I will soon be heading to Ghana to run a series of safety leadership and management workshops.  It’s a trip that requires health and safety precautions.

The safety issues primarily relate to the low risk of petty crime.  Sensible well-known precautions apply.  Avoid places where street theft is known to be more likely.  Minimise the value of what you take with you.  Keep your passport secure.  If you are unlucky enough to be caught up in a robbery, comply with demands without delay.

Health Risks

The health risks are more diverse and require careful planning.  A range of tropical diseases can be contracted depending on what you are doing and where you are likely to be going.  These determine what you are more like to be at risk from and what access you will have to health care if needed.  This is a why visit to your GP, or in my case the Boots travel vaccination service, is vital well in advance of the trip.

Thankfully, the pharmacist didn’t rely on memory to identify what was needed.  The health risk assessment was a comprehensive checklist covering both my medical condition and my planned activities in Ghana (and possible Kenya early next year).  This is a reliable approach to assessing risks that should probably be used more.  Why do we insist on making people do complex risk assessments involving guessing risk ratings in the many circumstances where the relevant hazards and what to do about them is well known good practice?

For my trip we determined that three vaccinations were necessary.  These are miracles of medical technology.  A safe(ish) sample of the disease agent is injected.  Our astonishing immune system then learns the signature of the disease.  Should you become infected, at the first sign of attack defence mechanisms are triggered to find and destroy all traces of the pathogens attacking you.  It’s a strong response to an early warning, one of the principles deployed by high reliability organisations.

Yellow Fever and the Panama Canal Project

For trips to Ghana one of these vaccinations has been made mandatory – yellow fever.  It’s a vicious tropical disease transmitted by mosquito bite (technically the vector for the virus).  It originated in Africa and it is still in African nations where most serious infections and fatalities occur.  Furthermore, it is more likely to be serious or fatal for visitors than native populations that have built up a degree of immunity.

One of the most dramatic examples of yellow fever’s awfulness occurred in the late 19th Century.  Yellow fever was first taken to the Americas in the 17th Century by the slave trade.  Within 200 years it was endemic to tropical regions including Panama where it lay in wait for the French diplomat Ferdinand de Lesseps.  Between 1881 and 1894 he attempted to construct a sea level canal across the country.  By 1884 the death rate in his construction workforce, who were treat like cannon fodder, was 200 per month, mainly from yellow fever and other tropical diseases.  Failure to take into account that the local rivers became raging torrents during the rainy season also contributed to the engineering solution being inherently disastrous and caused many deaths.  By the time the project went bankrupt, it is estimated that over 22,000 workers had died.

The American resurrection of the project in 1904 did not start much better.  However, the project Chief Engineer John Stevens did not just ignore the problem.  That yellow fever was carried by mosquito had been recently discovered.  Stevens appointed a Chief Sanitation Officer, Colonel William C. Gorgas.  Despite opposition from the project commission, two years of extensive effort took place to eliminate the risk at source – eliminating stagnant water, providing fresh water supplies, fumigating buildings and providing mosquito netting.  Much improved health care was provided for the smaller number of patients that still contracted diseases.  Over the period of the project, the total number of causalities reduced to 4,500 with a much larger work force.  There was clearly still much to do to improve health and safety in major civil engineering projects.

Vaccination Risks

So back to my trip to Ghana, accepting the requirement to be stabbed once for yellow fever and choosing to be stabbed twice more for other serious diseases was not a difficult choice.  I have also been one of the 1 in 3 people who suffer mild side effects from the yellow fever vaccination – a few days of light fever, headaches, aching muscles and sweaty nights.  When in Ghana I also intend to take steps to minimise the risk of being bitten – defence in depth is a vital principle for hazards that can kill with each layer of defence managed as if it was the only one.

Vaccination is essentially volunteering for certain injury and likely mild side effects to prevent an unlikely fatality.  But the risk of more serious consequences is not zero.  About 1 in 250,000 recipients of yellow fever vaccine suffer more serious side effects and die.  This is about the same as the average risk of fatality at work in the UK.  Hence, awareness of this possibility and seeking medical assistance without delay on experiencing the warning signs is a vital.

Vaccination for ‘Safety Pathogens’

An advantage of vaccination is that it is an automatic process.  Our immune system has evolved to learn the warning signs of disease pathogens without any need for conscious intervention.  It’s unfortunate that we can’t do the same for ‘safety pathogens’.  There can be many of these weakening operational risk control, safety management procedures and practices, and safety leadership.  It’s a forlorn hope that one or two interventions based around telling accident stories is enough to improve safety, however well this is done.

What is needed is persistent active safety leadership by every employee at every level.  This should be focused on the people each individual has the most direct influence on – each team leader’s direct reports and everyone’s fellow team members.

Critically, if senior leaders are not actively leading safely, effective safety leadership, management and risk control will not be widespread at lower levels of their organisation.  Multiple safety pathogens may be present, some in plain sight, without staff even realising that is what they are.  This is a lesson from multiple major accident inquiries.

If you would like to better equip your leaders to be active safety leaders, the new NEBOSH Health and Safety Leadership Certificate may help.  Please get in touch if you would like to find out more.

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