Stemming the TB tide in mining and migrating populations

JOHANNESBURG — Mabsia Molaoli of Ha Lenononyane, Lesotho, faces an uphill battle in claiming survivors’ benefits.

BY STEPHEN TSOROTI

Her husband worked at Hartbeesfontein Mine between 1980 and 1998 before he was retrenched.

Upon retrenchment, he received R14 000 in Mineworker Provident Fund benefits. He was diagnosed with tuberculosis (TB) within six months of returning home after termination at Hartbeesfontein Mine.

He was informed that his disease was occupational-related.

He returned to the mine with the TB diagnosis to apply for occupational disease benefits. He was asked to come back in a year’s time since he was on medication.

He never went back to Hartbeesfontein Mine as he had “recovered” and was running a business back at home.

However, in 2007 he came back to South Africa to work as a contract worker at Tsepong Mine in Welkom.

He died of TB in 2008 after he was diagnosed with TB and admitted at Harry Oppenheimer Hospital.

Although Mabsia used her savings to repatriate her husband’s body, she never received benefits for his occupational disease.

She even went to the mine, but was told that she was not entitled to any benefits as her husband was still on probation. She was informed that this was according to the agreement between her husband and his employer.


Spiwe Makaleni, a migrant worker in South Africa, went through almost similar experiences.

She was diagnosed with TB at Nketa Health Centre in Bulawayo, Zimbabwe, in 2015 after taking her TB medication for three months. She decided to go to South Africa.

“I had no problem when I arrived in South Africa since I had my six-month supply of drugs. My problems started when my supply got exhausted. I needed to go back home to get a fresh supply but at my job they could not allow me to do that. Besides I had no papers to stay in South Africa, which would have made it easier for me to approach the nearest health centre. So I defaulted,” Makaleni said.

“Unfortunately, after two months the TB returned. I got so ill that I had to be ferried home,” she added.

Makaleni finished her drug resistant treatment at an Integrated Tuberculosis HIV Centre (ITHC) in Rumuka township recently.

Ha Lenononyane and Makaleni cases are poignant tales in Southern Africa, accessing TB treatment for the migrants is so arduous, and at times, leads to fatal consequences.

According to the organisation Aids Rights Alliance for Southern Africa, undocumented migrants face challenges such as fear of deportation that limit their access to diagnostic and treatment services.

Deportation while on treatment or poor adherence may lead to drug resistant, poor outcomes and further spread of infection.

Among migrant workers with legal status, their access to TB diagnosis and care is subject to contracts, work permits and ability to access health care services or health insurance from State or the employer.

Zimbabwe TB Civil Society and Regional Coordinating Mechanism focal person, Donald Tobaiwa, says there are risk factors for TB exposure, infection, transmission and poor outcomes throughout the migration process, including overcrowded poor living and working conditions, increased vulnerability to HIV infection, under nutrition, language barriers, and lack of legal status, migrant unfriendly health services and a lack of entitlement to health services.

However, Tobaiwa says the instrument on the declaration on TB in the mining sector by Sadc heads of State and Government signed in August 2012 has made significant impact on the treatment of HIV/TB in the region.

“The instrument triggered action and responses at both regional and country level. The World Bank for instance initiated an intervention in four countries namely South Africa, Lesotho, Mozambique and Swaziland on combating TB in Ex-mineworkers,” he said.

This was the pre-cursor to the currently Global Fund supported TB in Mines in Southern Africa (TIMS) covering ten southern African countries.

The TIMS grant has constructed 11 Occupational Health Service Centres in the 10 countries, in a bid to ensure linkages between occupational health and TB whilst also facilitating access to compensation.

The World Bank is also working in four other countries in a complementary way by reaching out to Mineworkers, migrants and cross-border related interventions in Malawi, Mozambique, Zambia and Lesotho.

Deputy Director of the National TB Programme in the Ministry of Health in Zimbabwe, Charles Sandy, said: “Zimbabwe is implementing the provisions outlined in the Sadc Heads of State 2012 declaration to variable extents on different areas of the declaration.”

He adds that the NT programme does not look at the migration status.

“We offer treatment to anyone who needs it,” he said.

The Southern African region faces the highest TB burden in the world due to poor access to TB prevention, care and treatment.

In 2014, the African region accounted for almost a third (28%) of the world’s TB cases and has the most severe burden relative to population at 281 cases for every 100 000 people.

This is more than double the global average of 133 cases per 100 000 according to the 2015 World Health Organisation Tuberculosis Report.

The Southern African region also accounts for a staggering 74 percent of 9.6 million people who were also HIV positive.

Sadc states have long realised that migration in the region is increasing so is the upsurge of MDR TB, a type of tuberculosis (TB) caused by a bacterium (Mycobacterium tuberculosis) that has developed a genetic mutation(s) such that a particular drug (or drugs) is no longer effective against the bacteria.

“Poor access to health care services creates gaps in accessing TB diagnosis and treatment. This contributes to increased incidence of active TB cases, reduces positive clinical outcomes and increases the proliferation of drug resistance TB,” says Christabal Phiriof of Southern Africa Trust (SAT).

Phiri, who is SAT’s Mobilisation and Engagement Manager says silicosis and other occupational respiratory diseases; inadequate or no mechanisms for financial compensation of mineworkers and ex-mineworkers with TB.

Both Tobaiwa and Phiri believe if implemented, the Declaration on Tuberculosis in the Mining Sector in SADC Member States may lead to more commitment to move towards a vision of zero new infections, zero stigma and discrimination, and zero deaths resulting from TB, HIV, Silicosis and other occupational respiratory diseases.

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