Poor man's choice

Many Longtanzi villagers who suffer early stage black lung disease keep working in the mines. Those unable to carry on return disabled and soon became debt-ridden with mounting medical bills and no incomes.

Three days after Wu Licheng's father died of the disease, the 32-year-old and his wife are hurrying back to their jobs at the same gold mine where his father had worked.

"I was diagnosed with advanced black lung in 2008. Doctors told me I need to live in a dust-free environment. But I have to feed my family and repay the money we borrowed for my father's treatment. What choice do I have?" Wu asks.

Most villagers who work in mines are employed by sub-contractors rather than the mine owners, making it difficult to seek compensation, says Li Daoping, the village official.

Miners with black lung often conceal the disease from their employers for fear of losing their jobs. "The owner will simply say you can quit if you feel sick," Wu Licheng says.

Liu Zenglian, wife of Wu Lijun, a critically ill patient, says, "My husband relies on medicine to breathe and suffers from immense chest pain. The treatment has already cost us 50,000 yuan."

Liu is the family's only bread winner. All their income comes from a plot of 0.13 hectares, just enough to feed the family with two children.

"Every year we have to borrow money to cover the 6,000-yuan tuition and accommodation fees for my 14-year-old daughter and 10-year-old son," she says.

"Now nobody will lend us money if they know we are borrowing to treat black lung. They know the disease costs much and there is no way we can pay them back."

Different priorities

The Guanfang township government, which administers Longtanzi, has a fund of 100,000 yuan to help not just black lung patients, but all needy residents, allowing a maximum of 1,000 yuan per family.

The small subsidies make little difference in the cost of treating black lung, a chronic disease that can cost hundreds of thousands yuan.

In the past, many state-run enterprises had their own medical facilities for occupational diseases, where the workers had free treatment, but most of those facilities have disappeared, says Deng Chunming, deputy head of the Yunxi County Center for Disease Control (CDC).

To cut costs, most small gold and coal mines, where the risk of getting black lung is highest, take no safety precautions. Very few companies hold regular health examinations for their workers, he says.

Yunxi CDC has the county's only clinic dedicated to occupational diseases, but it saw just 60 patients from four enterprises last year.

"Most patients were sent here after health authorities urged their employers. We never saw a worker come here on his own," says Deng.

Occupational illness risks are not a compulsory evaluation. With or without it, a project can be approved. Health authorities cannot intervene even if they found a project fails to meet the standards, says Yin Yaoyun, head of Yunxi's health supervision department.

"It's very difficult to hold small companies to account for occupational diseases. It often takes a dozen visits to find the owner of a small mine," Yin says.

If a regulatory department imposes a penalty on a large company, the local government will try to impede execution of the penalty, he says.

"We fined a cement plant, a major taxpayer in the county, 50,000 yuan. But other authorities forced us to abandon the penalty," Yin says.

Pneumoconiosis is China's main occupational disease. At least 600,000 Chinese have been diagnosed with the affliction since the 1950s when the Ministry of Health first ordered cases to be reported. Li Hongde, a senior occupational disease expert at the Chinese Center for Disease Control and Prevention, says it has killed 130,000 people.

Of the 20,000 people diagnosed with occupational diseases every year, 15,000 are black lung patients, he says.

Employers should bear more responsibility in preventing and treating occupational diseases, according to Health Minister Chen Zhu.

The ministry has urged local government authorities to coordinate efforts to prevent occupational diseases and implement penalties on employers who fail to observe safety regulations.

But the health risks are not the main issue in Longtanzi. "How can I refuse a job that pays thousands yuan a month?" villager Wang Zongguo asks an official, who is trying to dissuade him from working in a gold mine. "Stop talking, I've made up my mind."