissolved minerals in the water : calcium, magnesium, sodium, potassium, arsenic, iron, manganese, mercury, cyanide and etc. as details in table 3.1

Primary sources In the mining industry, the entrepreneurs are not enforced to measure water supply quality or quality of drinking water in

40 the community or food chain contamination such as vegetables, rice, shells, fish and etc. Thus, it is responsibility of public health officers to collect samples of water supply or consumption water, including samples of vegetables, aquatic lives, and etc. to be analyzed in the exposure surveillance. Table 3.1 gives important parameters

Table 3.1 Processes and collection data in the environmental surveillance of gold mining.

Issues in the Collecting Process Data sources data 1. Data Secondary Data The Report of Collection - Air Quality: Total Preventive and suspended particles (TSP) Corrective and amount of tiny dust Guidelines for Health smaller than 10 micron Impacts and The (PM10), nitrogen dioxide, Monitoring of the hydrogen cyanide(HCN), Environmental hydrogen chloride(HCl). Quality in Case of 5-Years retrospective data Gold Mining. must be collected. - Noise Level: general noise. 5-Years retrospective data must be collected. - Surface water and groundwater Quality are affected by many factors, such as arsenic, copper, iron, lead, manganese, mercury and total cyanide. 5-Years retrospective data must be collected.

Issues in the Collecting Process Data sources data Primary data The areas for sample - The water samples in the collection must be area are gathered to analyze defined with water quality. The samples community are from groundwater, water coordination. supplies (both in-flow and Consumer behavior out-flow water), wells, rain survey of food water and drinking bottled consumption data are water manufactured from the useful to define the industries in the areas. The areas. parameters, including nickel and total cyanide are determined in the Notification of Health Department, Re.: Drinking water supply 2010 AD. - Ambient air quality, such as total suspended particles (TSP), PM10, hydrogen cyanide gas and nitrogen dioxide. - Collecting of samples of food, vegetables and aquatic lives, such as fresh water snails, hot basil and etc. in the areas that those usually are consumed in order to find out contaminants caused by chemical or heavy metal, such as arsenic, lead and cadmium.

Issues in the Collecting Process Data sources data 2. Data - Environmental data analysis analysis must be done and compared with standard parameters and to consider continuous trends of each parameter. -Data must be analyzed and are used for health risk assessment (HRA). -Data must be analyzed by using geometric mapping in order to see relationship between hazards (pollutions) and data of air, noise, surface water, groundwater, vegetables and aquatic lives quality.

3. Reporting A report of the analyzed the information must be simple, information concise and accurate. The to the information must be equally stakeholder reported to 3 groups of stakeholder organizations: the entrepreneurs who cause pollutions, the populations who are affected and the government sectors.. -To disseminate risks, preventive methods and self- care to the people.

Issues in the Collecting Process Data sources data 4. Problem - In case the parameters of Solving or environmental quality have Prevention exceeded the normal ranges, the entrepreneurs must correct the environmental quality to meet the normal ranges of the parameters, then report to the stakeholder organizations. -In case chemicals are found in food chain, the people must be warned about food consumption. -The people living in the surrounding areas should cooperate with continuous monitoring of environmental quality.

Example of secondary data analysis: Data collection from 5-years retrospective environmental monitoring report of arsenic in surface water in the observation wells and particulate matters

(PM10) in the area of Khao Chet luk sub-district, Tap Khlo district, Pichit province during 2006-2010 A.D. The parameters were compared with the standard values. Figure 3.2 and 3.3 give the details (Department of health, 2010)

Arsenic-filtered in surface water 0.012 0.010 0.008 0.006 SWST2 0.004 std. 0.002

Arsenic- Filtered (mg/L) 0.000 2004 2005 2006 2007 2008 2009

Figure 3.2 Arsenic filtered in the surface water

Figure 3.3 PM10 at sub-district Khao Chet Luk

An example of primary data analysis : A surveillance of water supply quality during 2011-2013, compared with the standard parameters. Figure 3.4 gives the details Manganese level

Figure 3.4 Manganese level in the village water supplies at Khao Chet luk sub-district, Tap Khlo district, Pichit province during 2011-2013 A.D.

Table 3.1 An example of analysis of water supply quality at Khao Chet luk sub-district, Tap Khlo district, Pichit province during 2011-2013 A.D.

Source Parameters Minimum Maximum Average Standard (mg/L) (mg/L) (mg/L) (mg/L) Water Manganese(Mn) 0.005 1.04 0.16 0.3 supply Iron (Fe) - 4.4 0.37 0.5 Arsenic (As) <0.005 <0.005 <0.005 0.01 Nickel (Ni) <0.002 0.06 0.023 0.002 Cyanide (Cn) 0.02 0.2 0.11 0.2

Chapter 4 Procedures and Methods of Health Surveillance Health surveillance is a continuous observation about distribution and epidemiological trends of diseases, using systematical data collection, data analysis and evaluation of the reports associated with mortality rate and morbidity rate, in order to find out changes of determinants or health impact from gold mining.. Health surveillance can be done by 2 types ; 1) Passive surveillance is collecting of data of diseases or health problems, such as respiratory disease, wheezing, neurological disorder, skin disease, cardiac and vascular disease and prenatal abnormality (abnormal gestation, abnormal fetal development) and etc., caused by gold mining. Table 4.1 shows passive surveillance data. 2) Active surveillance is data collection by continuous exploring diseases or problems. If diseases or problems are found, data will be gathered. By this method, data, such as levels of population exposure to heavy metal are collected completely through the questionnaires. The figure 4.2 shows active surveillance data.

Preparedness for healthcare providers In the beginning of health impact surveillance, the important activities are preparedness and competency development for medical staffs and health care providers, physicians, nurses, public health officers and staffs of district health promotion hospitals so that they can have knowledge and be competent for

47 screening pollution-related diseases or signs and symptoms, caused by gold mining, so those healthcare providers are capable in taking actions and the community will get reliable information about the diseases or ailments. Methodology : Sharing form experienced personals from the other area.

Table 4.1 Passive Surveillance Data Target Common disease ICD-10 Population / Analytical Method Frequency Data source Area Respiratory J40-J47 -The -5-Years Every 6 Hospital, such as System: asthma, J62 surrounding retrospective data months -1 -Out-Patient 21 dry cough, wet J68-J70 communities. analysis. year Groups cough producing -Data of each sub- Morbidity Report mucus, shortness of district and village (Rp.504) breath, wheezing are separately -In-Patient 75 and burning of the analyzed and Groups 49

nose and throat. compared with the Morbidity Report average values of the (Rp. 505) provinces and -Disease country. Notification -To study trends of Report (Rp.506) disease and analyze -Database: Hos for each age group. XP and -To find out the -MIT_NET/THO morbidity rates per Sub-district 49

Target Common disease ICD-10 Population / Analytical Method Frequency Data source Area 100,000 population health promotion of the diseases hospital, such as -Data Set Report (12 files) - Data Set Report (18 files) -Out-Patient 21 Groups

50 Morbidity Report

(Re.504) Nervous system: G10-G13 -The Every 6 headache, G20-G26 surrounding months-1 dizziness, fatigue, G44 communities year anorexia, confuse, G44.2 shaking of hands, G44.8 palpitation, G47.0 irritability, quick- G479 50

Target Common disease ICD-10 Population / Analytical Method Frequency Data source Area tempered, auditory G513 hallucination or other hallucination Integumentary L23 L23.0 -The Every 6 system: itching, L23.8 surrounding months-1 rash, inflammation L23.9 communities year L24.8

51 L24.9

L24.2 L24 L25.8 L25.9 Eyes: burning eyes, H00-H59 -The Every 6 watery eyes, surrounding months-1 blurred vision communities year

Cardiovascular I11-I15 I20 -The Every 6 system: fatigue, I21 I22 I23 surrounding months-1 51

Target Common disease ICD-10 Population / Analytical Method Frequency Data source Area chest tightness, I24.0 I24.1 communities year localized edema of I64 feet. I65 Perinatal P05-P08 -The Every 6 disorder: abnormal P61.0-P61.8 surrounding months-1 gestation and P83.0-P83.9 communities year abnormal fetal P90-P96 development 52

Data collection of integumentary diseases of people in the 11 surrounding villages of the sup- district Health Promotion Hospital, Khao Chet Luk from Morbidity Report (Rp.504) during 2008- 2012. Different morbidity rates and different trends are found in each village. Table 4.2 and 4.3 show the details (Department of Health, 2010)

Figure 4.1 OPD ailment rates per 1,000 population of the patient with diseases of skin and subcutaneous tissues in each village in Khao Chet Luk sub-district during 2008-2012

Figure 4.2 Morbidity rate of Parkinson disease per 100,000 populations in each village in Khao Chet Luk sub-district during 2005-2009

Figure 4.3 Morbidity rate of contact dermatitis per 100,000 populations in each village in Khao Chet Luk sub-district during 2005-2009

As active surveillance, the public health officers must search for the populations at risk, who expose to pollutions or have any pollution-related signs and symptoms caused by mining. It is a method of screening and surveillance. The scope of surveillance areas that exposed to both soil pollutions and water pollutions must be defined, then screening is necessary for the populations at risk who involve agricultural activities, consumption of water or food exposed to pollutions caused by gold mining. The surveillance can be conducted by observation of signs and symptoms of the patients who come for service at The sup-district Health Promotion Hospital. Table 4.2 shows a surveillance form about heavy metal contamination, general physical examination, physical fitness testing and exposure to heavy metal.

Table 4.2 Active surveillance data Data Data/Indicators Prospects/Area Laboratory Result Frequency Source -Data of annual -Workers/ staffs - Heavy metal levels in the samples must be Every year Provincial physical measured and compared with standard Labor examination values of the country and international Office, standards to see severity and trends. Provincial - Morbidity rate caused by heavy metals. Public - Other Risks for illness, such as smoking, Health contaminated food and water-supply and Office 55 etc. must be analyzed.

-Data of The people - Morbidity rates caused by heavy metal Every year Clinical exposure to living in the poisoning must be measured and compared surveillan heavy metals surrounding with the standard parameters in the country ce for areas and international standards. heavy - Sizes and severity are also analyzed for metal each area. exposure

Data Data/Indicators Prospects/Area Laboratory Result Frequency Source - Level of The people To evaluate health effect with arsenic Every year arsenic living in the exposure: surrounding - CBC ; complete blood count areas - Urine analysis - Renal Function test (BUN, Creatinine) - Liver function tests - EKG ; electrocardiography - Chest x-ray - Nerve conduction velocity (NCV) test 56

-Bone marrow pathology: it is not a good method to detect arsenic exposure because after entering into the body, arsenic will rapidly distribute to circulation system. A laboratory test that is useful for clinical decision making is 24-hour urinary arsenic level test. If 24h-hour urine cannot be collected, the first morning sample is considered. 56

Data Data/Indicators Prospects/Area Laboratory Result Frequency Source **Level of arsenic exposure can be confirmed by 24-hour urinary arsenic level test - Level of lead The people Blood lead level is the best method, used to Every year living in the screen and diagnose lead exposure. By this surrounding method, lead distribution into the body, areas balance of blood lead level, lead in bones and excretion of lead can be measured. 57 Since blood lead level may be varied for a

short period, so, blood should be drawn from veins and tested with atomic absorption spectrometer. Blood drawn from capillaries is used only for screening because of lead contamination from the environment. Using the atomic absorption spectrometer or other method, variations of results may be 10-15%, depend on which type of method used. 57

Data Data/Indicators Prospects/Area Laboratory Result Frequency Source Urine lead level : Urine lead level is a good method to measure lead exposure in the body, especially 24-hour urine collection and after using of chelation agents, Lead level in single urine collection may be varied during each period, depend on hydration status. If lead level in single urine

58 collection is high, it indicates that lead exposure into the body. If it is in normal range, it does not indicate too much exposure to lead. Tissue lead level (teeth, hairs and finger nails) It is used to detect long-term exposure to lead and is easily to be collected, especially hairs and finger nails and deciduous teeth in children

Data Data/Indicators Prospects/Area Laboratory Result Frequency Source - Level of The people Blood burden of mercury can be measured Every year mercury living in the in blood, urine and hairs. The half- life of surrounding mercury in blood is quite short (3 days) areas Blood mercury level can be used to detect acute exposure of mercury only. Urine mercury level can be used to detect chronic exposure to mercury. Hair mercury level can be an evidence to detect exposure to organic mercury 59

compound. By this method, exposure to mercury and health effects can be approximately detected but there is no definite evidence-based to confirm relationship between hair mercury level and severity of mercury toxicity. - Level of The people Urinary cadmium level indicates body Every year cadmium living in the burden of cadmium. Urinary cadmium level surrounding that is greater than 10 micrograms/grams 59

Data Data/Indicators Prospects/Area Laboratory Result Frequency Source areas creatinine is a risk factor for renal insufficiency. Preventive actions must be established to prevent cadmium level not to exceed greater than 5 micrograms/gram creatinine Blood cadmium level is a method to detect acute exposure to cadmium. If blood cadmium greater than10 micrograms/L, it is dangerous. 60

Screening for toxic effects on respiratory system can be done by pulmonary function test and chest x-ray. In case of chemical pneumonitis, pulmonary edema or emphysema, the chest x-ray results will show the lesions in the lungs. FVC(Force vital capacity) and FEV(Force expiratory volume) decrease in pulmonary function test,

Data Data/Indicators Prospects/Area Laboratory Result Frequency Source - Level of The people Manganese levels can be measured in blood Every year manganese living in the and/or urine. But there is no clinical surrounding benefit in the patient who has already had areas signs and symptoms. The manganese levels do not relate to the signs and symptoms. - Level of The people Measuring blood cyanide by UV-VIS Every year cyanide living in the spectrometry (WHO’s method:1995) surrounding

61 areas - Urinary The people Serum thiocyanate or urinary thiocyanate Every year thiocyanate living in the can be tested by UV-VIS spectrometry surrounding (WHO’s method : 1995) areas - Liver function The people Laboratory test to determine liver Every year test (LFT) living in the abnormalities surrounding areas

Data Data/Indicators Prospects/Area Laboratory Result Frequency Source - Complete The people This type of blood test is used to evaluate Every year blood count living in the physical health and health risks. It is very (CBC) surrounding useful for initial diagnosis in order to treat areas or prevent abnormalities. Blood can be drawn and collected from vein at elbow or wrist. 2.5-3 ml blood must be drawn and collected in a tube that consist of anticoagulant called EDTA to prevent

62 blood coagulation. -Health behavior The people - Exposure to heavy metal and health Every year Question- and exposure to living in the behaviors , such as smoking, consumption naire heavy metal surrounding of food and water supply must be analyzed. areas Source: Journal of Occupational Medicine, Toxicology, Department of Health; Diagnostic Criteria, Ministry of Labor, 2007; Toxicology Information Center; Re.: Policies and criteria that must be formulated to prevent and correct environmental and health impacts, case study of ores

Data interpretation The results of biological indicators can be used for initial analysis and interpretation referenced by ATSDR ,20121; Ministry of Labor 20072; Department of Medical Science 19893) Blood cyanide level Cyanide1 (µg/ml)

-Reference values in general population 0.0 – 0.14 -Reference values in occupational 0.2 – 1.0 population Mild toxicity values > 1.0 Severe toxicity values 2.0 – 10.0 Heavy smoker values 0.3

Thiocyanate level (µg/ml) Thiocyanate 1 Plasma Urine Non-smoker 1.0 – 4.0 < 2.0 Heavy smoker 3.0 – 12.0 < 2.5 µg/g creatinine Toxicity level 120.0 2.0 – 20.0

Category of the Heavy metals Level population Arsenic Reference values in - Blood level < 1µg/L general population1 - Urinary level < 100µg/L - Urinary level < 10µg/g creatinine - Arsenic level in fingernails ≤ 1ppm

Category of the Heavy metals Level population BEI (Biological - Arsenic level in hairs ≤ 1ppm exposure index) - Urinary level < 15 - Arsenic level in hairs › 0.8 mg/kg of dry weight of hairs. - Arsenic level in fingernails › 1.3 mg/kg of dry weight of fingernails

Reference values in - Arsenic level in the urine occupational of the last day of week <50 population3 µg/g creatinine Abnormal blood - The first morning urine › arsenic 50 µg/g creatinine concentration in occupational population3 Cadmium -Reference values in - Blood level 0.315 µg/L general population ages ≥1 years1 -Reference values in - Urinary level 0.193 µg/g general population creatinine ages ≥6 years1

-Reference values in - Blood level (not greater occupational than) < 5 mg/mL population3 - Blood level › 10 µg/mL -Risk level in occupational

Category of the Heavy metals Level population populations3

-Renal - Urinary beta-2- insufficiencies in microglobulin › 750 µg/g occupational creatinine populations3 BEI - Urinary level 5 µg/g (Biological creatinine exposure index) - Blood level 5 µg/L Manganese -Reference values in - Urinary level 1.26µg/L general population ages6-88 years1 -BEI (Biological - NA exposure index) Lead -Reference values in - Blood level 1.9 µg/dL general population ages 1-5 years 1 -Reference values in - Blood level 1.5 µg/dL population ages20- 59 years1 -Reference values in - Urinary level 0.677µg/L general population ages ≥ 6 years1 -Risk level in - Blood level ≥ 60 µg/dL occupational

population2

Category of the Heavy metals Level population -Reference values3 - Blood level 10-20 µg/100ml/ Urinary level 10- 70 µg/L -Mild toxicity values - Blood level 40 µg/100ml/ (asymptomatic)3 Urinary level 100 µg/L -Severe toxicity - blood level 70 µg/100ml/ values Urinary level 200 - 400µg/L (symptomatic)3 - Blood level 30 µg/100ml -BEI (Biological * If there is lead found in exposure index) blood, it indicates acute exposure to lead.

4.1 Health Risk Assessment After measuring heavy metal contamination in the environment, the results can be used for health risk assessment in the population at risk who consume contaminated water and food. Then, the data should be used for further risk management. Health risk assessment is a systemic study to describe and measure risks that can occur. Hazards, operation processes, activities and circumstances that relate to health impacts must be considered. It is a tool for evaluation relationship between environmental risks and health impacts and the hazards, including severity of the risk. Table 4.3 shows the details.

Table 4.3 Health risk assessment steps Health risk Description assessment step 1. Hazard Hazard identification is a collective term Identification that encompasses data collection and data analysis to summarize impacts of chemicals exposure in metallurgy to the human health. (See a material safety data sheet and health impacts in chapter 2)

2. Exposure Exposure assessment is used to estimate or Assessment measure the amount or concentration of a risk factor that the individual or population comes in contact with. The objectives of exposure assessment are : - To find out what type of agents or risk factor that is in contact with the lives or the environment - Calculate the amount of exposure to the agents or risk factors. - How it is exposed? -How long the exposure occurs. 3. Dose-Response Dose-Response Assessment Is used to study Assessment relationship between the amount or dose of the agents and severity of toxicities (the response) that affects health.

4. Risk In risk characterization, the exposure Characterization information from the 3 previous steps is taken and combined to determine health risks. The severity of risks in an individual

Health risk Description assessment step in each department, each work place or each firm may be different, depend on type of risk factor. Details that should be considered in this step are types and magnitude of adverse effects. Who are at risk? What type of work or activities that that they do.

4.2 An example of health risk assessment in case of ingested arsenic exposure. 4.2.1 Hazard Identification From the hazards mentioned above, heavy metals such as arsenic, manganese and etc. are found in the results of groundwater and water supply quality monitoring. If the people living in the surrounding areas still consume water from the water supplies and groundwater from those sources, they are at risk for manganese exposure.

4.2.2 Exposure Assessment Concentration of hazards, frequency of exposure, duration of exposure and exposure pathway should be assessed. 1) Concentration of hazards is an amount of arsenic in an observation well TSF663 (0.002 mg/L) 2) Exposure Frequency: the population consumes the water from those resources every day (2L/day)

3) Exposure Duration is the duration that the population live in the high-risk areas or expose to the hazards (70 years) 4) Exposure Frequency (365 days/year) 5) Body weight (an average body weight of an adult working woman is 53 kg.) 6) Average Time - Average Time for carcinogen exposure is 70 years x365 days/year (25,550 days) - Average duration of non-carcinogen exposure is EP x 365 days/year (25,550 days) 7) The route of exposure is ingestion. Equation for ingestion exposure assessment.

CDI = C x CR x EF x EP BW x AT Where: CDI = Amount of hazard received (mg/kg- body weight/day) C = Average concentration of hazard in the media over the exposure period (mg/L) CR = Contact Rate-amount of contaminated medium contacted per unit time (L/day) EF = Exposure Frequency-how often exposure occurs EP = Exposure Period-how long exposure occurs. (years) BW = Body weight-average body weight over exposure period (kg)

AT = Averaging time-period over which exposure is averaged(days) From the previous formula, it is found that

CDI = 0.002 x 2 x 365 x 70 53 x 25,550

CDI = 7.5 x 10-5 mg/kg body weight/day So the amount of ingested arsenic exposure is 7.5 x10-5 mg/kg body weight/day

4.2.3 Dose-Response Assessment Risk assessment of ingested arsenic exposure that may be carcinogen. The cancer risk is determined by use of the following equation.

Cancer Risk = CDI x CPS

Where:

Risk = Risk caused by carcinogen exposure everyday CDI = Chronic daily intake-amount of hazard received (mg/kg. body weight/day) CPS = Carcinogen potency slope by ingestion (mg/kg/day) CPS of arsenic is 1.5 mg/kg/day From the equation, it is found that Risk = 1.1 x10-4

In case of continuous exposure to arsenic at a concentration of 0.002 mg/L,The cancer risk will increase, 1 out of 10,000 people can have a cancer that can be acceptable. Risk assessment of ingested arsenic exposure. In case of non-carcinogen, hazard quotient (HQ) can be calculated as the following equation.

HQ = CDI

RfD Where: HQ = Hazard quotient If the hazard quotient is calculated to be less than 1, then no adverse health effects are expected as a result of exposure. HQ ≤ 1 No adverse health effects HQ > 1 Adverse health effects are possible

Severity Level 1 10 Very severe CDI = Chronic daily intake-the lifetime average daily dose of chemicals received (mg/kg body weight/day) RfD = Reference Dose-amount of chemicals received every day that does not cause any abnormality to our body (mg/kg/day) Reference dose of arsenic is 3 x 10-4 mg/kg/day

From the equation, it is found that

-5 HQ = 7.5 x10 3 x10-4

HQ = 2.5 x10-1 HQ = 0.25

4.2.4 Risk Characterization From the calculated hazard quotient (HQ) of arsenic exposure, it is 0.25, which is less than 1, then no adverse health effects are expected as a result of exposure.

4.3 Treatment and Rehabilitation The results of screening for the risk population indicate that the values exceed the standard values or abnormalities are found. Initially, the public health officers of district health promotion hospital who are well trained and capable to treat abnormality and continue to monitor or take the patient to see a physician who is specialty in an environmental management.

4.4 Setting community mapping or risk mapping Community mapping is a technique to identify risk factors which could impact on health problems. Anyway, this tool cannot tell that those risk factors are causes of disease. Thus, the results must be proven by other method. However, community mapping can be helpful and used as a tool for public health officer for planning, surveillance and problem solving.

Community mapping is a tool taking data of number of households, the people living in the surrounding areas who are at risk. The area is 3-5 kilometers around the mine. The map composes of location of the mines, observation wells, areas that samples for monitoring air quality and water quality will be collected, location of households around the mine with address, sources of village water supplies, flows of water, roads, district health promotion hospitals, community hospitals, hospitals, schools, temples and etc. The results of data of environmental quality and health impacts in the community maps that identify locations from which the patients or the population with symptoms caused by gold mine pollutions. It is done by public health officers of the district health promotion hospitals or village health volunteers. In the future, the data will be developed as GIS database. Figure 4.1 shows an example of community mapping.

Figure 4.1 A map of walking streets at Khao Chet luk sub- district, Tap Khlo district, Pichit province

4.5 Mental health surveillance of the community. Besides, physical health surveillance, mental health surveillance in the area is also necessary because the populations living in the surrounding areas often are anxious and worry about health impacts from hazards and chemical exposure. Individual mental health is defined of mental well-being in which every individual can cope with the problems and realizes his or her own potential to develop himself or herself for good quality of life and inner goodness with social and environmental change. (Department of Mental Health, 2007)

In order to screen mental health of the population, Goldberg’s general health questionnair-28 : GHQ 28 developed by Goldberg and has been translated into Thai by Thana Ninchaigowit is used for mental health surveillance. Basic mental health status and environmental factors are also included. The scoring is 0-0-1-1, total scale is 28. The ones who get more than 5 scores indicate that they have mental problem and need to be treated and rehabilitated by a psychologist. Home visiting is also helpful to decrease anxiety of the population.

4.6 A Study on consumption behavior of the population in the surrounding areas. Purpose : In order to study type of food: rice, vegetables, fruits and aquatic lives usually consumed by the people in the surrounding areas, including amount and frequency of consumption. The data must be used for health surveillance. Sample selection : The samples are the people who are consuming or have consumed food in the areas. (The ones who are not consume or have not consumed it will be exclude.) In case of being younger than 0-12 years old or older than 60 years old, interviews will be done through guardians or caregivers. Sample : A group of people of all age should be selected in the consumption survey: children aged 0-5 years, students aged 6-18 years, working men and women age 9-60 years and the elderly ages more than 60 years should be included.

Instruments: Consumption survey, which is applied from Food Frequency Questionnaire, Bureau of Nutrition, Department of Health) provides amount and frequency of food consumption data and intake of heavy metals that may be presented in foods. Amount of aquatic lives-spoon/meal Amount of rice/vegetables/fruits-ladle/meal Frequency: In case of everyday ingestion- meals/day Frequency: In case of ingestion some days- meals/week or meals/month Duration of ingestion (years) Data Analysis: Analysis of average and the 95th percentile (kg/day) consumption of each kind of vegetables and meats in each age. Analysis of food consumption frequency, days/year in each age.

4.7 Collection of samples of food, vegetables and fruits (Department of medical service, 2014) 1) Sample selection : - Samples from nature or grown in the areas for ingestion or distribution in the area. - Samples from vegetables and fruits that are main ingredients and are not minor ingredients of those are minimally ingested. - Samples form vegetables and fruits that are common consumed.

2) Sample Collection - To make sure that sample collection covering all part of the villages, each village will be divided to 4 parts: northern, southern, eastern and western part or proper parts. - Randomized sample collection will be done and samples of vegetables and fruits will be prepared. - The containers of the sample will be labeled. - Geographic coordinate system of collected samples must be defined. - Collected samples must be preserved. - Collected samples with details should be gathered by the government sector that accountable for those to send for pathology.

Chapter 5 Risk Communication and Risk Management

Risk communication is public exchange of information about risks and their severities between the entrepreneurs and stakeholder parties, such as extramural organizations, environmental agencies. The issues must be concerned but not panic. Knowledge and awareness of production processes, chemicals used, hazards and health impacts must be concerned for coordination to decrease health hazards, especially preventive factors. After data collection and data analysis, in case the data of the environmental and health quality exceed the standard values or greater than half of standard values, it should be continuous monitored and disseminated to the population for protection. The methods of communication can be news stations of the villages, radio stations of the communities, brochure, flap (leaflet) or public relations board in the center of the community, such as sermon hall in a monastery, temple, etc.

Examples of risk communication (Health Education for the people at risks) Basic instructions in case of heavy metals contaminated.

1. Avoid eating food that suspected heavy metals contaminated.

2. To avoid contaminated food, select other kind of food with same nutrients instead. 3. Vegetables and fruits prepared for cooking, must be cleaned and peeled the outer cover to decrease the residues. (Anyway, by this method, the residue from heavy metals cannot be reduced), They should be removed to petals, leaf or outer cover, then be cleaned with clean water several times or be rinsed by flowing tap water at least 2 minutes. Then choose one of the following methods: 3.1 Soak in solution of 1 tablespoon of vinegar and 4 liters of clean water for 15 minutes. 3.2 Soak in solution of 1 tablespoon of sodium bicarbonate powder or baking soda and 4 liters of clean water for 15 minutes. 3.3 Soak in solution of 1 tablespoon of salt and 4 liters of clean water for 15 minutes. 3.4 Soak in limewater, then, clean with clean water one more time.

Chapter 6 Laws and Regulations Relating to Mining Activities

6.1 Relevant Legislations Laws relating to gold mining project are: 1) The Mineral Act 1967 A.D. define that in the case of mining operations or mineral processing, no holder of a prathanabat shall carry out or omit to carry out any act that is likely to cause any poisonous ore or other poisonous substances to bring about danger to people, animals plants or properties. 2) National Environment Quality Act, 1992 A.D. states that, for the purpose of environmental quality promotion and conservation, the Minister shall, with the approval of the National Environment Board, have the power to specify, by notification published in the Government Gazette types and sizes of projects or activities, likely to have environmental impact, of any government agency, state enterprise or private person, which are required to prepare reports on environmental assessment. Environmental Impact Assessment: EIA A Notification of the Ministry of Natural Resources and Environment has been issued by the Office of Natural Resources and Environmental Policy and Planning (ONEP) in April 24th, 2012 A.D., in relation to type, size of project or activity required to submit environmental impact assessment report; and criteria, procedure, regulation and guideline to prepare environmental Impact Assessment Report. A mining industry is one of those 35 project types.

Environmental Health Impact Assessment: EHIA A Notification of the Ministry of Natural Resources and Environment has been issued by the Office of Natural Resources and Environmental Policy and Planning (ONEP) in August 31st, 2010 A.D in relation to types, sizes of project or activities required to submit environmental impact assessment report; and criteria, procedures, regulations and guidelines to prepare environmental Impact Assessment Report. In the additional notification, there are lists 11 project types, including lead mining, zinc mining, other type of metal industry, using cyanide, mercury, lead nitrate in production process, and other type of mining, contained arsenopyrite, that should be subject to environment and health impact assessment as part of the approval process.

3) Public Health Act 2535 B.E. (1992 A.D.) The purpose of execution of the Act, local government shall have the power to issue local rules and regulations for entrepreneurs, workers or communities to follow the Public Health Act 2011 A.D. Health and environmental issues must be nationalized and controlled, such as waste management, hygienic condition of a building, public nuisance and activities that impact health. Since those activities in relation to metals or minerals are harmful to health. And public nuisance may trouble / disturb the people living in the surrounding areas or to the victims, Those activities may cause odors, light, noise, heat, poisonings, vibrations, dusts, soot, ashes or any other damage or harm to health.

6.2 Health and Environmental Quality Standards 1) Maximum level for metal contamination in food Maximum Level of Organization Contaminant in Food 1 Notification of Ministry of - Arsenic is not greater than 2 Public Health no.98 (1986 mg/kg A.D.) LW January 21st, - Mercury in seafood is not 1986. Re : Prescribing greater than 0.5 mg per 1 kg. of Standards of Contaminated food Substances. - Mercury in other types of food is not greater than 0.02 mg per 1 kg. of food - Lead is not greater than 1 mg per kg of food 2 Joint FAO/WHO food Maximum Levels of : standard Program Codex Arsenic Committee on - 0.1 mg/kg for total as (animal Contaminants in Food fat, such as fat in pork) (2011A.D.) - 0.3 mg/kg for total as (rice) - PTWI (Provisional Tolerable Weekly Intake) withdraw Mercury - 0.5 mg/kg for total as (general fish) - 1 mg/kg for total as (archerfish) - PTWI 1.6x10-3 mg/kg of body weight

Maximum Level of Organization Contaminant in Food Cadmium - 0.05 mg/kg for total as (cauliflower, collard, cabbage, gourd, melon or cucumber) - 0.1 mg/kg for total as cowpea - 0.2 mg/kg for total as (green vegetable) - 0.4 mg/kg for total as (rice) - PTMI 25x10-3 mg/kg body weight Lead - 0.1 mg/kg for total as (tropical fruit) - 0.3 mg/kg for total as (cauliflower, collard, cabbage and etc.) - 0.3 mg/kg for total as (green vegetable) - 0.2 mg/kg for total as (cowpea) - 0.3 mg/kg for total as (fish) - PTWI withdraw Cyanide - PMTDI (Provisional Maximum Tolerable Daily Intake) 0.02 mg/kg of body weight/day

Maximum Level of Organization Contaminant in Food 3 EU Commission Maximum level Regulation No.1881/2006 Cadmium of 19 Dec 2006 : Setting - 0.05 mg/kg for total as (fish) maximum levels for - 1.0 mg/kg for total as (bivalvia) certain contaminant in - 0.1 mg/kg for total as (cereal) foodstuffs - 0.2 mg/kg for total as (rice) - 0.2 mg/kg for total as (green vegetable, herb) - 0.1 mg/kg for total as (root crop) Lead - 0.3 mg/kg for total as fish (flesh or muscles) - 0.1 mg/kg of wet weight of fruits - 1.5 mg/kg of wet weight of bivalvia - 0.2 mg/kg of wet weight of cereal, cowpea - 0.3 mg/kg of wet weight cauliflower, collard, cabbage, green vegetable and herb Mercury - 0.5 mg/kg for total as (general fish) - 1 mg/kg for total as (archerfish)

2) Maximum Level for Heavy Metal Contaminants in Water. Maximum Level for Organization Contaminant

1 Notification of Ministry of Maximum Allowable Natural Resources and the Concentration Environment. Re: Criteria - No arsenic (safe level 0.05 and technical measures for mg/L) protection. Public health - No cyanide (safe level 0.1 mg/L) and environmental - No lead (safe level is 0.05 mg/L) protection in poisonous - No mercury (safe level is 0.001 2008 A.D. mg/L) - No cadmium (safe level is 0.01 mg/L) - Iron 0.5 mg/L - Manganese 0.3 mg/L

2 Notification of Ministry of Drinking water in sealed Public Health no.61 (1981 container A.D.) Re : Drinking Water - Arsenic 0.05 mg/L in Sealed Container - Cyanide 0.1 mg/L - Lead 0.05 mg/L - Mercury 0.002 mg/L - Cadmium 0.005 mg/L - Iron 0.3 mg/L - Manganese 0.05 mg/L 3 Notification of Department Water supply system of Health, Re.: Drinking - Arsenic0.01 mg/L water supply quality (2010 - Lead 0.01 mg/L A.D.) - Mercury 0.001 mg/L

Maximum Level for Organization Contaminant - Cadmium 0.003 mg/L - Iron 0.5 mg/L - Manganese 0.3 mg/L

4 Notification of Ministry of Drinking Water Production Industry no.332 (1978 Plant A.D.) issued under the - Arsenic 0.05 mg/L industrial Product - Cyanide 0.2 mg/L. Standards Act 1968 A.D. - Lead 0.05 mg/L. - Mercury 0.001 mg/L - Cadmium 0.01 mg/L. - Iron 0.5 mg/L. - Manganese 0.3 mg/L.

5 Notification of National Surface water resource Environmental Board no.8 - Arsenic 0.01 mg/L (1994 A.D.) Re: .Standard - Cyanide 0.05 mg/L of drinking water quality in - Lead 0.05 mg/L surface water resource. - Mercury 0.002 mg/L - Cadmium 0.005 mg/L - Manganese 1.0 mg/L

6 WHO: Guideline for Drinking water drinking water Quality - Arsenic 0.01 mg/L - Cyanide 0.07 mg/L - Lead 0.01 mg/L - Inorganic Mercury 0.006 mg/L - Cadmium 0.003 mg/L - Manganese 0.4 mg/L

3) Maximum level for heavy metal in soil Organization Maximum level 1 Notification of National Soil quality standards for Environmental Board no.25 habitat and agriculture (2004 A.D.), Re.: Soil - Arsenic, not greater than 3.9 Quality Standards. mg/kg - Lead, not greater than 400 mg/kg. - Cadmium, not greater than 37 mg/kg. - Manganese, not greater than 1800 mg/kg - Mercury, not greater than 23 mg/kg

4) Reference value

EPA: IRIS ( In case of cancer) EPA: IRIS ATSDR Health Drinking Inhalation Hazard OSF water unit RfD RfC MRL Unit Risk risk -4 Arsenic 1.5 mg/kg-day 5x10-5 4.3x10-3 3x10 Not assessed Oral 3 mg/kg-day µg/l µg/m Chronic 0.0003 mgAs/kg/ day 88

(Inorganic) Hydrogen Not assessed Not assessed Not assessed 0.0006 0.0008 Oral cyanide/ mg /kg-day mg/m3 (15-364 days) Cyanide salt 0.05mg CN/kg/day Chronic-No derived

EPA: IRIS ( In case of cancer) EPA: IRIS ATSDR Health Drinking Inhalation Hazard OSF water unit RfD RfC MRL Unit Risk risk Lead Not estimated Not estimated Not assessed Not estimated Not assessed Not derived

Mercury - - - 1x10-4 - - mg /kg-day (methyl mercury) 89 89 Cadmium Not assessed Not assessed 1.8x10-3 5x10-4 mg Not assessed Oral µg/m3 /kg-day 1x10-4 mg (water) Cd/kg-day 1x10-3 mg (chronic) /kg-day (food) Manganese Not assessed Not assessed Not assessed 1.4x10-1 mg 5x10-5 mg Not derived /kg-day /m3

5) Trace Minerals 1. Manganese Manganese is a trace mineral that is necessary for brain functions, bone and enzymes formation. There is still not enough data to determine optimal levels of supplementation and quantity of manganese. Inadequate manganese intake has been associated health. On the other hand, excess manganese Intake can cause neurological disorders. Daily maximal manganese intake is determined in table 6.1. Moreover, long-term (2-3 months) exposure to battery can result in severe neurological disorders. However, there is no report of manganese poisoning from high concentration of manganese in food. (Kondakis XG et.al, refer in Department of Health 2003 A.D.

Table 6.1 Daily maximal manganese intake (Department of Health, 2003 A.D.) Daily maximal Group of people Age intake(mg/day) Infant 0-11 months Not defined Child 1-3 years 2 4-8 years 3 9-13 years 6 Teenage 14-18 years 9 Pregnant woman 14-18 years 9 ≥19 years 11 Breastfeeding 14-18 years 9 ≥19 ปี 11

2. Iron Daily recommended dietary allowance (RDAs) for iron that refers to average daily nutrient and causes no harm to the body, is shown in table 6.2.

Table 6.2 Recommended Dietary Allowance (RDAs) for iron (Greger JL 1999, reference in Department of Health, 2003 A.D.)

Maximum daily intake Group of people Age (mg/day) Child 1-13 years 40 ≥ 14 years 45 Teen-age 15-18 years 45 Adult 14-18 years 45 ≥19 years 45

Roles of organizations that take responsibilities of Health impact assessment in gold mining is the responsibility of 4 sectors that are: 1) Government sectors that are responsible for control, such as Department of Primary Industries and Mines – DPIM, Department of Industrial Works 2) Entrepreneurs or project owner 3) Environmental agencies 4) Public health sectors: Central public sector, provincial public health office, district public health office, hospital and sub- district health promoting hospitals. Environment data and health impacts must be integrated for health impact assessment as shown in table 6.1

- Create knowledge-centered Support and provide - Support the budgets operating support in the - Cooperate in the areas surveillance - Create knowledge- centered Support and - Follow the guidelines in EIA provide operating Pollution Control Department support in the areas Entrepreneurs, Project Owners

Regional Environmental Office Department of Health Monitor, Control, Supervise Department of Disease Control Provide, Operating, support Department of Medical Science Department of Health Provincial Environmental Office

Department of Primary Health Center 8 and 9 Industries and Mines Office of Disease Control and Prevention Medical Science Data of Monitoring Center Mental Health Center Office of Primary Industries and Mines, Region

Provincial Public Health Office of Pichit, Pethchaboon and Pisanuloke Province / Hospitals / Chief District Public Health Provincial Industrial Office Monitoring of Officer/Sub-district Health Promotion Hospital Health in the areas

Figure 6.1 Responsibilities of sectors in relation92 to health impact assessment of gold mine

Bibliography

Department of health, Ministry of public health.2010.The Report of Developmental System of Health Impact Assessment of mining project as pilot project in 3 provinces (Ratchaburi, Suphanburi and Phichit) Ministry of Labour,(2007). Standard of Diagnosis from Occupational Diseases, The Cerebration of the King’s 80th Anniversary Birthday (December 5th’2007) Edition. Bureau of Nutrition, Department of Health, Ministry of Public Health (2003). The Reference Quantity of Nutrients for Health that should Taken Daily (2003). Faculty of Medicine Siriraj Hospital. Handbook of Laboratory for Medical Examination. Retrieved from http://www.si.mahidol.ac.th/th/manual/Document/a07/Lead -hole%20Blood.htm Notification of Ministry of Natural Resources and Environment about the Academic Criteria and Measures for Health and Environmental Pollution Prevention.(2008). Retrieved from http://www.pcd.go.th/download/regulation.cfm?task=s9 Notification of Ministry of Public Health No.98 (1986). About The Standard of Contaminated Food. Notification of the Ministry of industry No. 332 (1978). Issued according to Industrial Product Standards Act A.D.1968 about The Industrial Product Standard of Drinking Water. Retrieved from http://www.pcd.go.th/info_serv/reg_std_water01.html#s3

The Report of The Environmental Impact Assessment on the Expansion Project of Gold Metallurgy Assembly Plant of the Akra Mining Co.,Ltd. Toxicology Information Center. The Toxicity from Lead. Retrieved from http://webdb.dmsc.moph.go.th/ifc_toxic/a_tx_1_001c.asp ?info_id=41 Medical Science Centre No.3 (Nakhonsawan) and Medical Science Centre No.2 (Phitsanulok), Department of Medical Sciences, Ministry of Public Health (2014). The Manual of Specimens Collection sending for Laboratory Examination. The Institute for the Promotion of Teaching Science and Technology (IPST). Gold Deposits in Thailand, Occurrences of Gold Ore and Gold Mining (2012). Retrieved from http://fieldtrip.ipst.ac.th/ Thailand Encyclopedia for Youth.Vol.36(2012). Gold. Retrieved from http://kanchanapisek.or.th/ Silpananthakul,Suthep. Health Impact from Mining and Sample Preparation of EHIA. Agency for Toxic Substances and Disease Registry (ATSDR). 2007. Toxicological Profile for Arsenic. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Services.

Agency for Toxic Substances and Disease Registry (ATSDR). 2006.ToxGuideTM for Cyanide CN. U.S. Department of Health and Human Services, Public Health Services. Agency for Toxic Substances and Disease Registry (ATSDR). 2007.ToxGuideTM for Arsenid AS. U.S. Department of Health and Human Services, Public Health Services. Agency for Toxic Substances and Disease Registry (ATSDR). 2007.ToxGuideTM for Lead Pb. U.S. Department of Health and Human Services, Public Health Services. Agency for Toxic Substances and Disease Registry (ATSDR). 2012.ToxGuideTM for Manganese Mn. U.S. Department of Health and Human Services, Public Health Services. Codex Alimentarius Commission.2012. Retrieved from ftp://ftp.fao.org/codex/meetings /cccf/cccf6/cf06_INFe.pdf Codex Alimentarius Commission.2005.Discussion Paper on Guideline Levels for Methylmercury in Fish . Retrieved from ftp://ftp.fao.org/codex/Meetings/CCFAC /ccfac37/fa37_35e.pdf. 6 January 2013 Curtis D. Klaassen.Casarett&Douall’stocixology: the basic science of poisons.7th ed.2007

FDA US . Action Levels for Poisonous or Deleterious Substances in Human Food and Animal Feed. Retrieved from http://www.fda.gov/Food/GuidanceRegulation /GuidanceDocumentsRegulatoryInformation/ChemicalCo ntaminantsMetalsNaturalToxinsPesticides/ucm077969.ht m#merc Intrgrated Risk Information System (IRIS). Retrieved from http://www.epa.gov/iris/ Kofi,A.D.2002. Public Health Risk Assessment for Human Exposure to Chemicals, Environmental Pollution, Vol. 6. Official Journal of the European Union COMMISSION REGULATION (EC) No 1881/2006 of 19 December 2006. Setting Maximum Levels for Certain Contaminants in Foodstuffs. Retrieved from http://eur-lex.europa.eu/LexUriServ/LexUriServ.do? uri=OJ:L:2006:364:0005:0024:EN:PDF WHO.2008. Guidelines for Drinking-Water Quality - Volume1: Recommendations Third edition, incorporating first and second addenda. Retrieved from http://www.who.int/water_sanitation_health/dwq/gdwq3 rev/en/ WHO.2011.Joint FAO/WHO Food Standard Programme Codex Committee on Contaminants in Food. Retrieved feom http://apps.who.int/food-additives-contaminants-jecfa- database/chemical.aspx?chemID=3511

Publication Working Group

Advisory group Director General of Department of Health Advisor Director General of Department of Disease Control Advisor Deputy Director of Department of Health Advisor (Environmental Health line) Deputy Director of Department of Disease Control Advisor Expertise of Department of Health Advisor Expertise of Department of Disease Control Advisor Director of Environmental Health Bureau Advisor Director of Food Sanitation and Drinking Water Bureau Advisor Director of Public Health Law Administration Center Advisor Director of Laboratory Center for Department of Health Advisor Director of Environmental Health and Occupational Advisor Disease Bureau, Department of Disease Control

Working group of information proceeding, surveillance, warning, and public communication, Department of Health 1) Miss Siriwan Chantanajullaka Chairperson Director of Health Impact Assessment Division 2) Ms. Amporn Bussarangsri Vice chairperson Division of Health Impact Assessment 3) Mrs.Preeyanuch Buranapakdee Vice chairperson 2 Bureau of Environmental Health 4) Ms.Dachanee Mahachanika Staff Bureau of Environmental Health

5) Mr.Charoen Harnpanchakit Staff Bureau of Environmental Health 6) Ms.Molruedee Treewai Staff Bureau of Environmental Health 7) Mr.Wirote Wacharakeattisak Staff Bureau of Food Sanitation and Drinking Water 8) Mr.Chailert Kingkaewcharoenchai Staff Bureau of Food Sanitation and Drinking Water 9) Mr.Chirapan Phromlikitchai Staff Bureau of Food Sanitation and Drinking Water 10) Mr.Rachapadung Damrongpingkasakul Staff Bureau of Food Sanitation and Drinking Water 11) Mrs.Lalana Thongthae Staff Bureau of Food Sanitation and Drinking Water 12) Mrs.Jittima Rodsawad Staff Division of Health Impact Assessment 13) Ms.Panita Charoensuk Division of Health Impact Assessment Staff 14) Mrs.Suwanna Jeerapokkakul Staff Center of Public Health Law 15) Ms.Wassana Kongsuk Staff Center of Laboratory for Department of Health 16) Ms.Benchawan Tawachasupa Division of Health Impact Assessment Secretariat of working group 17) Ms.Worrawan Pongprasert Division of Health Impact Assessment Secretariat assistant of working group

Working group of air pollution surveillance in the risk area Gold mining case 1) Mrs.Sukanda Padpadee Division of Health Impact Assessment, Department of Health 2) Ms.Panita Charoensuk Division of Health Impact Assessment, Department of Health 3) Ms.Piyamaporn Duangmontri Division of Health Impact Assessment, Department of Health 4) Ms.Wassana Lunsamrong Division of Health Impact Assessment, Department of Health 5) Ms.Chanajit Parn-u Division of Health Impact Assessment, Department of Health 6) Ms.Lamai Chai-ngam Division of Health Impact Assessment, Department of Health 7) Ms.Wassamon Sriphanom Division of Health Impact Assessment, Department of Health 8) Mr.Wirote Wacharakeattisak Bureau of Food Sanitation and Drinking Water Department of Health 9) Ms.Narawadee Chinnarach Environmental Health and Occupational Disease Bureau, Department of Disease Control

Coordinator and Words proofing staff 1) Mrs.Jittima Rodsawad Division of Health Impact Assessment, Department of Health 2) Ms.Worrawan Pongprasert Division of Health Impact Assessment, Department of Health 3) Ms.Pratum Sedajit Division of Health Impact Assessment, Department of Health 4) Ms.Itsaraporn Somsuay Division of Health Impact Assessment, Department of Health 5) Ms.Anong Thonguamyai Division of Health Impact Assessment, Department of Health 6) Ms.Ladda Pimjan Division of Health Impact Assessment, Department of Health

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