Low risk perception a stumbling block in TB, HIV interventions among miners
ON entering the mining town of Shurugwi, the small town is a hive of activities with people walking in jumbled directions, rubbing shoulders, hips kissing each other with everyone concentrating on his or her own business.
The road to the nearby Wanderer Gold Milling Mine is hued red with people in spooky appearances, some carrying gold ore in sacks on their shoulders while others appearing tired but confident in their gaits, carrying iron bars and hammers — their tools of the trade.
The whole area is up in dust as one group is crushing the ore, the other group panning, some blasting explosives while others are busy at the mills monitoring their ore being processed. You can hardly identify a person as they would be covered in mud and dust. The whole area would be engulfed in a thick cloud of dust.
This was the situation when I visited Wanderer Mine in Shurugwi where artisanal miners were going about their business oblivious of the dangers of contracting diseases related to such environs, worse still without protective clothing, exposing themselves to various diseases. Just like in any dire situation women always get the worst of it.
Young women, some of whom were pregnant, were all over the place panning for gold, separating metal from ore using mercury while their suitors took a rest, puffing homemade cigarettes from dry-hole residue tobacco, while being treated to some sweet melodies at a local shebeen.
They are grappling with other responsibilities that include reproductive, working at the mines and having to go home and cook for their husbands or boyfriends. The majority of them would be drinking fresh milk. Some say it clears the throat.
According to one artisanal miner, James Gore, this is pretty much the story of their daily lives. It’s a routine! They live by the rule of the jungle — the survival of the fittest. Like birds of the air, they live each day as it comes.
“This is not a place for the weak. You won’t survive. We go about our business as usual during the day but during the night there are other illegal activities that we indulge in. These include stealing gold ore from formal mines, blasting and when we hit a score we take our women to night spots,” said Gore a TB survivor.
According to him, artisanal miners do not have protective clothing and they brave the harsh conditions.
“I was once diagnosed of TB. What happened is that I started losing weight rapidly, I was very sick. I was having dry coughs and severe chest pains. Everyone was convinced that I was HIV-positive. I also resigned to fate thinking that I was dying. I started shunning people because I was afraid of getting tested until one day my parents took me to the hospital. I was tested for HIV and the results were negative. The doctor advised me to go for TB screening and the results came out positive. I was relieved because I had no HIV so I started taking my medication,” he said.
Gore said there was a group of medical practitioners that do routing screenings in mining communities but his acquaintances are not keen to get screened.
“My brother, if it were possible Government would recruit some of us to be peer educators and help my colleagues. If I tell them they don’t pay much attention because I am one of them,” he said.
A snap survey by this reporter indicated that most of the artisanal miners are not keen to go for screening albeit Government doing routine TB outreaches. It is evident that the risk perception of the artisanal miners in terms of contracting TB or even HIV is very low.
Deputy Director of the HIV, Aids and TB Unit in the Health and Child Care Ministry, Dr Charles Sandy said there was a very low risk perception among artisanal miners which made them more exposed to TB and HIV.
Targeted screening is part of the National TB programme in partnership with the International Union against Tuberculosis and Men and Women Lung Diseases (The Union) and Family Aids Caring Trust (Fact) which is the implementing partner, with funding support from Global Fund and USaid’s Challenge TB.
“They are not fully appreciative of the risks of underground mining with poor ventilation, smoking, dust exposure, mercury exposure, and the HIV high risk behaviours which they generally exhibit which also increases their risk for TB as well. This population which is responsible for generating a significant proportion of the country’s foreign currency has unmet health needs. There is need for earmarked funding as a proportion of the foreign currency generated to be channelled back to their health welfare. We will be advocating to the new Parliament for this support,” he said.
Dr Sandy said Government was making frantic efforts to combat the disease among artisanal miners. He said so far there had been an overwhelming response.
“We are implementing a communitybased active case finding project aimed at identifying TB in high risk groups (TAS4TB) through screening at community level using mobile digital X-ray and sputum examination. Government is being supported in this activity by the Global Fund and USaid’s Challenge TB funding mechanism. They seem to welcome the service as it is more accessible and free,” he said.
Dr Christopher Zishiri, Country Director of The Union also explained that outreach teams went around the districts offering free screening services which were not limited to TB only but also extended to HIV and Diabetes. All diagnosed patients are quickly linked to care at their nearest health facilities for management.
A TB expert Dr Milton Chemhuru corroborated Dr Sandy saying there was need to enhance interventions among risk groups such as small-scale and artisanal miners to be more conscious of the risks associated with mining as well as their sex behaviour.
Dr Chemhuru said there were robust systems in formal mining sector but little was being done to increase awareness of the risks of mining. He said there was need for a vigorous campaign to increase awareness among artisanal miners.
“The mining industry in Zimbabwe contributes to about 15 percent GDP and is strategically positioned as a measure to resuscitate the crippling economy of the country. Among the mining sectors are the small scale and artisanal miners, some are registered while others are mining illegally (gold planners or magweja or makorokoza). Hence there is no TB/ HIV/ Silicosis prevention and control in the last mentioned sectors.
“In the Midlands province we have one of the greatest number of artisanal miners in the country. We have makorokozas mining/ digging gold and chrome in most cases. These minerals produce dust which is associated with TB/ Silicosis. None of these makorokozas are exposed to routine screening of TB/Silicosis, hence the patients are only identified when they are ill or bed ridden. Above all, these artisanal miners do not have a fixed address and those who might be infected with TB may go around the country infecting others.
“The living conditions in the artisanal mining sector are poor. There is congestion, prostitution, drinking and misuse of dangerous drugs as well as a high risk of HIV among the miners and the surrounding population. HIV is associated with TB. What is mostly worrying is that there is no protection in terms of clothing or respiratory materials during the digging of these minerals and the artisanal miners are exposed to a lot of dust. Since most of the artisanal miners are not registered this is another reason which makes them not have fixed addresses,” he said.
Dr Chemhuru said there was need for Government to design TB programmes specifically for small-scale and artisanal miners.
“The formal mining sector in Zimbabwe has a well established health system and programs which include TB/ HIV/ Silicosis activities like: Surveillance, prevention/ control treatment and rehabilitation. In some cases silicosis and pneumoconiosis cases are compensated.
“In Zimbabwe, the national TB control programme has been concentrating in the control of TB among the general population while (I repeat) the formal mining sector has been preventing and controlling TB among its employees. The national TB programme has done very well in the populations mentioned above,” he said.