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4. Cardiovascular assessment at Tintaya studies potential high-altitude health risks to employees' children
Our Tintaya copper operation is located at Espinar in the Peruvian Andes, 4000 metres above sea level. Recent medical reports from China indicated that life at high altitudes may pose a risk to cardiovascular function of children. Our medical team at Tintaya, concerned at the reports, decided to conduct an assessment of the children of families living in the employee accommodation quarters. A full cardiovascular examination was carried out; and, in general, it was found that the children's growth and cardiovascular functions were healthy. The conclusion from the assessment was that the children at Tintaya were fundamentally healthy and that life at high altitudes does not represent a risk to their health, growth or cardiovascular function.
Many communities in Peru and throughout the world live at high altitudes. When mining projects are established at high altitude, they encourage the migration of workers and their families, who then live at or near their workplaces. In high-altitude environments, the amount of oxygen decreases progressively with altitude. Acclimatisation and adaptation mechanisms in the body are triggered, particularly at the cardiopulmonary level, in order to lead a healthy life at the high altitude.
The medical reports from China concerned the Tintaya medical team because they included cases of severe pulmonary hypertension in children, some of which were fatal. To conduct the study, the team engaged the support of noted specialists in the field, including Dr Susan Niermeyer, a well-known paediatrician, neonatologist and researcher of high-altitude impact on children at The Children's Hospital of Denver; Dr Luis Huicho, a paediatrician at the Child Health Institute in Lima; Dr Emilio Marticorena, a cardiologist with over 35 years' experience and research at high altitudes; and Dr Edgar Gloria, a cardiac ultrasound specialist with paediatric experience from the National Heart Institute of Lima.
The assessment was carried out between October and November 2002. A total of 326 children were examined, representing 98.5 per cent of all the children residing at Tintaya. The few not included were away at the time. Conducted with the full consent of the families, the project involved a range of components including:
- a home survey to identify all the children living at Tintaya, their place and date of birth, population ancestry, time of residence at the site, travel undertaken, and family and pathology history
- information sessions with parents and teachers
- assessment of the children's body size, proportions and vital signs
- medical assessment
- electrocardiogram
- ultrasound of the heart
- haemoglobin measurement (testing one drop of blood obtained by micropunction).
The project was not without its challenges. Apart from assembling the team of specialists and coordinating the children's availability through the two-week exercise, cardiovascular assessment of children of various age groups requires infrastructure and equipment tailored to the purpose. Portable medical equipment was made available, along with electrocardiogram and ultrasound equipment suited to the smaller body sizes of children.
The assessment was coordinated with the families and schoolteachers, so the children could be available for their medical examinations without interfering with their schooling. Vehicles were made available to transport the children to the hospital and then return them to the school or to their homes.
The results showed that, although there were identifiable differences in cardiovascular development, most children examined enjoyed good health, full activity and normal growth. No cases of symptomatic high-altitude pulmonary hypertension were identified. Five cases of congenital cardiopathies were discovered, representing 1.5 per cent of the children in the study; this percentage is not statistically different from figures found in populations living at sea level. The five children received appropriate medical treatment for their condition.
The conclusion that the children at Tintaya were fundamentally healthy and that life at high altitudes does not represent a risk to their health, growth or cardiovascular function must be interpreted in light of the population resident at Tintaya. Most children have some native high-altitude ancestry that likely aids in their adaptation to the environment. Other populations, such as the Han (Chinese) or northern Europeans, who do not have a genetic history at high altitude, may respond differently.
The scientific knowledge gained from this study is being made available for use in other research projects into children's health, with particular benefit to the thousands of communities living at high altitudes around the world.
