The old women and young mothers herding sick children gather after sunrise on the brown wooden benches just outside the clinic. At 9 a.m., still more than an hour before the doctor's arrival, health aide Vivian Harmer leads the wheezing congregation in prayer.
When the doctor finishes his four-hour visit, 40 people have traipsed through the tiny office and examination room. All have blamed the fine, gray alumina dust spewed by the Alpart refinery two miles away for their respiratory problems.
Short of breath and, increasingly, of patience, those living near Jamaica's bauxite mines and alumina plants have been brushed off by authorities as isolated complainers, their claims of ill health as nothing more than anecdotal.
But fresh evidence of a link between emissions and respiratory illness, coupled with a rising militancy among those who say the operations are poisoning their neighbors, has raised the question of what Jamaicans are willing to pay to develop their second-largest industry.
"It's not just the people who are choking to death. Look at my fruit trees! Look at my roof!" Udel Lloyd, an asthma sufferer, says, pointing to the rot and rust on her zinc-coated corrugated roof that was new four years ago. Her home flanks the railroad tracks serving Alpart. Sprinkled with the almost invisible dust from boxcars carrying the alumina to nearby Port Kaiser, Lloyd's mango and ackee trees bear misshapen black fruit.
A feisty 73-year-old, Lloyd says those living near the refinery despair of getting officials in Kingston, the capital, to deal with the problem.
"That's the Big Man over there," she says, gesturing toward Alpart. "What he want, he get. He make money for the government. Nobody in the government cares about us."
Residents of the bauxite- alumina sites, mostly in these undulating southwestern hills around Mandeville, have complained throughout the industry's half a century of operations here that their ailments stem from exposure. Health studies elsewhere have linked bauxite to hypertension and alumina dust to asthma and sinusitis. Jamaican authorities dismiss the complaints of illness.
Officials reject requests for compensation, medical treatment or corrective measures on the grounds that there is no statistical proof of causation from the processing of bauxite into alumina, the key element for making aluminum.
Complaints from thousands of Jamaicans about asthma, sinusitis and children with birth defects have prompted a militant minority to challenge what it describes as the Caribbean nation's see-no-evil policy. Angry demonstrators have clashed with police and set fire to company trucks.
"We don't think there's a connection, we know there is," says Courtney Gill, a 33-year-old former plant maintenance worker. He has twice placed his 9-year-old son, who suffers from cerebral palsy, in the path of a train to draw attention to the community's problems.
"He don't know what's going on, so he isn't scared," Gill says of the boy, also named Courtney. "I put my Bible on the tracks to mark where I would have to take him off if the train didn't stop, but it did both times."
Most of the asthmatics reject such extreme action but are angry nonetheless.
"They give people a few dollars so they'll go away and be quiet," Una Holness, a retired nurse's aide, says of the alumina plant managers. "But what is a few dollars in exchange for your health?"
Holness returned here five years ago after working two decades in New York City.
"At night, I cough until I vomit," says the 70-year-old, who says she has never smoked. "It's from the dust. I know it. Sometimes it falls so thick, it looks like snow on the veranda."
Even before community concerns escalated to public protest, the complaints of illness caught the attention of University of the West Indies medical student Patrece Charles-Freeman. After an exhaustive study of emissions and medical records within a 10-mile radius of the Halse Hall bauxite-alumina operation in neighboring Clarendon parish, Charles-Freeman this month submitted a doctoral thesis documenting dramatically elevated incidence of asthma, sinusitis and allergies among those living close to the mining and refining operations.
In her study of 2,559 people, Charles-Freeman found that 37% of adults and 21% of children living within six miles of the facility suffered sinusitis. Asthma afflicted 23% of adults and 26% of children. Allergies, likewise, were markedly more prevalent among those who lived closest to the plant than in control groups seven to 10 miles distant.
The industry needs to investigate the negative effects and implement corrective measures," Charles-Freeman says, outlining the recommendations detailed in her thesis.
Until three years ago, the four industrial complexes guided by the Jamaica Bauxite Institute issued periodic checks to the most persistent complainers, of about $17.
Although the Health Ministry provided Charles-Freeman with equipment and staff to conduct her environmental health study, she said the institute and the industrial enterprises - all part-owned by the government - refused to provide her their monitoring data and at times attempted to thwart her investigations.
"Jamalco threatened to cut off water to people if they cooperated with the study," she says of the alumina producer in her study area, an enterprise owned by the Jamaican government and Alcoa.
Jamalco referred inquiries to Alcoa headquarters in Pittsburgh, where spokesman Kevin G. Lowery said no one at the Clarendon plant recalled having contact with Charles-Freeman but that some monitoring data were available in periodic reports made to the government.
Alpart spokesman Lance Neita likewise said air quality data were supplied to the Jamaica Bauxite Institute. He declined to discuss other issues.
The Health Ministry's chief medical officer, Barrington Wint, says the bauxite-alumina industry hazards have gone unstudied because of a shortage of funds and more urgent priorities.
One study underway at the International Centre for Environmental and Nuclear Sciences at the University of the West Indies is measuring how deeply bauxite and other heavy metals have penetrated the food chain. The center's director, Gerald Lalor, notes that the soil around Mandeville is also replete with cadmium, mercury, lead, arsenic, uranium and other elements known to pose health risks to humans.
"It's a very tricky business because there are so many variables in the picture," says Lalor, who shares Wint's view that little attention has been paid to bauxite and alumina health risks because Jamaican authorities are overwhelmed by other problems, such as high HIV/AIDS incidence and the worst murder rate in the Caribbean.
Those officially charged with ensuring that bauxite mining and alumina refining are done safely contend there is no reliable evidence that exposure to alumina dust is harmful. They attribute the claims of illness to economic motivations.
"We have long recognized that when the so-called environmental lobby came in, most of the problems had nothing to do with the environment. They are social and economic problems," said Parris Lyew-Ayee, managing director of the Jamaica Bauxite Institute, responsible for keeping Jamaica competitive in the world alumina market and protecting the environment.
Jamaica is the only major bauxite source where the mines are in populated areas, Lyew-Ayee said, noting that the deposits in Australia, the biggest producer, are in the outback. Neither the mining of bauxite nor its processing into alumina is very labor-intensive, so the operations provide few jobs for the surrounding communities of farmers. Although the $773- million industry is Jamaica's most lucrative after tourism, fewer than 5,000 people are employed in it across the country.
Lyew-Ayee disparages Charles-Freeman's research as unreliable because it covered only a small area. He dismisses claims of roof damage from dust as the fault of inferior materials. As for crop failures and stunted fruit growth, he said species grown by the industry on reclaimed land prosper and that the problems elsewhere are "not from alumina dust - any dust can cause that."
Having entered the fray amid the free-market frenzy that gripped Jamaica in the first years after its 1962 independence, bauxite's early industrial chieftains amassed power and autonomy on a par with the departed colonial masters. The first mining operations, contracted with foreign giants such as Alcoa and Kaiser of the U.S. and Alcan of Canada, required nothing in the way of post-mining reclamation. Though the institute has imposed tougher standards during the last decade, the industry remains self-regulating and driven by official edicts to keep costs down.
The Water Resources Authority oversees ground water quality and has determined that wells close to the alumina operations exceed the World Health Organization's acceptable levels for sodium by as much as 400%.
At the farm of Pauline Wellington, rainwater is collected in a cement spillway running downhill into a sunken cistern. The water picks up the alumina dust, washing it into the drinking-water system she shares with her father and six children.
"We are slowly dying inside," she says.
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