INTRODUCTION

Safety and health although closely related are not the same. Safety is
concerned with injury-causing situations whereas health is concerned with
disease causing situation. Another view is that safety is concerned with
hazards to humans that result from sudden severe conditions, health deals
with adverse reactions to prolonged exposure to dangerous but less intense
hazards.
Both concepts are accurate in portraying safety and health issues. However,
there is no clear line between the two concepts.
Occupational health and safety is one of the most important aspects of
human concern. It aims an adaptation of working environment to workers for
the promotion and maintenance of the highest degree of physical, mental and
social well-being of workers in all occupations.
The question of occupational health and safety, as a global issue, is now
taking a new turn. The main contributory factors towards this idiosyncrasy
seem to be due to the rapid industrial and agricultural development that are
taking place in the developing countries, and the emergence of new products
and product processes from these places. Many of these countries are moving
from manual labor to service mechanization in the main productive sectors,
such as manufacturing, mining and agriculture, hence the potential
occupational health ramifications should be anticipated. Also the insatiable
desire of these countries for technical advancement has brought about the
importation of sophisticated machinery and pieces of equipment not only into
the industrial production sector, but also to services and commerce. This
invariably has been associated with a change in the structure of the labor
force as a whole including a rise in the employment of women. As to be
expected the health problems would also change.
The benefit of occupational health service in developing countries is seen
locally as well as on a national level. The positive impact of occupational
health service locally may be observed in reducing morbidity and work-related
injuries. In addition, this also means fewer losses to employer and worker as
there will be a reduction of wage losses and decreased compensation costs.
The reduction of absenteeism is of great importance concerning skilled labor,
especially so in countries where there is a shortage of skilled labor.
Making working conditions healthy and safe is in the interest of workers,
employers and governments, as well as the public at large. Although it seems
simple and obvious, this idea has not yet gained meaningful universal
recognition. Hundreds of millions of people throughout the world are
employed today in conditions that breed ill health and/or are unsafe.
Each year, work-related injuries and diseases kill an estimated 2 million
people worldwide, which is greater than the global annual number of deaths
from malaria. Annually, an estimated 160 million new cases of work-related
diseases occur worldwide, including respiratory and cardiovascular diseases,
cancer, hearing loss, musculoskeletal and reproductive disorders, mental and
neurological illnesses.
An increasing number of workers in industrial countries complain about
psychological stress and overwork. These psychological factors have been
found to be strongly associated with insomnia, depression and fatigue, and
burn-out syndromes, as well as with elevated risks of cardiovascular diseases.
Only 5-10% of workers in developing countries and 20-50% of workers in
industrial countries with a few exceptions) are estimated to have access to
adequate occupational health services. Even in advanced economies, a large
proportion of work sites are not regularly inspected for occupational health
and safety.

For this assignment this time, I will focus on cases of occupational accidents
in oil palm plantation industry. There are hidden cost in accidents and near
accidents in the workplace, including estate and farms. In Malaysia,
workplace safety is regulated by the Occupational safety and health Act. 1994
(OSHA), which outlines procedures, delegates responsibility and prescribes
penalties for offences.
Designed to protect the safety, health and welfare of employees arising out of
their daily work routine, the Act stipulates the creation of safety and health
policy if the workplace with more than 40 employees must set up a safety and
health committee.

A CASE STUDY OF OCCUPATIONAL INJURY CAUSED BY A FALLING

PALM OIL FRUIT IN PALM OIL PLANTATION
Personal protective equipment also known as PPE can be defined as
equipment that is used to protect the user against health or safety risks at
work. It can include items such as safety helmets, gloves, eye protections,
coveralls and safety shoes. Based on the Personal Protective Equipment at
Work Regulations 1992, the regulations required that PPE is properly
assessed before use to make sure it is fit for purposed, maintained and stored
properly, provided with instructions on how to use it safely and used correctly
by employees. According to Malaysian’s Department of Occupational Safety
and Health (DOSH), until December 2015, agriculture, forestry, logging and
fishing sector is the second highest reported case of occupational accidents
with 480 cases. In agriculture sectors, especially in oil palm plantation, safety
helmet is one of the important PPE for head, eye and neck protection. In
1994, Department of Labor had specified that, safety helmet need to be worn
if there is a possibility of falling or flying object. In a case study reported a
man sustained brachial plexus injury caused by a falling fruit bunch (FFB).
The FFB weighed 10 to 20 kg and fell from a palm tree of a height of 5.5
meter. Thus, usage of PPE especially safety helmet in oil palm plantation is a
must to prevent occupational accidents during work. Accordingly, the
objective of this study is to gather information on the knowledge, attitude and
practice on the usage of safety helmet among oil palm workers.

Background: Adult brachial plexus injury usually occurs due to trauma.

These include motor vehicle accident, penetrating injuries and falls. We report
a rare case of brachial plexus injury caused by a falling fresh fruit bunch
(FFB).

Case presentation: A 20-year-old man sustained a left brachial plexus

injury while he was harvesting fresh fruit bunch (FFB). The palm tree is only
5.5-meter-high indicating the age of the tree to be between four to five years
old with the approximate weight of the FFB between 10 to 20 Kg (Figure 1).
The harvester used the existing sickle to harvest the fruit and he had to stand
right below the fruit to harvest it and the fruit fell on his left shoulder (Figure
2). Immediately after that he experienced numbness of the left upper limb
and was not able to move his left upper limb. There was no head injury. He
was referred to specialist about 6 weeks after the injury.

FIGURE 1: A FFB can weigh between 10 to 50 Kg depending on the age of the tree and had
numerous thorny tips that is sharp and can cause injury upon impact.

FIGURE 2: Position that lead to FFB fell directly on the shoulder of the harvester
On examination the patient was alert. He had ptosis of the left eye. The
trapezius muscle was functioning normally with Grade 5 power. There was
already atrophy of the supraspinatus and infraspinatus muscle. The left
shoulder joint was subdued and the sulcus sign was positive. All other muscle
of his left upper limb were not functioning. The sensation over the C5 to T1
dermatome was absent. His peripheries were warm. The peripheral pulse was
felt. The capillary refilling time was less than 2 seconds. An MRI was done
and findings were reported as traumatic avulsion of C5-T1 nerve roots. He
sustained a pan global brachial plexus (Figure 3) injury.

FIGURE 3: Brachial plexus originating from C5 to T1 and supplying major nerve at the arm,
forearm and hand

A brachial plexus exploration was done and there was fibrosis around the
nerve roots. Narcotization of nerve to biceps was done using the phrenic
nerve using the sural nerve. as a graft. Also the suprascapular nerve was
necrotized using the spinal accessory nerve. At 1 year 4 months after the
surgery, he was able to flex his elbow to 90 degrees and the muscle power of
the biceps was Grade 3. The shoulder was not subdued and the sulcus sign
was negative. There was no recovery in the other muscles.
Occupational Disease OSH Management System where workers are
exposed to high levels of noise that can potentially impair hearing. Mill
management have to provides adequate personal protection equipment
(“PPE”) supplemented by training and signage throughout the mill to protect
workers from any occupational diseases (“OD”) such as loss of hearing.

OSH Management System Some Plantation Group has put in significant

investments to develop and implement a comprehensive Occupational Safety
and Health Management System (“OSH MS”) for the Company, guided by the
Malaysian Standard 1722 (“MS 1722”). which were awarded The National
Occupational Safety and Health Excellence Award for Agriculture by the
National Council of OSH (NCOSH) Malaysia in 2014 and 2015 respectively.
The success and effectiveness of this OSH MS continues to be improved upon
and is still in use today as a foundation for OSH-related management
decisions. The OSH MS entails group-wide implementation and documentation
of critical work systems and practices such as Hazard Identification, Risk
Assessment and Risk Control (“HIRARC”), Chemical Safety Management and
Chemical Health Risk Assessment (“CHRA”), as well as our Group’s
Emergency Response Plan (“ERP”), Terrorist Threat & Security procedure,
OSH Training & Induction programme, Accident Reporting and Investigation
procedure, Document Control procedure, Workplace Investigation procedure,
and PPE procedure.

A CASE STUDY OF OCCUPATIONAL INJURY CAUSED BY A FALLING

PALM OIL FRUIT IN PALM OIL PLANTATION