Desmond Tutu has an op-ed in the Wall Street Journal today highlighting the problem of TB among South African mine workers. He makes the convincing argument that strengthening the focus on TB control in South Africa’s mining sector is key to controlling TB worldwide.
With $2.5 trillion in mineral reserves, South Africa has the largest mining sector in the world. Migrant workers from neighboring countries come here in droves to extract gold, diamonds, chromite, vanadium and coal.
The work can be devastatingly toxic for the body. South Africa’s 500,000 mine workers have the highest recorded rate of TB among any demographic in the world. The conditions that give rise to such epidemics also fed recent strikes in our platinum mines, which descended into tragedy and dozens of deaths in August in the country’s Marikana region.
Working conditions in the mines are inhumane and untenable. While underground, miners breathe in silica dust that can inflame and damage their lungs and weaken their immune system. Because they live and work in cramped spaces, the cough of one person infected with TB can circulate for hours while others breathe it in. Miners are also at risk of being infected with both HIV and TB. Sex work is common surrounding the all-male hostels where miners live. When HIV damages the immune system, a dormant TB infection quickly advances into contagious TB disease.
Miners then return home and spread the disease to their families and communities. In this way, mine-associated TB gives rise to 760,000 new cases annually in Africa. Inadequate and interrupted treatment can then lead to drug-resistant strains of the disease.
This takes a heavy economic toll. According to a study commissioned by the Southern African Development Community, TB costs South Africa alone $886 million each year in health-care costs and in impoverishment when family providers are too sick to work, or die.
The South African mine industry have been in the news recently as wild cat strikes, police suppression and potential coverups have focused the world’s attention on the conditions of mineworkers. As the archbishop says, targeted health interventions can go a long way to making this industry more humane and decent place to work.
This matters to those of us sitting comfortably in the west. TB is a global disease — and a very, very scary one at that. It is easily transmittable, and certain strands of the disease are all but untreatable. Focusing intervention efforts on places that need it the most is an efficient and cost effective way to mitigate the spread of the disease.