“We think of TB as a snake. The head is in South Africa [at the mines] and the body is in the other countries in the region”; Mining companies must step up fight against TB

March 24, 2014 12:01 am

Mining companies must step up fight against TB

By Rose Jacobs

Seven years ago, the picture of tuberculosis infection among workers at Anglo American’s coal mines was relatively grim: the incidence rate stood at about 900 people per 100,000 – above the rate for South Africa as a whole at the time, despite the countrywide rate having tripled in the previous decade.

The numbers were not entirely surprising. Miners in southern Africa are often migrant workers, living far from their hometowns and villages, staying in often crowded, poorly ventilated shared housing that can serve as a hotbed for TB.

Prostitution drives up HIV infection rates, and HIV exacerbates TB; about two-thirds of people with active TB in South Africa are also HIV-positive, according to World Health Organisation estimates.

Moreover, the dust in many mines irritates the lungs, leaving workers particularly prone to infection.

What is surprising, then, is what has happened in the years since: even as TB incidence rose across South Africa, it fell by two-thirds at Anglo American’s coal operations, to 330 per 100,000 in 2013. What changed?

“Everything,” says Brian Brink, the company’s chief medical officer. “Somehow, we got everything right.”

Part of the change was down to company-wide policies, such as a pledge to offer all contractors access to the high-quality medical care enjoyed by company employees. Anglo American also shifted away from the bunkhouses of old in favour of family-style housing. And it has managed down lung disease in the workforce, reporting zero cases of silicosis in 2012 and 2013.

The one division, however, shows where the company as a whole needs to go: the coal mines are leading in areas such as healthcare information systems and using new technologies to keep track of sick workers and their treatment regimes. “All that says to me is that it can be done,” says Dr Brink.

Unfortunately, Anglo American’s story is not necessarily representative of the industry as a whole. Its numbers are helped, for example, by the fact that the company no longer mines gold in southern Africa; gold tends to be found in silica rock, whose dust particles are particularly jagged and thereby hard on the lungs.

“You couldn’t invent a better environment to generate TB among workers,” says Aaron Oxley, executive director Results UK, an anti-poverty group. “Being a South African gold miner is one of the biggest risk factors for developing TB – or, unfortunately, being married to one.”

Indeed, despite what big mining companies have done to combat TB among their staff (small and medium-sized groups often have a poorer record), miners often unwittingly infect their families back home.

Employees who stick to their treatment regime while at the mine, supported by health workers, managers and peers, may drop it on visits home because of stigma or practicality. Often, they are returning to poor, rural communities lacking strong healthcare facilities.

“We think of TB as a snake. The head is in South Africa [at the mines] and the body is in the other countries in the region,” says Lucica Ditiu, executive secretary of the Stop TB partnership. Countries particularly affected are Lesotho, Mozambique and Swaziland.

Dr Ditiu hopes that a declaration by southern African heads of state, signed in 2012, committed to ending the TB epidemic in the mining sector might be a significant step forward in fighting the body of the snake.

Benedict Xaba, minister of health for Swaziland at the time, who was instrumental in getting the declaration signed, agrees that a regional approach is essential, not only to co-ordinate treatment but to create educational campaigns that fight stigma.

“In our countries, people don’t want to believe they are suffering from TB,” he says. “They consult traditional healers. They don’t want to be diagnosed.” Stop-and-start courses of treatment can also lead to multi-drug-resistance, multiplying the cost and suffering by many factors.

A strong association of ex-miners doing outreach work in communities is helping, says Mr Xaba. But, just as everything needs to go right at Anglo American’s coal mines, everyone needs to lend a hand more broadly – from governments to charities to funding organisations.

“I’m optimistic that we’re moving in the right direction. Now we need to put our foot on the pedal and accelerate,” he says.

A high-level Southern African Development Community summit in Johannesburg this week, hosted by Kgalema Motlanthe, South Africa’s deputy president, and looking at the regional response so far, could do just that.

The event will “provide analytic evidence of the economic costs and benefits of investment on TB in the mines while engaging key stakeholders to commit resources to address gains in the current response”, according to its organisers.

Results UK’s Mr Oxley believes this is the time for mining groups to act. He acknowledges some have made huge efforts to combat the disease. But there is still a way to go for the industry as a whole, from ensuring better housing to investing more in silicon dust technology to ensuring contract workers get the same care as employees. “They have a chance to be the heroes here,” he says. “But if they don’t come to the table with something meaningful, they’ll start to look like villains.”