THE KUMASI ORGANOPHOSPHATE POISONING: ALL YOU NEED TO KNOW ABOUT THE HEALTH CONSEQUENCES

INTRODUCTION .

 On Thursday December 6^th 2012, the media in Ghana reported of the incident of an explosion at an agrochemical warehouse in Kumasi.  This led to smoke and gas spillage of the chemicals stockpiled in the warehouse located at Atwima Boko, a small town near Kumasi.  A strong offensive, pungent smell accompanied the spill leading to breathing difficulties for residents around the areas of Abuakwa, Asuoyeboah, Kwadaso, Santasi and other surrounding suburbs. Reports had it that the gas and the accompanying offensive smell were practically spreading to all parts of the city. Several cases of hospitalization of victims who are mostly children were reported.  These chemicals contained organophosphates, compounds used in the manufacture of pesticides and other agrochemicals. Because of the toxic nature of these compounds, the United Nations (UN) under the auspices of the World Health Organization (WHO) put in place three (3) major international conventions to help control the manufacture, distribution (including import and export), storage and use of these chemicals as a matter of Public Health Safety.  They are the;

Rotterdam Convention (1998)

Stockholm Convention (2004)

Basel convention (1989)

Ghana, represented by the Environmental Protection Agency and the respective ministries has ratified these conventions, especially the Rotterdam Convention which we ratified on 30 May 2003. This is to augment the fact that these chemicals can be highly toxic and needs a concerted effort among Governments, State Agencies, NGOs, Traders, Farmers and all other Public Interest Groups to ensure public safety in the manufacture, distribution, storage, use and disposition of these chemicals. This report was commissioned by Samuel Ofori – Agyekum, a Ghanaian medical student to bring the public’s attention to the potential health hazards of prolonged exposure to these chemicals. It should be regarded as such and not to be taken as the final authority document on this subject.

WHAT ARE ORGANOPHOSPHATES?

An organophosphate (sometimes abbreviated OP) is the general name for esters of phosphoric acid. Phosphates are probably the most pervasive organophosphorus compounds.  They are mostly used in the manufacturing of pesticides and insecticides. For those of you in Ghana, most of the agrochemicals you see in the shops contain organophosphates.  But in the final processed form, they cannot be as harmful as the explosion in Kumasi which led to a direct spill. In the 1930s, the German military developed these substances as neurotoxins in World War II. They function as cholinesterase inhibitors, thereby affecting neuromuscular transmission. To the extent that these compounds can be used in war, should tell you of how dangerous they can be to your health, with lethal doses leading to death. 

HOW DO THEY WORK?

These compounds can enter our bodies through broken skin, our lungs when we inhale gas spills or smoke as happened in Kumasi or by mouth.Organophosphates work by a simple mechanism in our bodies. They target an enzyme called Acetylcholine esterase (AChE). The function of this enzyme is to degrade a neurotransmitter chemical  (Acetylcholine) that helps in the transmission of impulses to your muscles at the junction between these muscles and the nerves that innervate them. Organophosphate toxicity stops the action of these enzymes. What happens then is that your muscles continue to receive constant stimulation to the extent where they lose their strength and become very weak. When this happens, you will find difficulty in breathing; your heart will be beating too fast, and many other serious conditions.

HOW DOES IT AFFECT OUR HEALTH?

The Health effects of organophosphate toxicity can be grouped under different classes

1. Gastrointestinal:   They can cause nausea, vomiting, diarrhea, abdominal pain, feacal incontinence.

2. Cardovascular:       Bradycadia ( Slow heart beat), Hypotension ( very low blood pressure). This can lead to fainting/collapse and even death if the heart is not able to pump enough blood to essential organs like the brain.

3.  Respiratory:           Severe respiratory distress (difficulty in breathing), constriction of the muscles of the walls of your bronchioles and cough.

4.  Ocular: Blurred vision,

5. Glands: Excessive Sweating,  Excessive and involuntary shedding of tears.

6. Nervous:  Anxiety, confusion, restlessness, seizures and coma.

Other potential health effects could be paralysis described as acute paralysis secondary to continued depolarization at the neuromuscular junction.

CAN THEIR EFFECTS BE MINIMIZED? AND HOW?

Yes. Their effects can be minimized through medical care. It is not the purpose of this report to offer specific medical solutions. Victims are advised to report to the nearest health facility for care. However, the immediate at-home solution is to wear protective nose masks to limit inhalation of these poisonous chemicals.

DISCLAIMER:  I do not intend to suggest, by this publication, its dissemination or otherwise that this the final authority document on organophosphate poisoning or toxicity. It is purely intended for educational purposes and should not be used as a substitute for expert medical advice based on special information available to the practitioner which I may not have access to. Because this is intended for public use, all medical details have been avoided as much as possible.