TB: Miners hardest hit

Mineworkers in South Africa are believed to be the population worst affected by tuberculosis in the world. Wilma Stassen explains why.

Wilma Stassen

MUSA Ernest Nkoko is a 52-year-old ex-miner with multi-drug-resistant (MDR) tuberculosis. He lives in KaShoba in the Lubombo region of Swaziland with his wife and five children aged between 9 and 27 years. Co-infected with HIV, Nkoko says he has been on treatment for MDR-TB for the last four years. The disease has diminished Nkoko's lung capacity and rendered him too weak to do any work, and he and his family rely on his wife's income as a part-time cleaner.

In the early 1980s, Nkoko boarded a train to South Africa to work in the mines. He was employed as a general labourer in the old Vaal Reef gold mine, now known as Anglo Ashanti Gold. After nearly 16 years of working in the stopes - the frontline where the actual gold reef is mined - Nkoko developed lung problems, and shortly after he was retrenched and repatriated to Swaziland. Since his return home, Nkoko suffered with lung problems that made it difficult for him to find and retain work to provide for his family. Eventually he was diagnosed with MDR-TB in 2008 and has been on treatment ever since.

Apart from the normal retrenchment package owed to workers, Nkoko hasn't received any compensation or support from the mine for the lung disease he contracted during his time there.

Why miners are at increased risk

Mineworkers in South Africa are believed to be the population worst affected by TB in the world. According to the Chamber of Mines, 2,984 of every 100,000 mineworkers develop TB, although others believe the number to be as high as 7,000 per 100,000. To put the numbers into perspective, in Swaziland - which is considered to have the highest TB-infection rate in the world by the World Health Organisation  - only 1,200 per 100,000 population are infected.

There are various explanations for the high rate of infection among mineworkers. The most important of these is HIV, which makes a person more susceptible to developing TB. Mineworkers are at a higher-than-normal risk for acquiring HIV due to the fact that they are often separated from their wives and families and may therefore partake in risky sexual activities.

A second big risk factor adding to the high rate of TB among miners is silicosis. This lung disease is caused by the inhalation of silica dust, which is commonly expelled during gold-mining processes. Silica damages the lungs' defence mechanisms, increasing the risk of TB infection 10-fold. Silicosis is irreversible and a person is at heightened risk of TB for the rest of his life, even after leaving the mines.

Another important factor adding to mineworkers' increased risk for TB is their migration pattern. Treatment for TB and other diseases is often interrupted or stopped when migrant mineworkers leave South Africa to return home to neighbouring countries.

'There is believed to be as much as $2.5 trillion under the ground [in mineral wealth] in South Africa - which is good news for the country's economy, but bad news for mineworkers,' said Joel Spicer of the Stop TB partnership at a recent media briefing. The 'bad news' he was referring to is the high rate at which mineworkers are suffering and dying from TB, a preventable and curable disease.

'Fatalities from TB in mines are much higher than those of mine accidents, yet the media gives much more coverage to mine accidents,' said Dr David Mametja from the National TB Programme in South Africa. Peter Baily from the National Union of Mineworkers (NUM) concurred, saying that for every fatal accident, five mineworkers die from occupational disease.

Professor Jill Murray of the National Institute of Occupational Health pointed out that although all accidents in mines are investigated, there are no enquiries into TB deaths, which far outnumber accidental deaths, 'although it is provided for in the [Occupational Health] Act'.

Although there are regulations in place to manage silica dust exposure among mineworkers, few mines uphold the necessary standards as the regulations are not enforced. 'And if one considers the state-of-the-art machinery used to mine for gold, the mining companies should really be doing a lot more to control silica dust exposure,' said Murray.

'Exporting' TB

Mametja pointed out that TB among the mining population is about more than just the individual's health - it also affects the health of the mineworkers' family and community, often crossing international borders. According to a position paper by the South African Department of Health, the migrant workers employed in South African mines have established a pattern of 'oscillating migration', where they move between urban and rural areas and across borders. As a result, the TB acquired in the mines has the potential to fuel TB transmission in the workers' home region.

Oscillating migration in South African mines has been shown to perpetuate the TB epidemic in Lesotho. A recent study showed that close to 40% of adult male TB patients in three of Maseru's main hospitals were working, or had formerly worked, in South African mines. Furthermore, at least 25% of drug-resistant TB cases treated in Lesotho since August 2007 had a history of work in the mines or were referred directly from the mines in South Africa.

This 'export' of TB from South African mines has led to efforts by the South African ministries of health and minerals to join forces with other Southern African countries, especially Lesotho, Swaziland and Mozambique, to collaborate on patient monitoring and treatment efforts in the region.

The South African government also recently showed its commitment to fighting TB when President Jacob Zuma announced the goals of the National Strategic Plan on World AIDS Day last year to achieve zero TB and HIV deaths. Furthermore the South African Ministry of Health commemorated World TB Day on 24 March in a mine complex to highlight the severity of this issue among the population of mineworkers. - Health-e news service (www.health-e.org.za)

*Third World Resurgence No. 261, May 2012, pp 6-7