Low risk per­cep­tion a stum­bling block in TB, HIV in­ter­ven­tions among min­ers

Sunday News (Zimbabwe) - - Front Page -

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.

Small-scale gold min­ers busy on their pits

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