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World They built a Chinese boomtown. It left them dying of lung disease with nowhere to turn.

23:30  15 december  2019
23:30  15 december  2019 Source:   washingtonpost.com

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A dying dentist being treated at a Virginia facility gave the CDC a warning: There was a suspiciously large number of other dental professionals at the clinic. Seven of the patients were dead, and two more were dying of a rare chronic, progressive lung disease that can be treated but not cured.

LEIYANG, China —Ill and defeated, Xu Chunlin approached the railing, the limits of a search for justice.

Before him was a 30-foot plunge into Shenzhen’s rush-hour traffic. Behind him stood police he had just clashed with. On the overpass with him were about 80 other former construction workers mulling the same desperate calculus.

Leap now? Or wait to die when their lungs gave out? 

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Knowing the early warning signs of lung disease can help you receive treatment before the disease becomes serious or even life threatening. Wheezing: Noisy breathing or wheezing is a sign that something unusual is blocking your lungs ' airways or making them too narrow.

The lungs are the primary organs of the respiratory system in humans and many other animals including a few fish and some snails.

The journey that led them to that bridge began in the early 1990s. The men were young and healthy then, wide-eyed migrant laborers from rural Hunan province. Shenzhen was a scruffy border boomtown to the south — not yet today’s cosmopolitan hub of 12 million — where they flocked for off-the-books jobs as drillers.

a large city landscape: A view of the Shenzhen skyline. © Lam Yik Fei/Getty Images A view of the Shenzhen skyline. Many Hunanese worked for years, even decades, boring into the bedrock to build subway lines and the foundations of Shenzhen’s whole cityscape. But they didn’t know the inadequacy of the $1.50 cotton masks they were given, or the irreversible harm of inhaling silica dust that caked their faces once their drills bit into granite-streaked crust.

More than 100 former laborers from Hunan have died in the past decade from silicosis, an incurable condition caused by inhaled dust particles that scar and harden the lungs.

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A common health problem, lung diseases range from mild to severe. WebMD breaks down the Tens of millions of people suffer from lung disease in the U.S. Smoking, infections, and genetics are The trachea (windpipe) branches into tubes called bronchi, which in turn branch to become progressively

About 600 more are suffering or slowly dying, the leaders of worker groups say. Three dirt-poor communities in Hunan that once survived off their earnings — even saw progress — are now mired in debt and grief while surviving workers spend their little savings and energy to clamor for compensation.

Two stories of China

The lives of Hunan’s drillers trace China’s diverging realities.

One story is reflected in the gleaming skylines they built: the backdrop for a prosperous middle class of 400 million people who live in China’s cities and power its economy. Another story is framed by struggle: a vast, rural underclass still toils in hazardous conditions, lacking documentation or means to seek redress except through confrontation with the government.

Lau Kar-leung standing in front of a building: Xu Chunlin first traveled to Shenzhen in 1989 and later introduced other Hunan villagers to construction jobs there. He made a relative fortune and lives in a three-story brick home with ornate copper doors, but he has paid a price: Four brothers died of pneumoconiosis, and he is terminally ill. © Gerry Shih/The Washington Post Xu Chunlin first traveled to Shenzhen in 1989 and later introduced other Hunan villagers to construction jobs there. He made a relative fortune and lives in a three-story brick home with ornate copper doors, but he has paid a price: Four brothers died of pneumoconiosis, and he is terminally ill.

Forty years after China shifted away from its socialist system — and the promise of cradle-to-grave care for workers — the country is settling hard questions accumulated in the rush to modernity.

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They built mud huts below the road leading to the farm of Karen Blixen—made famous in the film Kibera is an African version of a Chinese boomtown , an advertisement for solid human ambition. Leaving the Pentagon, your correspondent is persuaded by concerned patrons to hire a watchman as

Lung disease refers to disorders that affect the lungs , the organs that allow us to breathe. Lung disease is a major concern for women. To diagnose asthma, the doctor asks about your symptoms and what seems to trigger them , reviews your health history, and does a physical exam.

Who benefited and who suffered? Who is owed compensation and who should pay up?

Since early 2018, Hunan’s ailing drillers, led by Xu and others, have traveled more than a dozen times to Shenzhen to demand help. In early November 2018, hundreds of them occupied a government complex before police dispersed them with batons and pepper spray — further aggravating their weak lungs.

It was during that standoff — according to the accounts of four protesters, activists and news accounts — that workers cornered by police on an overpass threatened to commit mass suicide by hurling themselves onto an eight-lane highway.

Xu, one of the protest leaders that night, said he was ready to die for the cause.

But he also felt responsible for these men, he later explained. He was one of the first Hunanese to bring fellow villagers to Shenzhen in the 1990s, setting off a chain of success and tragedy that would unspool over 25 years.

Standing on that overpass, Xu said, he yelled at the men to back away from the ledge and the madness. Keep calm, he told them, and fight another day.

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“China is like a cart. It won’t move forward if you don’t push,” he later said. “If you’re not afraid of dying, you can accomplish anything in this country.”

Ghost homes

Steep sandstone ravines carve across Sangzhi county, a part of Hunan province with little industry or even agriculture. But multistory homes with faux-European balustrades line county road 420. They are the rewards of laboring in cities like Shenzhen — and monuments to the human cost.

“Everyone builds a big house and then there’s no one to live in it,” Gu Zhongping, a former driller, said as he drove along, pointing out homes with a former Shenzhen worker dying or dead.

a motorcycle parked on a dirt road in front of a house: Money made in Shenzhen allowed families in Leiyang county to build bigger and bigger homes. © Gerry Shih/The Washington Post Money made in Shenzhen allowed families in Leiyang county to build bigger and bigger homes.

Gu Hejian, in the house with red posters for his son’s wedding, doesn’t expect to live much longer. Zhong Yichuan, who lived behind a corner store, died two years ago. Wang Zhaogang died in April and was buried by 10 ill workers counting the days themselves.

More than 26 former drillers in Sangzhi county have died of lung disease since 2009, according to residents, who say deaths are accelerating, with about 100 others who are seriously ill. In two other Hunan counties, Leiyang and Miluo, about 500 villagers who worked in Shenzhen have been diagnosed, according to workers’ representatives.

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The left -behind children in China are children who remain in rural regions of China while their parents leave to work in urban areas. In many cases, these children are taken care of by relatives, usually by grandparents or family friends, who remain in the rural regions.

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Although official figures are unavailable, a Hunan city-level document found online supported the villagers’ claims. A 2017 health check showed that 290 villagers, mostly in Sangzhi, had silicosis.

Work-related lung diseases have held steady or declined in developed countries as jobs such as coal mining waned and safety standards rose. In China, cases are growing.

In 2018, about 873,000 Chinese workers had pneumoconiosis, a broad class of lung disease, up from about 559,000 in 2000, according to China’s National Health Commission. Love Save Pneumoconiosis, a Beijing nonprofit, estimates the true number of sufferers to be much higher — possibly about 6 million.

Chinese officials, who are drawing up new plans to study the crisis, say 23 million workers are at risk of getting the disease. That’s far more than the 11.5 million at-risk workers in India, 2 million in the United States and 1.7 million in Europe estimated by health authorities and researchers.

Workers who inhale dust and tiny mineral crystals found in rock and sand do not immediately feel symptoms. But over months, sometimes decades, the lodged particles do devastating damage.

Number of workplace pneumoconiosis sufferers in China Number of workplace pneumoconiosis sufferers in China

Walking, even talking, becomes difficult. Lying flat creates the sensation of suffocation, so most patients sleep sitting next to a small oxygen machine. In the latter stages, they suffer heavy wheezing, steep weight loss, frequent bouts of colds and fevers. Pneumonia and tuberculosis can easily turn fatal. Sooner or later, the lungs simply give out.

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Not only would left -handed people have been encouraged not to be during this period, life was also pretty difficult for them and they quickly became very conspicuous. " They went to work in factories using machines designed for right-handers - and the left -handers looked awkward," says McManus.

The left lung has an indentation bordering where the heart resides, called the cardiac notch. The lungs are surrounded by two membranes, known as the pulmonary pleurae. The inner layer directly lines the outer surface of the lungs , and the outer layer is attached to the inner wall of the rib cage.

Behind a trash-strewn basketball court that serves as a village square in Sangzhi county, a country doctor, Li Li, watched Cheng Xiangyong, a 49-year-old who was doubled over the couch in her office, coughing up long, thick goop.

“He should have 1½ to three years to live,” Li predicted as she prepared familiar drips: ambroxol to dissolve mucus, aminophylline to dilate air passages and an antibiotic.

Three of her silicosis patients recently died. Sick workers keep streaming in. The one-room clinic she converted out of a ramshackle storefront doesn’t have proper medicines, equipment or, Li admits, know-how.

But for sick workers in the remote hills who need care several times a month, it’s better than a two-hour drive to a city hospital or six hours to the provincial capital, Changsha, she said.

“We have so many people like this,” Li said. “I tell them not to come. I can’t handle them. I can’t handle the risk.”

As he clutched a table, Cheng’s hoarse wheezes filled the room. He had drilled on and off in Shenzhen for 13 years until 2017, when his symptoms surfaced. His weight recently plummeted from 156 pounds to 114.

Cheng worried about dying as quickly as his friend Gu Erhu, whose lungs failed Aug. 14 just hours after they spoke. Cheng worried about not having money to buy his own casket, about leaving his wife, Chunyue, and his 82-year old mother to fend for themselves.

“We’ll manage,” Chunyue said, smiling across the table. “There is no other way.”

Free-market laboratory

Shenzhen had a population of 30,000 in 1980 when China’s Communist leaders designated it the country’s first free-market laboratory. Within decades, farmland and mangrove swamps would turn into factories for the world’s iPhones, Asia’s fourth-largest stock exchange, and high-rise towers and digs for the super-rich such as $4,000-a-night St. Regis hotel suites.

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a couple of people that are standing in the water: Tourists look out over the Shenzhen skyline from the 69th floor of the Shun Hing Square building. © Daniel Berehulak/Getty Images Tourists look out over the Shenzhen skyline from the 69th floor of the Shun Hing Square building.

Shenzhen’s economic output soared from $4 million in 1980 to $340 billion in 2018. Officials have often marketed the city as China’s window to the world.

For Xu Chunlin — decades before he thought about jumping from the bridge — Shenzhen was a path out of hardscrabble Leiyang county in Hunan.

A short and badly underfed 21-year-old in 1989, Xu first ventured 500 miles south that year with four brothers to work at Shenzhen construction sites. He returned for Lunar New Year with 5,000 yuan (about $710 in today’s money), he recalled, and immediately spent it all on more than 3,300 pounds of rice to pile in a granary so his family could recover to their healthy body weights.

Within four years, Xu was working as a middleman. That meant introducing villagers to Shenzhen’s subcontractors, who set aside half the positions at work sites for the Hunanese. Sometimes the jobs were worth $45,000, making Xu a relatively rich man on his cut.

“Everybody in the village wanted to know me because I had jobs,” he said, sitting in a three-story brick house he built in Leiyang county with elaborate copper doors. “Every boss in Shenzhen wanted to know me because I had men.”

The Hunanese crews relied on handheld jackhammers and controlled explosives to open the ground, sometimes 150 feet deep. They would then pour concrete into the pits for pillars that bore a building’s load.

“Pay attention and be safe,” one Hunan worker, Zhong Pinxie, recalled bosses saying before they threw him onto a site with almost no training. In those early years, he said, he was given a simple conical mask to cover his mouth and nose. He didn’t wear goggles or earplugs before going down a four-foot-wide pit for four-hour shifts.

Zhong worked so many drilling jobs that he learned Shenzhen’s subterranean geography. The new subway line in Luohu bored easily through crumbling rock. In the Nanshan flats, where malls and Shenzhen University rose, it was granite-streaked earth that kicked up thick dust.

“When the drill bit touches,” Zhong said, “it’s like a cannon goes off in your face.”

That’s precisely what would cause the opaque globules that dotted his lungs in X-rays last year — a telltale sign of advanced silicosis. But Zhong didn’t know that at the time; few did. Education and awareness on worker safety was scant, and symptoms of lung disease wouldn’t surface for several years.

The middleman Xu had shifted into administrative work by 2008, when a construction engineer handed him a one-page document about pneumoconiosis and said quietly: “Don’t do this job too long.”

“I thought he must know something,” Xu said. “But from beginning to end, none of the companies or government ever did any publicity about cause or effect.”

a bunch of items that are sitting on a table: Wang Quanlong’s home is filled with stacks of medicines and oxygen bags to relieve symptoms of pneumoconiosis. The disease is incurable and often leads to a slow, painful death. © Gerry Shih/The Washington Post Wang Quanlong’s home is filled with stacks of medicines and oxygen bags to relieve symptoms of pneumoconiosis. The disease is incurable and often leads to a slow, painful death. Off the books

By 2009, silicosis was becoming difficult to ignore. Media reports started to surface about subterranean drillers falling ill. Groups of workers from Leiyang started petitioning Shenzhen authorities, who agreed to give payments of as much as $15,000 to those who could prove their employment.

But for the vast majority of drillers, that was impossible.

Since the 1980s, when China’s economic reforms unshackled peasants from their land and sent them streaming into cities in search of work, nearly 300 million migrant workers have occupied a legal gray area.

As it embraced free enterprise, the ruling Communist Party neglected workers from the countryside, members of the very class it ostensibly championed.

Despite a 2008 law requiring all employers to offer written contracts, just 35 percent of migrant workers signed them in 2016 — a number that is falling, according to China’s National Statistics Bureau, which has stopped releasing data. A 2014 nationwide survey by Love Save Pneumoconiosis found that just 7 percent of workers with the disease reported ever signing a contract.

a man wearing a suit and tie: Wang Quanlong was one of about 80 sick drillers who threatened to commit suicide in 2018 if Shenzhen authorities did not pay compensation for pneumoconiosis. © Gerry Shih/The Washington Post Wang Quanlong was one of about 80 sick drillers who threatened to commit suicide in 2018 if Shenzhen authorities did not pay compensation for pneumoconiosis.

The construction industry — a sector that accounts for a quarter of all work fatalities — is known for relying on subcontractors called baogongtou who hire workers informally, said Eli Friedman, a China labor expert at Cornell University.

The system, he said, “pushes risk to the bottom.

Work-injury insurance also has lagged. China launched a national plan only in 2004. Today, about 80 million migrant workers, or roughly 27 percent, are covered, officials said in May.

Shelly Tse, director of the occupational health studies center at the Chinese University of Hong Kong, said the Shenzhen workers were further handicapped by the latent nature of pneumoconiosis.

“By the time workers feel progressively worse 10 years later, they can’t identify which company they worked for when they contracted the disease,” Tse said. “Companies may already be bankrupt.”

'Built on our bones'

With little hope of compensation for workers, grief — and anger — boiled over in rural Hunan last year.

Xu, the former middleman, watched the death toll in his villages tick up to more than 70. Six sick men committed suicide. Local clans like the Caos, who buried three brothers who contracted pneumoconiosis in Shenzhen, were devastated.

So was Xu’s own family. Four of his brothers, who worked in the Shenzhen pits, had died, the youngest at 26. Xu, himself diagnosed with terminal silicosis, was well off financially, but Leiyang county was struggling.

“We had to do something,” he said. “People need to survive.”

Similar scenes were playing out in Hunan’s Sangzhi and Miluo counties, as ill workers began mobilizing to take their demands to Shenzhen, where they joined forces.

On Nov. 5, 2018, a large group of workers, furious about a lack of progress, occupied the government compound and demanded to see Shenzhen’s mayor. They slept overnight on mats and by the night of Nov. 7, more than 300 workers had gathered at the scene.

After 8 that evening, authorities made their move. Videos from the incident show riot police with pepper-spray guns flushing the protesters out of the government complex. The retired workers keeled over on the pavement outside, coughing, as paramedics whisked away the injured.

Dislodged from the building, scores of angry protesters regrouped, then veered toward an overpass, where they threatened to jump, said three petitioners from Leiyang and Sangzhi. It was a final gambit.

It worked.

Police rushed to block the crowd surging onto the bridge. By midnight, city officials had emerged to appeal for calm alongside cooler heads like Xu.

Negotiations began at 11 the next morning. Weeks later, a deal was announced: Shenzhen would pay silicosis sufferers between $17,000 and $35,000 and cover medical costs moving forward. Yet many still were not satisfied.

In the absence of robust courts, China often settles labor disputes this way, said Mary Gallagher, a political scientist at the University of Michigan. Rural petitioners organize mass, repeated demonstrations; officials hope to appease them with one-off payouts. “But they never acknowledge the systemic failures,” she said.

Clashes between the Hunan petitioners and authorities have continued. Dozens of workers hoping to return to Shenzhen or Beijing to seek more money have been repeatedly intercepted and, on at least one occasion, roughed up by police, petitioners said.

a group of people in a field: For years, men have left Leiyang county in central China’s Hunan province to work in the border metropolis of Shenzhen. © Gerry Shih/The Washington Post For years, men have left Leiyang county in central China’s Hunan province to work in the border metropolis of Shenzhen.

Stricken villages have become closely surveilled. During one trip to Sangzhi county, a Washington Post reporter was surrounded by plainclothes security officials and forced to leave the province. Authorities harassed villagers who were interviewed during another visit.

Xie Decai, Sangzhi county’s deputy director of propaganda, denied official wrongdoing and said he held 10 meetings with villagers.

“Some are still unhappy, but it’s not a matter of whether they get compensation, it’s a matter of how much,” Xie said. “As far as we are concerned, the matter is settled.”

The dispute isn’t settled for a Sangzhi county protest leader who sat in a farmhouse plotting his 13th or 14th trip to petition in Shenzhen or Beijing. He got $24,000 in compensation for silicosis, but the money wasn’t enough to raise his children, said the protest leader, who feared official reprisal and spoke on the condition of anonymity.

“Justice doesn’t exist in this society,” he said. “It has glory and wealth and skyscrapers built on our bones.”

In a picturesque valley across Hunan, the former middleman Xu, 51, didn’t speak of compensation. As villagers fell ill one by one over the years, he said, some families begged for help, others cursed him for finding jobs for drillers in Shenzhen.

“I did it with good in my heart,” he said. “How could we have known?”

In the past two years, he has spent $12,000 feeding and lodging protesters in Shenzhen. He advises families of pneumoconiosis petitioners across the country on WeChat. He checks up on Leiyang widows whose husbands once followed him south to work. He’s still petitioning.

All he wanted was a public accounting of the disease by the government, he said, not money.

Xu waved a hand at his big house, at the empty rooms. If he had never found drilling, he said, they might be filled with his brothers, his nieces and nephews.

“It’s conscience.”

gerry.shih@washpost.com

Yuan Wang and Lyric Li in Beijing contributed to this report.

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