KHAMBHAT, India — A few years ago, when occupational safety activists came to Hydersha Diwan's village here, 300 miles north of Mumbai, he drove them away with threats and bluster.

Today, he wishes that he'd listened.

Doctors say the 50-year-old is dying of silicosis, a wasting lung disease that he contracted inhaling deadly silica dust as a grinder of agates — colorful, semi-precious stones exported to the United States and other Western countries, and commonly used in silver and brass jewelry, rosary beads and home decorations.

“I was a supervisor for a grinding and polishing unit for 10 years or so,” says Diwan. “But when the workers stopped coming, I did the grinding myself for three or four years.”

Once a proud, muscular man, Diwan is hollow-eyed and emaciated, unable to sleep and hardly able to eat because of a relentless, hacking cough.

Throughout a GlobalPost interview with his family members, he slumps on the stoop of his home and coughs. The sound of it is horrible: a dry, futile rasp that yields no relief. It goes on and on, forcing a listener to imagine the sand that fills his lungs. Finally, he reels forward and spits a long, viscous trail of saliva onto the pavement, making it clear why he has positioned himself on the edge of the stoop.

Then the coughing overcomes him again.

Some may call it poetic justice, given Diwan’s hostile reaction to the occupational safety activists.

Diwan's workers “stopped coming” when the deaths of friends of co-workers made it impossible to deny that their jobs were killing them. Some failed to show up because they were dying themselves.

But silicosis is a fate too horrible to wish on anyone, and Diwan only bears a small portion of the blame for the disease that, mercifully, took his life as well, 10 days after he met with GlobalPost.

Agates at a mall near you

An opaque, semi-precious stone, an agate would be familiar to almost any American, even if the mineral’s name isn’t.

Agates vary in color from bright blue to glowing amber and deep black. They yield beautiful striped patterns when cut and polished. In addition to jewelry and rosary beads, they are used for decorative eggs, hearts and spheres and the like. New Age merchants market them as having the power to protect from stress, stomach pain, “energy drains” and even bad dreams. “This is the stone that everyone should have,” asserts one web retailer.

But the stone's silica content means that grinders and polishers are highly susceptible to silicosis, or “grinder's asthma” — an incurable, tuberculosis-like occupational disease. That's especially true in India, where agate workers typically earn less than a dollar a day, and exploitative employment conditions prevent them from adopting even basic safety measures.

According to investigations by the Vadodara-based People's Training and Research Center (PTRC) and the Ahmedabad-based National Institute of Occupational Health (NIOH), agate grinding and polishing here ranks among the world’s most dangerous work. As many as a third of Khambhat agate workers develop silicosis.

Since the grinding and polishing work takes place in sheds and empty lots located in residential areas, it also claims one out of ten of the workers’ children and family members, who breathe the same deadly air.

Because of India's disastrous preference for tiny, unregulated sweatshops over formal sector industries, there's no visible target like Foxconn to shoulder the blame — even though Khambhat exports hundreds of thousands of pounds of polished agate to be sold by US retailers each year.

And virtually nobody in India or abroad is doing anything to stop the killing of Khambhat's stone polishers.

“It's not exactly rocket science. The cause of silicosis among gem cutters is known, and the means to prevent it are readily accessible,” said Brian Leber, chief executive of Chicago-based Leber Jeweler Inc. Leber has done extensive advocacy work to eliminate dangerous and exploitative labor practices in the colored gemstones industry worldwide.

An ancient trade

Once known as Cambay, Khambhat has been an important center for gem and agate processing for hundreds of years. Although the city's traders now source the raw stones from as far away as Africa, and though silt has choked the local river, closing the ancient port, in some ways the agate polishing industry has hardly changed.

Instead of building factories here and in other locations across the states of Gujarat and Rajasthan, agate traders buy raw stones and supply them to so-called artisans who chip them to size, cut and grind them into shape and polish them to a smooth, shiny glow.

Exporters boast of modern manufacturing methods on their websites, or on business-to-business portals like Alibaba.com. But most, if not all of them, use this ancient system of outsourcing.

This enables them to avoid implementing safety standards that would be required under Indian law if they located their equipment under one roof and hired their workers under contract, according to Jagdish Patel, the occupational safety expert who founded PTRC in 1992.

It’s a stretch to call these laborers self-employed. PTRC's survey of nearly 5,000 agate workers found that three-quarters do not own the machines they use. Fewer than one percent buy their raw stones or sell the finished agate. And many take advance payment, or “baki,” that effectively leaves them in thrall to an agate trader, even though all forms of bonded labor are illegal in India.

“Self-employment in agate work is a deceit,” Sudarshan Iyengar, vice chancellor of Ahmedabad-based Gujarat Vidyapith University wrote in a monograph to the PTRC study.

The result is disastrous.

To make agate grinding and polishing safe, manufacturers need to use a combination of water and suction to knock down the deadly silica dust and prevent workers from breathing it.

Because Khambhat's workers are paid a piece rate that averages about $1 a day, they're unable to buy basic safety gear, such as a dust mask. The margins are so thin that even middlemen who employ five or six workers cannot afford the electricity for water pumps and exhaust systems.

“The relationship between traders and workers is temporary,” said Khushman Patel, secretary of an area traders' organization called the Cambay Agate Association. “But we have made some recommendations to the workers about safety.”

According to the agate trader, it is hard to find workers today. “Even the poor send their kids to school and you can't find unskilled laborers,” he said. As a result, local firms are shifting away from products such as rosary beads that require a lot of grinding — the most dangerous process — to more natural shapes that can be created by chipping and polishing.

Throughout Khambhat, however, workers still grind stones into beads by the hundreds of thousands, by pressing them against a clattering vertical wheel that produces a cloud of silica dust. Sometimes they work without even a bandana over their mouths for protection.

Conducting a house-to-house survey in 2010, PTRC identified nearly 5,000 of these cottage industry workers, including around 1,200 workers drilling holes for stringing beads and 700 grinders — who run the highest risk of contracting silicosis.

When GlobalPost visited some of these grinders, a snowy coat of silica dust covered the machines. We could see and taste the silica in the air. Worse still, the processing was being done amid villages where hundreds of people live, often just outside workers' homes.

In one village, 50 paces from a house where another grinder had recently died, two women were grinding agate for beads without water or an exhaust system to collect the dust. Dressed in cheap cotton saris and rubber flip-flops, all they had for protection were the bandanas covering their noses and mouths. A drum polisher, which tumbles the stones together with abrasive materials, sat idle beside them. The air tasted of ozone, and a milky cloud of silica dust caught the sunlight.

“My whole family is doing this work,” one of the women said, desperately. “Do something for us.”

Industry apathy

Jagdish Patel, of PTRC, worked for years to force local traders and government bodies like the Gems and Jewelry Export Promotion Council (GJEPC) to acknowledge that the industry was killing workers. (The secretary of the Cambay Agate Association and the PTRC activist are not related; Patel is a common surname here).

A balding chemical engineer whose cherubic face belies the dogged temperament of a trade union activist, Jagdish Patel traveled to Hong Kong, Geneva and Basel, to protest at trade fairs and meet with officials from the International Labor Organization (ILO) and World Health Organization (WHO).

Only after a damning 2010 report on silicosis in the Indian agate industry by the US-based National Labor Committee did the GJEPC finally visit Khambhat to address the issue.

But when GJEPC finally organized a public meeting to discuss silicosis, it was monopolized by traders who refused to accept that their industry was causing the disease.

According to the activist, nothing substantial has changed.

“We wanted the [gem] council to shoulder some responsibility for this,” Jagdish Patel said. “You do not have any moral right to promote the export of these products unless you shoulder the responsibility for the death and disease. But they are still not doing anything positive.”

A 2010 GJEPC plan to build a safe, common facility for workers, funded by agate traders, could eliminate the worst effects of the industry's loosely regulated outsourcing practices.

But the PTRC activist laments that it has not gotten off the drawing board.

GJEPC says work is progressing.

“The Council is sensitizing the workers of Khambhat with the hazards of the technology which they are using,” Sanjay Singh, regional director, GJEPC Jaipur, told GlobalPost by email.

“A center of excellence is being set up in Khambhat with the help of Government of India and State Government of Gujarat where workers will be trained on machines of non hazardous technology. At this center the workers will be allowed to use the machines for manufacturing the agate gems of their own on payment of nominal user charges. ... The land allotment is in process. It is expected that it will start in a year’s time.”

For many workers and their family members, that will be too late.

A deadly epidemic

Silicosis is virtually inevitable after years of inhaling silica dust, which scars and inflames the lungs. But as little as a few weeks of exposure to high concentrations of silica dust can cause the disease. Once contracted, silicosis itself is incurable and the acute form is fatal. Moreover, it has been shown to cause lung cancer and it makes its sufferers three times more likely to contract tuberculosis, which is endemic in India.

Since PTRC began screening agate workers for silicosis in 2007 in conjunction with doctors at Karamsad Medical College, the non-profit has documented about 200 cases of silicosis among about 700 workers who submitted themselves for testing. More than 70 of those 200 have already died of the disease, forming the basis of an ongoing complaint to India's National Human Rights Commission (NHRC). But there has been little or no relief.

The anecdotal evidence is also grim.

In interviews with GlobalPost in Khambat, agate polishers recounted an epidemic of death among their families and co-workers — telling of manufacturing sites where as many as 15 out of 20 workers employed over the years have died from silicosis.

“Over 10 years, I might have employed 20 or 30 workers off and on,” said 43-year-old Karimsha Husseinsha Diwan. “Most of them have died.”

“Maybe 100 of my colleagues and relatives have died of this over the past 20 or 25 years,” said 51-year-old Bashir Nur Mohammed Malik, an agate grinder who was diagnosed with silicosis in 2012. “Seven members of my immediate family [who worked in the industry] have died — my father, my mother, two brothers and both of their wives, and one sister.”

“Both my father and brother died of silicosis, and my mother has been diagnosed,” said 35-year-old Prakash. “At least 30 or 40 workers from the same 'factory' must have died over the years.”

PTRC's research provides a depressing explanation of why they keep coming back — sometimes even after being diagnosed with silicosis. Almost all of the workers are Muslims or Dalits (once known as “untouchables”) or hail from the underprivileged castes known in Indian legalese as the “Other Backward Classes.” Only 10 percent have any other skill, such as driving a rickshaw or weaving.

Buyer beware

GJEPC's director in Jaipur concedes that there is a problem in Khambhat. But he says that silicosis is not a problem at “other centers” of manufacturing, which are using “different technology.”

While it's impossible to say that there are no safe facilities anywhere in India, activists say that they are rare, at best. And no Indian agate manufacturer appears to be claiming high safety standards for its workers in a bid to attract business from Western companies that deal in “fair trade” or “ethical” jewelry.

Jagdish Patel's PTRC has yet to discover a facility in Khambhat that provides adequate safety measures, after more than a decade of advocacy on behalf of agate workers.

“I've been in the industry 37 years, and to my knowledge there is no [Indian] factory in those beads and cabochons and the type of products you're describing,” adds Eric Braunwart, chief executive of Columbia Gems, who has investigated shifting his production from China to India. “I could be wrong. There might be one in India. But I would be surprised.”

That’s not to say all agate sold in the West is suspect.

In China, Braunwart worked with his Chinese manufacturing partner to develop a low-cost, wet-process exhaust system to protect their grinders. And when Jagdish Patel visited China to document the industry's best practices for traders back home, he also witnessed large-scale agate polishing units that have adopted wet-process grinding techniques and employed exhaust systems to dispose of silica dust.

But agate and gem polishers at other units from China to South Africa are at grave risk of silicosis, according to reports by organizations like Labor Action China, which won a 2.6 million yuan (~ $419,000 USD) settlement in 2010 for Chinese grinders.

Meanwhile, neither the gem nor the agate industry has a mechanism like the Kimberly Process, which certifies “conflict-free” diamonds, or Goodweave (formerly Rugmark), which guarantees that carpets and other products have been manufactured without child labor. So once those stones hit display cases in stores across the US and Europe, it's “buyer beware.”

Exports to the West

Nobody keeps official statistics for India's total agate exports. But a GlobalPost analysis of GJEPC export statistics suggests that perhaps as much as $110 million worth of colored gemstones were shipped to the US between April 2012 and January 2013. By dollar value, the bulk of that comprised emeralds, sapphires and rubies, according to a GJEPC official. But cheap, semi-precious stones like agate may well have accounted for most of the tonnage.

According to documents Patel obtained from Piers Trade Intelligence, a subscription-only database of US waterborne trade activity, and showed to GlobalPost, US-based traders imported around 140,000 pounds of polished agate and similar semi-precious stones from India over five months in 2009. This included nearly 50,000 pounds of polished stones from Khambhat-based Krishna Agate.

Those stones almost certainly end up in malls across America. Some of the country’s biggest retailers, as well as many online merchants and specialty shops, offer agate-based products.

But consumers lack the information to know if a polished agate has contributed to the painful death of workers. Under US law, stores are required to label merchandise with the country of manufacture. Those rules don’t require companies to provide detailed information about where their immediate suppliers source the materials they use in the manufacturing. And traders in this competitive market keep their supply chains confidential. So a product labeled “made in California” may well contain agate that was processed in India.

GlobalPost requested supply chain and safety information from online shops and major retailers selling agate in the US. Some of these companies have strict internal policies against the exploitation of workers, wherever they may live. But most of them did not respond to repeated inquiries, and none provided sufficient information to allow an outsider to verify that they had eliminated dangerous practices from their supply chain.

“Even when it comes to finished jewelry items that lay claims to being 'ethical', things aren't always so cut-and-dry,” said Leber, the jeweler and advocate for better labor conditions in the gem industry.

“For instance, we've seen items being sold by a well-known 'fair trade' retailer that, while they may have been made by a women's co-op in the developing world, utilize gemstone beads that were almost certainly cut ... by cutters who in a couple years will contract silicosis and likely die at a young age.”