TB and Mines: Caring for miners is our business

Alice Tembe, CNS Correspondent, Swaziland
‘The fear of the immigration system, the stigma, and loss of jobs, has driven mine workers away from accessing the TB services they need’, this was the statement made by an ex-mine worker during the launch of a ‘TB and the Mines’ partnership project that Swaziland has embarked upon in collaboration with South Africa, Lesotho and Mozambique.

The National TB Control Programme Director, Mr. Themba Dlamini noted that, “Despite that there are mainly just two mines in Swaziland, many of the people are working in mines in neighboring South Africa.” Mr. Dlamini, explicitly noted that investing in this project is investing in the protection of the whole country. The project was hatched to respond to TB in the mines based on the premise that:

•Swaziland has the highest TB burden( 1380 per of 100000 incident TB cases occurring annually)
• TB/HIV co-infection rate has remained above 80%
• HIV Treatment uptake among HIV positive TB patients has always been low with significant increases noted only in 2011
• challenges in controlling the TB situation are compounded by the continued increase in drug resistant TB cases in the country to unusally high levels

Ms Victoria Masuku, the Project Coordinator, who is leading the ‘Strengthening Systems and Empowering Southern African Communities Project’ explained that, there are about 2,000 registered mining companies in South Africa, and they employ about 500,000 mineworkers. Approximately 40% of these mineworkers are from Lesotho, Swaziland and Mozambique. She noted that mineworkers in the Southern Africa sub-region have some of the highest TB incidence rates in the world.

The TB and Mines Project is aiming to reduce TB mortality and morbidity amongst the mining population through improving access to quality TB services, ensuring a continuum of care by miners, ex-miners and their families. However the main challenges faced in achieving this are:
(i)    lack of clear data on the size of location of miners & ex-miners
(ii)    Absence of TB treatment protocols which currently screen for mining as an occupational risk factor
(iii)    Weak  coordination and reporting of extension of services to miners and ex-miners
(iv)    Lack of a clear multi-sectorial approach to addressing TB and its associated key risk factors/social determinants
(v)    Lack of Policy and legislation to treat TB as an  occupational risk in mining sector and to grant compensation

One ex-miner, noted that ‘there is silence around compensation for TB as an occupational risk, and most companies do not even conduct pre and post medical assessments to establish source and time of infection. On the other hand, the miners either do not know that they can claim compensation, or they are too sick to process the paperwork or they fear mentioning their TB status for fear of losing their jobs.’

Ms Masuku further noted that, in South Africa alone TB incidence is 2500- 3000/100,000 in the mines while in the general population it is 948/100,000. That means TB incidence among mineworkers is 10 times higher than the WHO threshold for TB emergency (250 per 100,000). Hence the project recommended that a mapping exercise be implemented to establish the geo-location and size of miners and ex-miners, as well as to intensify TB awareness and implement cross-border referral systems to ensure continuum of care for all miners and ex-miners. Another strategic decision was to establish a system to assist miners in claiming their benefits and compensation post-employment.

Alice Tembe, Citizen News Service - CNS
14 July 2014