PRETORIA, February 13, 2017 – With little formal education, Bongani, 48, took on his father’s trade as a mineworker. Each year for the past 28 years, he leaves his wife and three children in Swaziland to go and work in the mines of South Africa. He has worked at 12 mines in three provinces throughout the country.
When he is contracted to work, he lives in one of the many hostels, which look more like boarding school dormitories, provided by mining companies for the mineworkers they employ.
While employed, he receives basic healthcare from his employer, but between employment contracts, Bongani (not his real name) will not receive company-provided healthcare and will have to source medication for any chronic conditions on his own. Often, he will not have access to his medical records.
“The time in between contracts is the most challenging not just for me but for my fellow miners too, especially when one is ill,” said Bongani. “Yet when you are sick it becomes harder to find work.”
This is not just Bongani’s story. It is the story of many of the estimated 500,000 mineworkers currently working in South Africa. Current statistics indicate that there are 2,500–3,000 diagnosed TB cases per 100,000 mineworkers in South Africa’s gold mines. This is 10 times the World Health Organization’s threshold (250/100,000 people) for an emergency. In addition, an estimated 70% of occupational TB cases go undetected, according to a recent World Bank economic analysis on TB in the mining sector.
“TB in South Africa’s mines is a complex, 150-year-old problem,” said Dr. Patrick Osewe, Global Lead, Healthy Societies Global Solutions Group, at the World Bank, and Team Leader of the Southern Africa TB in the Mining Sector Initiative. “There are millions of miners living in Southern African countries, and many of them don’t know that they could have a chronic illness, putting themselves, their families and communities at risk.”
Mineworkers such as Bongani, also have no incentive to reveal any diagnosed conditions such as tuberculosis (TB) or HIV, because it might render him unemployable and expose him to stigma among fellow mineworkers and among family and friends. If his wife or children get infected too, they will have even less access to healthcare and be less able to adhere to treatment. For TB, for example, failure to adhere to treatment may lead to multi-drug resistant (MDR) and extensively drug-resistant (XDR) strains of the disease, which are more costly to treat.
In addition, crossing the border to his home in Swaziland once a year carrying a three-to-six month supply of medication could cause issues with border control authorities. And, once in Swaziland, he would not have access to medical support for potential side effects or medication refills.
There are an estimated two million ex-mineworkers living in South Africa and the neighboring labor-sending countries of Lesotho, Swaziland and Mozambique. There is a high-incidence of TB among mineworkers; several factors that contribute include prolonged exposure to silica dust, poor living conditions, high HIV prevalence in mining communities, poverty, and a poor cross border health referral system.
In addition, the unique circular movement of mineworkers across provincial and national borders fuels infection rates, adversely affects adherence to TB treatment, and contributes to the incidence of drug resistant strains.
To fight TB and address some of the underlying social causes of infections among mineworkers, the World Bank and development partners such as the Global Fund have undertaken a series of initiatives, including studies and innovative projects, and is mobilizing stakeholders and resources.