Sending them home to die: Tuberculosis in the mines

Photo credit: CNS
Alice Tembe, CNS Correspondent, Swaziland
“You could easily share a room with sixteen other mine workers, if one develops TB he will take his medication and complete treatment while staying in the same room”, these were the words of Mr. Musa Ndlangamandla, a Swazi ex-miner who developed Multi-Drug Resistant Tuberculosis (MDR-TB) after working in the mines for seven years in South Africa.

He noted that from spending eight hours underground everyday and getting exposed to silica dust, he developed TB that later became MDR-TB for which he took medication in combination with his anti-retroviral medication (ARVs). Having recovered from MDR-TB, his greatest consolation is that he never lost his mind, despite the fact that on top of regrettably having suffered so much, he was not compensated by his employers.

This is just but one of the many stories shared during a Policy Dialogue on Tuberculosis, Silicosis, HIV, Portability of Social Security Benefits and Compensation in Swaziland for miners and ex-miners. Interestingly, Swaziland has one mine while a large majority of this affected population comes from working in over 1600 mines in South Africa. Dr. Cleopas Sibanda, a Senior Labor Official with the Swaziland Ministry of Labor and Social Security said that the risk factors for TB among miners and ex-miners include ‘HIV status, and other comorbidities, that weakens the body’s defense and thereby increases chances of developing TB by three fold; exposure to silica dust that causes silicosis, especially for those working in gold mines, increasing their TB risk by six fold.TB risk in individuals with both silicosis and HIV increases by 18 times. Separation from families particularly for those who migrate to South Africa for employment in the mines simply exacerbates their prediacment.’

The Policy dialogue looked to legislators to influence migration rules and regulations to allow the affected population to access medical care and workman compensation. It is suffice to say that ignoring the plight of miners and ex-miners with TB and/or silicosis is suicidal as TB can easily spread in the communities where they retire to. While some regional progress has been achieved through harmonization of treatment protocols and standard cross border tracking and referral system development, the government still needs to engage on a lot many issues to curb this spread of the disease. These include:
  • Legalization of labor migration
  • Standardization of labor migration 
  • Legal documentation of labor migrants
  • Workplace health and wellbeing of labor migrants
  • Post-employment health and wellbeing of labor migrants
  • Signing inter-governmental memorandum of understanding for care of the workforce
These key actions will contribute largely to the care, compensation, access to services and expertise resources for over 7000 estimated Swazi miners currently employed in South Africa and 22000 ex-miners. According to the WHO Ending TB Strategy, the only way to stop TB in this generation is when all cases are diagnosed timely and treated with appropriate medication, ensuring patient adherence and infection control. These key steps can be achieved only by addressing the labor migration concerns of the current miners and ex-miners.

Alice Tembe, Citizen News Service - CNS
15 July 2015