During a taekwondo class ten years ago, Evelyn van den Heuvel noticed for the first time that something was wrong. Sometime in April 2011, she could no longer make the ‘turning staircase’ smooth. The opponent is hit hard against the side of the body with a swing of the leg. “At first I was able to finish those stairs very neatly, very beautifully,” she says. “But I was less and less able to keep my balance.”
Van den Heuvel was 26 years old at the time. She was in good health, exercised a lot, “sometimes forty hours a week”. She also flew full-time around the world as a flight attendant for KLM: India, Thailand, Malaysia, many European destinations. This also came to a head from 2011 onwards. Her work increasingly dulled her. Not a little, but huge. During ‘layovers’, the period between the outward and return flight, she sometimes slept for twenty hours at a time in hotels. “Gosh, it’s great that you can sleep so long”, colleagues reacted.
More annoying was that Van den Heuvel was no longer able to help her passengers properly. She started to lunge in her hands or legs – or everywhere at once. In November 2011, she was admitted to a hospital in New Delhi “because of screaming stomach and headaches.” She lay there for a day. “Nobody could find anything, but they should have flattened me on the plane with two morphine injections.”
More than ten years after her first complaints, Van den Heuvel is at home, in Berkel en Rodenrijs. After she was fired from KLM in 2016 due to work refusal, she remained unemployed. Van den Heuvel still gets tired quickly, has difficulty concentrating. Every day after lunch she sleeps for one and a half to two hours straight; her partner helps with the care of their son and daughter on Wednesday afternoons. She cannot afford much effort besides childcare. “It doesn’t get any better than this,” she says.
On April 29, the Centrale Raad van Beroep, the highest administrative court in the field of social security, ruled that Van den Heuvel is entitled to partial disability benefit. Her complaints led to a substantial work limitation, according to the ruling that was only released later. “I felt taken seriously for the first time,” says Van den Heuvel, although she also admits that she was in the way. In conversations with doctors, she initially pretended to be braver than she actually felt.
According to her, after the first report of her complaints to the company doctor at KLM in 2011, there was a vague response. Van den Heuvel: “That doctor said: ‘There may be something of a bacterium or virus in the air, but we don’t know much about that yet.’” The diagnosis was MUS, somatically unexplained physical complaints.
She herself, she told the doctor, had learned something about toxic substances in the cabin air – from burnt oil from the engines – which ended up in the air circulation. Did her miserable situation have something to do with the neurological effects of that ‘aerotoxic syndrome’? “Every time I got off the plane, into the fresh air, I was already feeling better,” says Van den Heuvel. “But those words aerotoxic syndrome were absolutely taboo at KLM, you couldn’t talk about that.” A KLM spokesperson says that he cannot go into the past of former employees such as Van den Heuvel for privacy reasons.
I want to warn those young girls who are going to fly around the world, but come home sickzie
When Van den Heuvel found it no longer responsible to fly in 2012, she was given an administrative job by KLM twice, on the ground. First in 2012, in 2013 again. Planning training courses, checking invoices, putting personnel files in the right folder. Not a job to get excited about, but she was off the plane. Van den Heuvel recovered, had fewer headaches, but still quickly became tired and unconcentrated.
The ax fell in 2016: according to the medical examiner of the UWV benefits agency, Van den Heuvel was 100 percent fit for work. “My illness was not recognized and the doctor couldn’t do anything about it. So then you are healthy and fully fit for work.” The 21 hours she worked at that time was very difficult for her, she told the doctor. “My whole life was dominated by that work; I couldn’t do anything strenuous besides it.” Her request to continue doing administrative work or to be deployed on the Dreamliner – a brand new aircraft with cleaner air – was rejected.
First your health to the buttons, then lost your job, and also no money
When Van den Heuvel subsequently refused to return to work full-time, she was immediately fired by KLM. Because of her refusal to work, she did not receive a disability benefit from the UWV.
It touched her deeply. “First your health is ruined, then you lose your job, and no money at all.” She challenged the decision. When at the end of 2019 the Rotterdam court assessed her as fit for work for thirty hours – still not enough for a WIA benefit – she appealed. “If only to warn all those young girls who are going to fly around the world, but then come home sick.”
The multiple chamber of the Central Appeals Board partially agreed with Van den Heuvel on 29 April. She has too many complaints to be able to work fully, although according to the administrative judge she can handle more than the twelve hours that the former flight attendant herself uses as a maximum. The Council has instructed the UWV to take a new decision based on 21 hours of work capacity (three times 7 hours a week). Van den Heuvel thus became the first ex-employee from the aviation sector to acquire the right to a WIA benefit on the basis of health complaints that, according to her, are caused by polluted cabin air.
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Lack of evidence
The Council leaves the cause of the former flight attendant’s complaints unanswered for lack of evidence. The aerotoxic syndrome has been studied for about twenty years; At the insistence of several European member states and concerned trade unions, European aviation organization EASA is looking at the problem. Dirty air in the cockpit became a major topic in Germany after a 149-passenger German Wings plane nearly crashed over Cologne at the end of 2010 after the pilots became unwell due to dirty air. In the United Kingdom, the death in 2012 of British Airways pilot Richard Westgate attracted a lot of attention. For a long time he struggled with problems such as those of Evelyn van den Heuvel,
It is well established that toxic substances from burnt oil from aircraft engines can end up in the air circulation system, and that people react very differently to this. But then? Measurements by TNO in 2013 showed that there are too few particles in the cabin air to cause chronic health complaints. In contrast, international research by British and Australian experts from June 2017 found such a link. They argued for recognition of the aerotoxic syndrome as an occupational disease.
Neurologist Gerard Hageman of the hospital Medisch Spectrum Twente also assumes a connection between the poison and the complaints. The external expert on whose advice the Central Appeals Board relied, based on Hageman’s research.
‘Pronunciation important to others’
Worldwide, many thousands of pilots, stewards, flight attendants and air marshalls (security officers on aircraft) suffer from complaints such as those of Evelyn van den Heuvel, says former doctor and pilot Michel Mulder. He spent years researching the phenomenon and frequently raised the alarm about it in the media. Mulder is happy that Van den Heuvel came further in April than a sick KLM pilot who was still in court in 2017. “The ruling of the Central Appeals Board may be important for aviation personnel with similar complaints,” says Mulder. The UWV contradicts this. The April 29 ruling stands alone, a spokesperson said.
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Whistleblower Mulder estimates that “at least many hundreds” of people have similar complaints in the Netherlands. “At KLM alone, there are about three hundred of the approximately three thousand pilots, so 10 percent of the total flight crew.” These numbers are at odds with information from KLM, which says it has only received four reports in the past ten years “from employees who suspected that they have an occupational disease due to cabin air”. Mulder says in his medical practice, “to have had at least ninety employees of KLM cockpit and cabin crew with complaints such as that of Van den Heuvel.”
The procedure against the UWV has cost a lot of energy, says the former flight attendant. Van den Heuvel is now standing still, pending the new UWV decision on her benefit. Only then will she make a decision about further steps, such as personal injury proceedings against KLM. “I have already sent the first papers needed for this.”
A version of this article also appeared in NRC in the morning of June 21, 2021