The gold-mining sector came under heavy criticism from clinicians, ex-miners, advocacy groups and the Minister of Health for the tuberculosis crisis it faces at the recent South African TB Conference, held in Durban from 1 to 4 June, 2010.
“If TB/HIV is a snake in Southern Africa, we know that its head is in South Africa in the mines. We are exporting TB and HIV throughout the region,” stated the South African Minister of Health, Dr Aaron Motsoaledi during the conference’s opening plenary.
Paula Akugizibwe, of 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 in its response toTB.
The South African Chamber of Mines, along with medical officers from the largest mining houses, such as AngloPlatinum and Goldfields, described the best practice interventions and guidelines that have been developed and implemented in the mining sector, at a symposium on TB in the mining industry hosted by the Chamber of Mines at the conference.
Why is there a TB problem in South Africa’s mines?
Mineworkers are at increased risk for developing TB as poorly ventilated conditions in the mines and hostels increase the risk of transmission. Silica dust increases the risk of developing TB. Migration back and forth between home and mine reduces the likelihood of diagnosis and increases the chance of treatment interruption and failure. Health care for mine workers is often poor and TB screening by employers is inconsistent and unverified, as outlined in a study published last week by researchers from Oxford University and the London School of Hygiene and Tropical Medicine.
Interventions by the mining sector outlined at the symposium included the production of resources which outline the responsibilities of mining houses to address TB, such as the Safety in Mines Research Advisory Committee Handbook of Occupational Health and the Department of Mineral Resources (DMR) Guidance Note for TB Control produced in 2001.
A TB Review Tool which audits TB programmes in mines has also been established.
There are also efforts to provide isoniazid preventive treatment (IPT) to all HIV-positive miners and a Dust Team to address silicosis in the gold mines has been instituted, through the Mine Industry Occupational Safety and Health (MOSH) Best Practice Adoption System which aims to facilitate widespread adoption of knowledge, technology and practice in order to improve health and safety performance in South African mines.
Additional efforts are also being made to address the risk factors that place mineworkers at increased risk for developing TB,such as phasing out the hostels where mineworkers live in overcrowded conditions. ‘Living-out allowances’, to support mineworkers living outside of hostels, are being paid and financial support for home ownership is being made available.
However, activists and clinicians presenting at the session questioned if these interventions were enough.
‘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 look into the problem of TB in the mines – stated that, "the extent to which Miners’ Phthisis [TB] prevails at the present time is so great that preventive measures are an urgent necessity".
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 Health Tuberculosis 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 World Health Organization, which declares it a health emergency when the TB incidence of a country is 250 per 100,000 per year.
Silicosis (an occupational disease caused by inhaling dust from gold production) is very rare in most developed countries, but is widespread among miners in South Africa and other developing countries.
The association between silicosis and tuberculosis has long been recognised. Rates for active tuberculosis in silicotic subjects are 2- to 30-fold higher 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, Professor Gavin Churchyard of the Aurum Institute 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. According to Goldfields, there were 1778 new cases of silicosis in 2009 among the company’s employees.
According to ARASA, the compensation system for mine workers is rife with legal and policy challenges, including the fact that miner workers get worse TB compensation than other workers. 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 (approximately 350km apart) in his efforts to secure the compensation to which he is legally entitled, but is yet to receive.
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 (1.4%) 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 National Union of Mineworkers’ National Secretary for Health and Safety, warned that the union would 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 lawyers' fees”.
Lynette Mabote from ARASA expressed concern about this view, saying that “former mineworkers, whose labour built [the South African] economy, have been left to the mercy of a system that was historically designed to maximise exploitation and impunity.”
Prof. Churchyard added that greater accountability was necessary. “When deaths are caused due to mining accidents, companies are held to account. No one is held accountable for the deaths caused by TB in the mining industry. This is an unprecedented public health disaster and urgent action is needed.”
South African Chamber of Mines, Satellite Session: TB and the Mining Industry. 2nd South African TB Conference, Durban, 1-4 June 2010.
Murray, J et al. Occupational respiratory disease in mining. Occupational Medicine 54:304-310, 2004.