Felix Jakens, Grassroots Campaigns Manager at RESULTS, was recently asked to write an article on TB in the gold mining industry in southern Africa for the Medcin magazine . Here it is in its full glory:
“If TB and HIV is a snake wrapped around the continent, then the head is here in South Africa, and the fangs are in the mining industry” Dr Aaron Motsoledi, Minister of Health, South Africa
When I was asked to write a piece for the Medsin magazine titled ‘how the mining industry costs lives’ I was slightly taken aback: I have 800 words to try and document a topic as vast as that? That can’t be done. Of all of the world’s industries, I would be as bold as to say none has exacted such a heavy loss of human life as mining. From Greek slaves being worked to death in Rome’s salt mines, to early coalmine shaft-failures in Wigan and Newport, to collapses in modern China as illegal mines strip rare minerals from the earth to provide parts for mobile phones, many lives have been lost as we seek to extract all manner of objects from the earth.
So in an issue with so much death, drama and catastrophe who spares a thought for the men who survive ‘life at the mine’ only to take home with them a death sentence? A cave-in at illegal mine in Zimbabwe causing 20 deaths will make headlines around the world; but gold mining activities being directly linked to 760,000 new cases of deadly tuberculosis and many thousands more of degenerative silicosis, each and every year?
That isn’t a story; and yet this tragedy is unfolding on a scale that we can barely begin to imagine.
South Africa already has the second highest incidence of TB in the world with an infection rate of around 1,000 per 100,000 population; while among gold miners the rate rises to approximately 7,000 per 100,000 (the UK is around 14). That’s around one in three cases across the sub region and around 9% of the total burden; what’s more, data on this issue is sketchy at best, with many hundreds of thousands of men having worked in the mines who no longer identity as ‘former mine workers’ but who has suffered from extremely high exposure to silica dust and TB bacterium. This group has been described as ‘ticking time bombs’.
But why are miners in the region so uniquely vulnerable?
Epidemiologists refer to a ‘perfect storm of disease’ in which physical, biological and social factors combine to create the highest rates of TB in the world. Exposure to silica dust, HIV infection, difficult working conditions and poverty come together to create the highest TB infection rates in the world.
Around 90% of all the miners working in the South African gold mines migrate from rural areas or from neighbouring countries. High levels of poverty and unemployment mean a job in the mines is often the only work available. These men stay in cramped, single-sex hostel-style accommodation which leads to high risk of HIV infection; miners in Southern Africa have HIV infection rates of around 30%, which is very high. Being infected with HIV and the resulting weakening of the immune system makes a person 20-30 times more likely to develop TB.
In the mines themselves, the cramped, hot working conditions are highly conducive to the spread of airborne TB bacteria. Miners are provided with protective masks but their size, and the heat of the mines, means they are often taken off, leaving miners exposed to silica dust and TB bacteria. Measures to prevent the spread of TB, such as air circulation and ventilation are extremely difficult to implement in the mines, which can be many kilometres deep with tunnels as narrow as two metres wide.
A miner working without protective apparatus exposes himself to silica dust. Silica dust is found in gold mines and is easily inhaled. Once in the body the lungs cannot remove it and it can lead to a disease called silicosis, where lung function is impaired and has a variety of harmful effects. One of these is that silicosis damages the lungs and renders an individual around three times more likely to contract TB.
Given the immense damage being done to miners and their communities, one would assume that this is a problem which has surface in the recent past; again you couldn’t be more wrong. In 1903 the Milner Commission Report into TB among miners stated “the extent to which TB among miners prevails at the present time is so great that preventative measures are a an urgent necessity”
So why has so little been done to stem this tide of misery? Again, in an issue so strewn with paradoxes, the interventions needed to tackle the issues of TB, HIV and silicosis are well know and cost effective. Prevention exposure to silica dust through introduction of dust dissemination technology, reducing single sex hostel style housing, ensuring on site diagnosis and treatment for workers and many others are well documented and proven to be effective.
To frustrate the issue further, sector wide application of these interventions would yield an overall positive financial gain to mining companies. A World Bank economic analysis of the issue estimated that an upfront spend of around $750 million would provide a benefit of $800 million by reducing loss of working hours, amount of training needing to be provided, healthcare costs etc.
So despite this issue being clearly understood for over 100 years, with proven cost effective interventions widely known, hundreds of thousands of miners still contract TB every year. But why?
Again, as we keep returning to, the answer is not simple, there are several interconnected factors. Firstly the mines themselves have a serious case to answer. From minor lacks in compliance to outright flouting of health and safety legislation, the mines are a major player in this issue. The Government of South Africa and surrounding countries can also do much more. In SA itself the compensation system for ex-mineworkers is archaic beyond repair and desperately needs to be overhauled.
Currently the fine levied against mines that breach health and safety legislation is too weak to be effective against multi-billion pound mining companies; the importance of mining to the South African economy clearly has an influence over the decisions of government. Unions also must have a case to answer. One accusation is that once these men leave the mines to return, sick, to their communities they are ‘out of sight out of mind’; no longer paying union dues and in some of the most remote, rural areas of the region. Donor governments can and should do more for these communities; using their leverage to increase pressure on all actors to do more to tackle these epidemics.
Looking back, it isn’t hard to understand why so few people are aware of this issue. When a mine collapses its clear who is at fault; the issue flashes into our minds and we can make clear judgements about blame and recourse. With an issue like TB the people who die are out of sight, in rural communities, away from the glare of the press. They die slowly, contracting silicotic TB years after they leave the mine. These men are poor, often abjectly so, with little capacity for recourse, and they have been dying in their thousands since the inception of mining.
But that can’t be where we end, and RESULTS, along with Medsin and our partners around the world are working tirelessly to raise the awareness and create the political will to have a lasting and positive effect on the lives of miners, their families and their communities.
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