South African miners given hope in battle for lung damage payments

South African miners given hope in battle for lung damage payouts

Court ruling paving way for class action against 30 mine companies over silicosis raises prospect of billions in compensation

Toto Willie, a former miner who contracted silicosis, stands outside his home in Cape Town. Photograph: Jose Cendon/Bloomberg via Getty Images

uyani Elliot Dwadube walks carefully between the tidy lines of homes in Melody township, his steps kicking up small clouds of yellow dust. Decades ago, he came from his home in a village hundreds of miles away to work in the gold mines of South Africa’s Free State. With his health now failing and supported by the paltry wages of his wife, a domestic worker, Dwadube, 72, is hoping for justice before he dies.

His demands are straightforward: he wants fair compensation from his former employers for the damage done to his lungs during the years he spent drilling ore in narrow tunnels deep underground.

Dwadube suffers from silicosis, scarring of the lungs caused by fine dust inhaled underground. He is not alone. Up to 500,000 former mineworkers in South Africa and neighbouring countries are thought to suffer from the incurable occupational disease.

A groundbreaking court decision last month brought new hope to men such as Dwadube. A South African judge said human rights lawyers could launch an unprecedented “class action” that, if successful, would force more than 30 mine companies to pay compensation to everyone they have employed since 1965 who has had silicosis.

In a major breakthrough for campaigners, it would also mean payouts to relatives of former miners affected by the disease who have already died. The total sum could be billions.

Vuyani Elliot Duadube and his wife, Pamela. Photograph: Thom Pierce

Luvoko Enoch Madindala, a former mineworker near the town of Allanridge, who has silicosis, said: “This is a big victory. I never thought we would get this far. Even if we know there is still a long way to go, I will pray for us to go on and win.”

Madindala arrived in Allanridge in 1981, aged 18. For the next 30 years, he worked in the mines, using drills, picks and hammers in confined spaces deep underground. Workers were given helmets, gloves, boots and knee guards, he said, but no masks that would have filtered out the harmful dust filling the air.

“No one ever mentioned silicosis by name. No one ever explained that our lungs would be damaged through inhaling dust. They never really taught us about safety,” said Madindala, who was laid off by his employer five years ago when a doctor told him that he could no longer work.

“We used to do blasting twice a day and were working just minutes afterwards in the dust. The mines just used us up and threw us away.”.

Lawyers acting for the miners say the dangers from silica-laden dust were raised a century ago as the great South African mining boom got under way. A solution – blowing vast quantities of chilled air through the mines and masks – was also known, but only began to be implemented recently.

Georgina Jephson of Richard Spoor Inc, one of the law firms behind the class action, said: “The apartheid government effectively facilitated the whole system through the provision of cheap and expendable black labour. There have always been very good and strict laws about health and safety underground, but these were not enforced, certainly not under apartheid and only haphazardly since.”

Lukuko Enoch Madindala. Photograph: Thom Pierce

South Africa was the world’s top gold producer for a more than a century, but it has fallen to seventh place behind Peru over the past decade. The country is thought to be the source for about one-third of all the precious metal currently in circulation.

“Mining is a very powerful industry and [it has been] in the government’s interest to allow it to prosper. Johannesburg would not be here if not for mining and our country was built on mining, but at massive expense in human life,” Jephson said.

Miners played a central role in the struggle against apartheid and the industry has long been a flashpoint. In 2012, in one of the most traumatic episodes in recent South African history, 34 miners who were calling for higher wages were shot dead by police outside a platinum mine near Johannesburg, the country’s commercial capital.

Former miners with silicosis and other diseases have long been entitled to limited compensation from a government-administered fund, to which some mining companies make a contribution. However, the sums are limited, there is a huge backlog of claims and relatives of miners who have already died receive nothing.

The court decision last month means that women such as Gertrude Ludziya, 66, could receive substantial payouts.

Ludziya’s husband died in 2002, six years after being diagnosed with silicosis. He had worked for 18 years on a mine near the two-room home near Allanridge where his widow lives. She received the equivalent of about £3,000 in compensation from the fund in 2004, but nothing else, and has to support her 14-year-old disabled granddaughter after her son-in-law, a former miner who also had silicosis, died.

“It’s really, really tough. I’ve had to let out half my house just to have enough to eat. I’ve heard about the court case and I suppose it might be good news. Or maybe not. Our need is desperate and I’m not getting my hopes up,” Ludziya said.

Striking miners hold a sign calling for silicosis payouts during a protest in Carletonville. Photograph: Alexander Joe/AFP/Getty Images

Some mining houses recognise that current compensation for victims of silicosis is inadequate and are eager to reach a settlement, said Alan Fine, a spokesman for six gold companies, to Associated Press shortly after the court decision to allow collective action was made public.

“The companies don’t think it is in their interests to have that hanging over them, and neither is it in the workers’ interests to have to suffer delays of the sort that would be inevitable,” he said. “We want to find a solution as soon as possible.”

The mining companies named in the action have appealed the decision, setting the scene for a long legal battle before any compensation is paid.

It takes about 10 years for miners to develop silicosis from constantly inhaling dust, according to doctors. The delay before diagnosis means that the extent of the problem is still unknown. Many of those affected by the disease are from remote rural areas, sometimes in neighbouring countries, and die without understanding the cause of their suffering. Once miners have silicosis, they are usually infected with tuberculosis.

The landscape also shows the scars of the mining industry. When Madindala worked in Target mine, there were three shafts open. Only one is now functional. Much of the gold that brought so many workers to the region has gone and huge white hills of waste rise above expanses of sparse grass on wasteland.

Pamela Dwadube, who supports her husband Elliot with her wage as a maid, said she had faith in South Africa’s justice system. “I don’t blame anyone. For a long time, I had no hope. But now I have a very big hope in me,” she said.

Citation:
Burke, Jason. "South African Miners given Hope in Battle for Lung Damage Payouts." The Guardian. Guardian News and Media, 20 June 2016. Web. 20 June 2016. <https://www.theguardian.com/world/2016/jun/20/south-africa-miners-silicosis-battle-compensation-lung-damage>.

Response:
The mining industry is a core part of the South African economy but this article highlights such economic growth was at the expense of many lives. If the court case above goes further, the amount of compensation will be range in the billions as up to 500,000 former miners have been diagnosed with silicosis. The author of this article, Jason Burke, is biased against the mining companies as he focuses on the stories of victims over the excuses of large corporations. Burke does mention that some companies are willing to pay but shows them thinking about following through with compensation because it is in their best interest not to aid victims. He also shows that safety precautions were in place and silicosis was a known disease but the companies failed to educate the miners and enforce the rules for their safety. One of the miners spoken too said that a lot could have been prevented if masks have been provided.  This may have been written to raise awareness about the situation and apply international pressure on the companies involved. The reality that many people were used by the mining companies and tossed out when they got sick is devastating for many who had no other job source. I hope that South Africa's justice system can reward the hope of the miners and their families that have been waiting for so long.

Malawi failing to protect albino community: Amnesty

Rights body raises alarm over attacks against people with albinism, but government dubs Amnesty report as "unfair".

Azad Essa07 Jun 2016 21:35 GMT

Body parts belonging to people with albinism have become sought after in parts of southern and eastern Africa [Amnesty International]-

The Malawian government has failed to protect people with albinism, leaving this group to the mercy of criminal gangs who hunt for their body parts, Amnesty International has said.

In a new report released on Tuesday, the rights body said the attacks on people with albinism over the past two years were "unprecedented" and that a lack of action on the part of authorities has created a "climate of terror" for those living with the condition.

According to the Malawi Police Services, at least 69 people with albinism have been attacked in Malawi since 2014. Amnesty said that at least 18 people have been killed, five others abducted since November 2014. At least four were killed in April 2016 alone.

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Body parts belonging to people with albinism have become sought after in areas of southern and eastern Africa. Some believe they contain magical powers, leading to reports of them being sold on the black market.

While attacks have routinely taken place in Tanzania and Kenya and Burundi, "albino hunters" appeared to have moved on Malawi over the past 18 months in particular.

The report released by Amnesty, entitled "We are not animals to be hunted or sold" described the severity of the attacks, including mutilation and dismembering.

The report alleges that police lacked the adequate training and skills to investigate such crimes. It further raised concerns over the police officers' ability to take human rights abuses endured by people with albinism seriously.

"Some police officers carry the same prejudices against people with albinism that exists within the wider Malawian society," the report said.

It's a claim Patricia Kaliati, Malawi's minister of information, vehemently denies. Kaliati said that her government was "doing everything possible to protect this community".

"For Amnesty to suggest we are doing nothing is not helpful and not fair," she told Al Jazeera.

Bonface Massah, the head of the Association of People with Albinism in Malawi, welcomed the report, calling it "a very positive development" for those with albinism.

"It has highlighted the attacks and also has shed light on the deep-rooted social issues facing those with albinism in the country and gives us an opportunity to address it.

Living conditions have become so difficult for those with albinism in Malawi, that in April, United Nations expert Ikponwosa Ero, said if nothing was done, they risked "systematic extinction".

There are an estimated 7,000-10,000 people living with albinism in Malawi out of a population of 16.5 million.

"The situation is a potent mix of poverty, witchcraft beliefs and market forces which push people to do things for profit," Ero told Al Jazeera.

According to a report released by the Red Cross, witch doctors in neighbouring Tanzania were willing to pay as much as $75,000 for a complete set of albino body parts - including all four limbs, genitals, ears, tongue and nose.

Simeon Mawanza, Amnesty's researcher for southern Africa, who worked on the report, said that tracking down the buyers was still the most obscure piece of the puzzle. "The source, we are still searching for the source of these attacks," he told Al Jazeera.

The report also found that people with albinism suffered "widespread societal discrimination including verbal abuse and exclusion from accessing basic public services".

Experts say that people with albinism also endured discrimination at schools and hospitals.

Citation:

Essa, Azad. "Malawi Failing to Protect Albino Community: Amnesty." Al Jazeera. Al Jazeera Media Network, 7 June 2016. Web. 7 June 2016. <http://www.aljazeera.com/news/2016/06/malawi-failing-protect-albino-community-amnesty-160607121919448.html>.

Response:

Our family friend warned his albino nephew to be careful not to travel alone and to stay away from large crowds. A couple weeks later the nephew went missing and his uncle was accused by family members to having sold his nephew to witch doctors for his body parts. When he said he was only warning the nephew, the family called the police and the police went to the local witch doctor and asked him whether the claims were true. The witch doctor confirmed the claims. Our friend has been in prison for a couple of months.

I am aware going into this article response that I have a very evident bias against the Malawi government and their efforts to protect the Malawian people because I live there and I don’t see any efforts. The author of the article, Azad Essa, is biased against the Malawian government as he often states their failures to protect the people and only one vague quote from the minister of information about their efforts. He doesn't list any specific changes or actions on the government's part which tells me he did not find any. As Essa writes these attacks are taking place because of a combination of poverty and belief in witchcraft. Therefore, such claims by Patricia Kaliati that the government is doing everything they can to end these attacks is most definitely not true.  First of all the government needs to combat poverty, the root of the problem, instead of funneling the majority of foreign aid into their own pockets. All foreign aid needs to be monitored by donors to ensure that it is not misspent so it can ease the burdened of poverty smothering so many people.  Poverty is the direct cause of lack of education which leads people to see people with albinism as inferior when in reality a genetic disorder has nothing to do with inferiority.

Secondly, a fear of witchcraft is deeply rooted in culture and so it is evident that is the majority of people are scared out of their minds of witchcraft, the police probably are too. Essa talks about the police holding the same prejudices that the rest of the country. How can the government send prejudice police to help the people they are prejudice against? As I stated earlier, the police went to the witch doctor as a valid witness of the nephew being kidnapped. But what needs to be understood is that from the guluwankulu that dance along the rural roads dressed as monsters to the ex-witchdoctor telling my dad that he used to fly over the city in spirit, witchcraft is a part of a lot of Malawian's culture. People need to be freed from this fear of this darker power. I honestly believe that the Malawian this supposedly predominantly Christian country needs to be freed from their worldly fears.

This article will make international organizations, like Amnesty, aware of the situation in Malawi and put pressure on the Malawian government to take action against this violence. I hope that the government will not only tackle the immediate problems but the roots of poverty and witchcraft in not only Malawi but other African nations as well.

'I have to be taller.' - Vidhi Doshi

'I have to be taller' : the unregulated world of India's limb-lengthening industry.

Young Indians are paying for complex,painful procedures despite the absence of medical oversight in the race to improve marriage and career prospects.

Komal never told her friends where she went for six months last year. The 24-year-old, fromt he town of Kota, in western India, went to see Dr Amar Sarin, an orthopaedic surgeon in Dehli, who made her eight centimetres (3in), a procedure which involved breaking the bones in her legs and wearing a brace until she could walk again.

Her parents had to sell the family’s ancestral lands so she could get the surgery, but for Komal, the extra height is worth it. “I have so much confidence now,” she says. “I was just 4’ 6” [137cm]. People used to make fun of me and I couldn’t get a job. Now my younger sister is doing it, too.”

In a country where height is considered attractive, Komal is one of a growing number of young Indians using their increasing prosperity to improve their marriage and career prospects, and fuelling a cosmetic surgery boom.

However, limb lengthening surgery is completely unregulated in India and many of the surgeons performing it lack experience. As it also carries a certain stigma, the Guardian has chosen not to reveal Komal’s real name.

Dr Sarin says: “This is one of the most difficult cosmetic surgeries to perform, and people are doing it after just one or two months’ fellowship, following a doctor who is probably experimenting himself. There are no colleges, no proper training, nothing.”

Patients recover after undergoing limb lengthening surgery. Photograph: Amara Sarin

Prospective patients appear undaunted, including those from abroad. India’s reputation for cheap and well-trained doctors attracts people from around the world, in a medical tourism industry worth an estimated $3bn. Cosmetic surgeries make up a large slice of that figure, drawing increasing numbers from countries in Europe, America and elsewhere where procedures can cost four or five times as much.

Dr Sarin, who started offering the surgery five years ago, has treated 300 patients already, and only a third of them are from India. “It is a growing trend in India,” he says. “I get around 20 calls a day, with people telling me ‘I want to be tall, I have to be taller.’”

One man who had surgery in 2015 says he met at least 20 doctors before deciding to go ahead with the procedure. “Many of the doctors I approached had only done it once or twice before, and one had never ever done it before. I searched for around one year before I found the right person to do it.”

Last month, an ethics committee in the Indian state of Andhra Pradesh summoned orthopaedic surgeons who had operated on a 23-year-old man, after doctors raised concerns about why “unusual, experimental surgery” was performed. The surgery divides orthopaedic specialists in India, many of whom contend that the surgery is extremely difficult to perform and can cripple people for life.

An x-ray showing the progress of limb lengthening surgery in India. Photograph: Amar Sarin

Dr Sudhir Kapoor, the president of the Indian Orthopaedic Association, says: “We don’t recommend for people to do this surgery except for in very rare cases. These surgeries are not done routinely and there’s a high risk of complications.”

Limb lengthening surgery was pioneered in the 1950s, in a small Soviet town called Kurgan in Siberia. Its inventor, a Polish man named Gavriil Ilizarov, once dismissed as a quack, became known as the “magician from Kurgan”, after he performed orthopaedic operations on people including an Olympic high jump champion. Ilizarov never intended for his technique to be used for cosmetic purposes; his work was targeted at people who had had accidents or were born with limbs of different lengths.

Now, the controversial Ilizarov technique is being used by surgeons across India, though with many modern modifications to make it quicker and less painful. Sarin, who has earned an international reputation for his skill in performing the surgery, says he struggled with the ethics of performing it at first. “I used to wonder whether what I’m doing is right, but when I saw how much their self-esteem was improving, I decided to keep going,” he says.

It’s worth it when you see how much their self esteem grows

Amar Sarin, surgeon

The surgery should be used only as a last resort, he adds. “We often turn people away,” he says, explaining many of his patients have suffered acute psychological disorders. “We try counselling first, but we’ve had patients who even threaten to commit suicide if I refuse to do the surgery. Twice I’ve had to call the police in emergency situations like that.”

Though he has performed the surgery successfully on hundreds of people, Sarin admits: “It’s madness to do it.”

Still, he feels successful limb lengthening can transform a person’s life: “You can barely recognise them. It’s worth it when you see how much their self esteem grows.”

Citation:

Doshi, Vidhi. "'I Have to Be Taller!'" The Guardian. Guardian News and Media, 08 May 2016. Web. 10 May 2016. <http://www.theguardian.com/world/2016/may/09/i-have-to-be-taller-the-unregulated-world-of-indias-limb-lengthening-industry>.

The very concept of "limb-lengthening" sounds absolutely mortifying but the reality of having your legs broken and wearing a cast until you can walk again all to be three inches taller is exactly that: mortifying. As the bulk of our societies push people to fix, improve and change themselves to fit-in better, plastic surgeries are only going to become more popular. Obviously in India, marriage prospects and employment are high stakes and are definitely enough to push people to have this risky limb-lengthening surgery. There are high enough stakes for a family to sell ancestral lands to afford such surgeries that could leave the patient completely crippled for the rest of their life. But the author of this article, Vidhi Doshi, shows the ethical dilemma surgeons who originally set out to improve the lives of those who had had accidents or were suffering are now facing. Now they are meeting the demands of self-improvement because of dissatisfaction. Although Doshi lists the great lengths that people all around the world will go to have such a surgery, he is biased against the surgery because he writes more about the ethical dilemma or the risks of the surgery over statistics of more patients getting jobs post-surgery. He also shows that although there are those that are desperate, many come from all around the world to India for the purpose cheap self-improvement surgeries. Medical tourism is a billion dollar industry in Indian because many patients come from all around the world to have affordable and fast surgeries in India. So, there are a lot of people that such an article can be aimed at, even if just for them to question whether the battle with ethics is worth another celebrity's  nose. If a person wants to change one thing about themselves, they will find another part to be dissatisfied later. It is a vicious cycle of never quite being good enough until after another surgery and then another. But so much of this is linked to a self-improvement cultures that are only growing.  So, after reading the final line of this article of a doctor proclaiming that the improvement in self-esteem is worth it, do you think it is worth it? 

Measure

Measure

When the Patient Won't Ever Get Better - Daniela J. Lamas, M.D.

When the Patient Won’t Ever Get Better

By

Daniela J. Lamas, M.D.

April 28, 2016 12:00 pm April 28, 2016 12:00 pm

Photo

Credit Stuart Bradford

“Tell me,” my patient’s daughter asked at the other end of the phone line. “Is she stable?”

I wasn’t sure how to answer.

My patient hadn’t been home in nearly three months. It had all started to come apart in the fall. Until then, she’d been a healthy 90-year-old who lived alone and cooked all her own meals, played tennis in the summer, binged on movies in the winter. But then there was a strange pain in her back, a visit to an urgent clinic and a harrowing ambulance ride to the emergency room. A tear had developed in the wall of her aorta, one of the main vessels carrying blood from the heart. In a windowless conference room, the doctors told my patient’s family that without emergency surgery, she would most likely die.

To her family’s relief, the surgery went well. But there were complications – first pneumonia, then kidney failure, delirium, profound weakness. After two weeks she hadn’t died, but she hadn’t recovered, either. Because she was still dependent on the ventilator, her doctors took her back down to the operating room for another procedure, a tracheotomy, cutting a small hole in her neck to serve as a more permanent connection for the ventilator. Because patients with tracheotomies can’t eat using their mouths, at least not at first, she returned from the O.R. with another new tube, a feeding tube in her stomach.

Another few weeks passed in the I.C.U. It seemed that as soon as one infection got under control, another developed. From time to time, my patient’s delirium seemed to clear – when she was strong enough to breathe through the tracheotomy without the ventilator, she could speak with her family and offer one-word answers to questions. Her whisper was so soft they could barely hear her. On other days she was scared and wild-eyed, hands bound with soft “mitten” restraints to keep her from pulling out the feeding tube that delivered the thick white liquid slurry pumping from a bag on an IV pole above her head directly into her stomach.

One day, her family learned that she had a bed at another facility, called a long-term acute care hospital. This was good news, her doctors told the family. It meant that this weak, intermittently delirious woman who looked nothing like the spry 90-year-old who’d come to urgent clinic some months before didn’t need the I.C.U. any longer. They were cautiously optimistic.

In this new hospital, she did get better. Some days she managed to stay off the ventilator for eight hours, then 12, then a day, then two. Her tracheotomy was removed and the hole in her neck started to heal. Her delirium lifted, replaced by a dull, lifeless gaze. Her kidneys improved. And then, things stopped getting better. Time slowed. There she was – neither dead nor truly alive – stuck, it seemed, in limbo.

One Saturday, she spiked a fever. Her breathing grew ragged. Back in the E.D. she was intubated once again, then sent up to the I.C.U., where her daughter called us to ask, “Is she stable?”

I debated about how to respond. The ventilator was delivering sufficient oxygen. Intravenous med drips were acting directly on her heart to keep her blood pressure at an acceptable level. Her kidneys were functioning to make urine.

But behind the façade of stability was a more dire truth: she might never get better. With her constellation of ventilation dependence, infections and delirium, she had what doctors call “chronic critical illness.”

Her story isn’t unique; there are about 100,000 chronically critically ill patients in the United States at any one time, and with an aging population and improving medical technologies, this number is only expected to grow. The outcomes of these patients are staggeringly poor. Half of the chronically critically ill will die within a year, and only around 10 percent will ever return to independent life at home.

Chronic critical illness is not something I learned about in medical school, or something that many doctors even talk about. One reason might be that the care for the chronically critically ill quite literally takes these patients out of our view – they move, as my patient did, from hospital to long-term care and back again, accompanied by a growing stack of medical records as things slowly fall apart.

In the early moments of critical illness, the choices seem relatively simple, the stakes high – you live or you die. But the chronically critically ill inhabit a kind of in-between purgatory state, all uncertainty and lingering. How do we explain this to families just as they breathe a sigh of relief that their loved one hasn’t died? Should we use the words “chronic critical illness”? Would it change any decisions if we were to do so? Here, I find that I am often at a loss.

I was quiet on the other end of the phone line that night. Was my patient stable? For the moment, she was. But with each event like this one, and there would be more, my patient would move further from the hope of ever reclaiming that life she had had in the fall: living in her own home, watching movies, cooking. I felt that I could see the weeks and months spooling out, a moment of calm, a new emergency. But this wasn’t the time to tell her daughter, not on the phone, not tonight.

And so I told her the truth – one truth, at least. Her mother was critically ill, but stable for the night.

Citation: 

Lamas, Daniela J. "When the Patient Won't Ever Get Better." New York Times. New York Times, 28 Apr. 2016. Web. 03 May 2016. <http://well.blogs.nytimes.com/2016/04/28/when-the-patient-wont-ever-get-better/?ref=health>.

This article is very different than the articles I focused my response on in the past. To start the author is a doctor rather than a journalist which gives us a very different viewpoint. I know that I often think of the suffering patients or the anxious family waiting for the next phone call (which is good) but not as often the doctor or caregivers.  Even though my mother is a doctor and  I often heard phone calls much like the ones the author Daniela Lamas makes,  I never really thought as much about the responsibility that is placed on doctors to give the life or death answers even if there are none. Daniela Lamas talks about her training that never really prepared her for these situations that will only become more common for in a world with improving technology and a growing elderly population. She has a bias against that aspect of her training and the fact that it is not spoken about enough among medical professionals more. Maybe she is warning  medical students about the difficult decisions that are inevitably coming their way that can only be taught through experience. Or she is subtly telling families that to be patient when such questions cannot be answered.

Indonesia: Drowning in rubbish - Jack Hewson

Indonesia: Drowning in rubbish

Will a plastic bag levy be enough to fix Indonesia's rubbish problem?

Jack Hewson | 22 Apr 2016 13:47 GMT | Indonesia

• Engagement: 13

Sometimes you have clean days at Cimaja, but when the wet season rains hit, the rivers empty and swamp the break in hazardous debris [Jack Hewson/Al Jazeera]

Cimaja, Indonesia - Pro surfer Dede Suryana drops into an 8ft wave face, turns hard at its base and pulls into a barrel. Seconds later he emerges from behind the curtain of water, into the early morning sun. By the shore, palm fronds sway gently in the offshore breeze and swallows dart from tree to tree.

At first glance it's a tableau of West Javan paradise, but look closer and other details catch the eye. A used Pocari Sweat bottle bobs, wrappers for Indo Mie instant noodles float nearby, and a limp plastic bag drags on another surfer's leg rope.

Today is a relatively clean day at Cimaja, but when the wet season rains hit, the rivers empty and swamp the break in hazardous debris. Another local wave named "Lojis" has been rendered nearly unsurfable by the chronic accumulation of synthetic detritus. 

"Used diapers, sanitary pads - you see it all out here, but plastics are most common," says Dede. "There are a lot of villages upstream, and they just use the river as a dump. 

"You're thinking, is the trash old or new? If it's really old then maybe the water will have washed it clean, but if it's new ... well ..." he pauses then laughs. "You're sort of worrying if you could get a disease." 

Across the archipelago, Dede has witnessed similar scenes to those at Lojis, and was famously photographed on a giant "wave of trash" in the Sunda Strait, between Sumatra and Java. The image, which went viral in 2012, is a fitting icon of Indonesia's biblical plastic rubbish problem - described last year as a "state of emergency" by a senior official from the Ministry of Environment and Forestry.

People may gather and exchange recyclable waste for cash through a government-promoted network of 'trash banks' [Brent Clues/Al Jazeera]

Trying to address Indonesia's rubbish problem

To address the issue, the government recently introduced a plastic bag levy, to be trialled in 23 major cities. If successful, the charge will be rolled out nationwide in June. 

Currently the levy will apply to branded retailers such as Indomart and other store chains. In Jakarta, the levy has been set at 200 rupiahs, or $0.02 per bag, but other city administrations are free to charge more or less. 

Environmental campaigners have generally welcomed the move but complain that the levy is too low and that plastic bags are only one aspect of Indonesia's waste management crisis. 

Despite these issues Tiza Mafira, the director of the Plastic Bag Diet Movement, who began the petition calling for the levy in 2013, is upbeat about its impact. 

"It's prompted a discussion and is leading to a better understanding about waste," she says. 

In many developed nations decades-long public awareness campaigns have stigmatised littering, and plastic packaging is widely considered cheap, tacky and damaging to the environment. 

But in Indonesia those awareness campaigns have not been fought. 

Consequently, concern for the effects of plastic waste is low, and attitudes towards waste disposal and littering are often flippant. 

"Most people don't care in Indonesia, this is the problem," Dede says. "Fishermen in particular really don't understand. I've been on many boat rides for surf trips and they just throw all their rubbish straight into the sea." 

To make matters worse, plastic packaging is considered modern and preferable to organic wrappers, which are perceived as rustic and outmoded. 

In years gone by, throwing organic waste behind one's home, or by the side of the road, was not problematic. Now plastic food packaging is disposed of as casually as the banana leaves that were traditionally used to wrap rice parcels. 

'Fishermen in particular really don't understand. I've been on many boat rides for surf trips and they just throw all their rubbish straight into the sea,' Dede explains  [Jack Hewson/Al Jazeera]

No sustainable solutions

But while such attitudes have contributed to Indonesia's plastic waste crisis, the government's inadequate collection and disposal services are also to blame. 

"There is no enabling system," says Yuyun Ismawati. A waste management expert at BaliFokus, a Bali-based environmental NGO. "If the government ran these services in a proper way then people would change.

"Charging bags to the consumer isn't fair, in my opinion." 

For Yuyun the new plastic bag levy doesn't address Indonesia's main waste disposal issues. Firstly, because plastic rubbish only accounts for 14 percent of Indonesia's total solid waste. And secondly, because the levy currently does not apply to unbranded retailers - like street markets, roadside kiosks and food carts, among others - who account for 90 percent of the 9.6m plastic bags handed out in Indonesia every day. 

"The levy misses the point," Yuyun says. 

Countering these criticisms, Tuti Mintarsih, director-general for toxic materials and waste management at the Ministry of Environment and Forestry, said that the levy was still in its trial phase and would be extended to unbranded retailers in June, when the price of plastic bags would also be re-evaluated. 

Tuti explained that the bag levy was part of Clean Indonesia 2020,a broader government initiative, mandated by the 2008 Municipal Solid Waste Law, intended to promote the three Rs: reduce, reuse, recycle. 

As part of the scheme, better waste disposal is being promoted through a growing network of "trash bank" facilities, currently 3,800 nationwide, where citizens may exchange recyclables for cash. There has been significant uptake of the scheme since it began in 2011, with a reported national monthly transaction value of 34.4 billion rupiahs, or $171m, as of October. 

But with the programme's risible operational budget of 15 billion rupiahs ($1.2m) - "very little" by Tuti's own admission - the ministry has scant hope of creating comprehensive recycling services for a geographically scattered population of 250 million people. Awareness of the trash bank scheme is also poor, with many people in West Java unaware of its existence. 

"What the government needs is a genuinely comprehensive strategy, that addresses all types of waste and coordinates between the relevant government bodies," says Yuyun. 

As it appears unlikely that Indonesia will be clean by 2020, those who care about the plastic rubbish issue are forced to take matters into their own hands. 

"Now we have a beach clean-up every Friday," Dede says. 

"But," he pauses and smiles, "we burn it, because there's no rubbish truck to take it away."

Citation: 

Hewson, Jack. "Indonesia: Drowning in Rubbish." Al Jazeera. Al Jazeera Media Network, 22 Apr. 2016. Web. 26 Apr. 2016. <http://www.aljazeera.com/indepth/features/2016/04/indonesia-drowning-rubbish-160419163910625.html>.

Response:

Throughout the world, many nations and people groups do not put enough emphasis on the importance of conserving the environment.  In Indonesia specifically,  a combination of this indifferent attitude and lack of governmental intervention is highlighted in this article  by the author Jack Hewson. The article begins by focusing on the relevance of a bag levy in local supermarkets. Although there may be a positive outcome, can a small move ( about 14% percent of the country's total plastic usage) truly improve the environment? The author writes in favour of the plastic bag levy because he states a couple times that the "levy was still in its trial phase and would be extended to unbranded retailers in June", which shows that the government are getting involved and trying a way to reduce the amount of waste being poured into the environment. The legislation may also affect unbranded retailers (responsible for 90% of the plastic) in the future. Although Hewson may be in favour of the levy he also emphasizes the importance of the local government setting up more legitimate programs that offer alternatives or deal with the rubbish issue and that one legislation is not enough. Because Indonesia is an archipelago, the establishment of a nationwide waste disposal system may be harder than a country with a unified land mass. This is a problem that needs to be tackled in the near future and should not be viewed as impossible. If those that use the ocean and rivers as a rubbish dump do not have a reliable alternative, than no matter how many activists confront them they cannot change. At the end of the article Hewson points this out with the example of Dede having a beach clean-up to favor the environment but then burn the rubbish because of lack of an alternative.