“If TB/HIV is a snake in Southern Africa, we know that its head is in South Africa in the mines,” stated Health Minister Dr Aaron Motsoaledi.
Paula Akugizibwe from the Aids and Rights Alliance for Southern Africa (ARASA) stressed that the mining sector, which she referred to as a “TB factory”, was over a century behind schedule with regards to its TB response.
The South African Gold Mining Industry may well have the highest incidence of TB in the world, with cases ranging from 3000 to 7000 per 100 000 miners per year, according to the South African Department of HealthTuberculosis Strategic Plan for South Africa 2007 – 2011.
Nationally, the overall TB incidence is estimated to be 920 per 100 000 for 2008 according to the WHO.
The World Health Organisation (WHO) declares a health emergency when the TB incidence is 250 per 100 000 per year.
Each 10% increase in mining is associated with a 0.9% higher rate of TB incidence in sub-Saharan countries, according to a study released in the American Journal of Public Health by Dr David Stuckler and colleagues last week.
The study suggested that the mining sector could be responsible for more than 700,000 cases of incident TB in sub-Saharan Africa every year and showed that, independent of HIV, there were significant associations between mining production and TB incidence in countries with high HIV prevalence.
“If we look at the response relative to the magnitude of the problem of TB and HIV in the mines, the mining industry is driving a wooden wagon of circa 1903,” stated Akugizibwe.
In 1903, the Milner Commission set up to which look into the problem of TB in the mines issued its first report.
According to this report, “The extent to which Miners’ Phthisis [TB] prevails at the present time is so great that preventive measures are an urgent necessity, and that such a large number of sufferers in our midst is a matter of keen regret.”
Akugizibwe called TB in the mines issue the “greatest public health threat ever and a human rights scandal”.
Professor Gavin Churchyard of the Aurum Institute described it as “a public health disaster that is unprecedented.”
Silicosis (dust from gold production) does not exist in most countries, except in South Africa.
The association between silicosis and tuberculosis has long been recognized. Rates for active tuberculosis in silicotic subjects range from 2- to 30-fold more than those
in the same workforce without silicosis, according to a review published by Jill Murray of the National Institute for Occupational Health in South Africa. The risks of silicosis and HIV infection exponentially increase the risks of TB in gold mineworkers.
In 2003 the South African mining sector launched an initiative to eliminate silicosis and developed targets for silica dust reduction. However, –Churchyard pointed out that the elimination of silicosis would require dust levels to be at least 50% lower than the targets that have been set by the sector.
Meanwhile, Stuckler’s study showed that gold mining greatly increased TB incidence independently of HIV. This was possibly because of silicosis as well as the confined environment in mines and hostels that is conducive to TB transmission. According to Goldfields, there were 1778 new cases of Silicosis in 2009 in the company.
A former mine worker from Lesotho who attended the conference said that, after contracting TB in 2007, he was dismissed. He has since had to make several taxing and costly trips between Maseru and Johannesburg in his efforts to secure the compensation to which he is legally entitled, but is yet to receive.
According to ARASA, the compensation system for mine workers is rife with legal and other challenges, including that miner workers get worse TB compensation than other workers.
The process of assessing compensation claims is slow and extremely bureaucratic. A 2005 audit by Deloitte found that the Compensation Fund was insolvent and that mining companies’ levies (paid by companies to the Compensation Fund due to the occupational risks for developing TB in the mining sector) would need to be substantially increased in order to cover the deficit. Over the 21 month period during which the audit was conducted, only 400 of the 28,000 claims submitted were paid out.
Currently, the burden of responsibility for this shortfall is being shifted between different government departments and the mining sector, and disagreements between the Chamber of Mines and the Department of Health about who should be held responsible for correcting the compensation fund’s deficit have resulted in a court case that will be heard later this year.
However, Mr. Eric Gclilitshana, the NUM’s National Secretary for Health and Safety warned that the union wwould not support litigation against the mining houses, because experience has shown that “litigation does not benefit the ex-mine worker, as all the funds go to the lawyer’s fees”.
However, Lynette Mabote from ARASA expressed concern about this view, saying that “former mineworkers, whose labour built our economy, have been left to the mercy of a system that was historically designed to maximise exploitation and impunity.”