David Rochkind is a freelance photographer who just returned from five weeks reporting as an IRP Fellow in South Africa where he examined the tuberculosis epidemic in the mining industry.
Q: Why did you choose to do a story on tuberculosis in the mines of South Africa?
A: First and foremost because it’s about tuberculosis (TB). TB is a very underreported important issue that deserves more coverage. So many people die of TB, it’s the second highest killer of preventable diseases. There hasn’t been any significant advancement in medicines or vaccines in the past 80 years.
Specifically in the mining community I chose the story because I’ve been interested in the way labor communities interact with the industry that employs them; in the ways that their health is affected by that. This was a good way to weave together the health and labor issues that I was interested in.
Q: You’ve covered miners in other countries and parts of the world. How was this similar or different to those stories?
A: Most of the mining stories I’ve done in Latin America have been with artisanal miners, sort of independent, impoverished miners who have no connection to any industry. They show up to a tract of land and they start mining with rudimentary tools. There is none of that in South Africa. The mines in South Africa are run by large corporations and are fairly well run as far as infrastructure is concerned.
Q: How adept is the South African government at dealing with the tuberculosis problem?
A: They have proven to not be adept at all. It’s a huge problem that has never been reigned in. It’s at the point now where people think it is almost impossible to control without a vaccine. Regardless of what policies or laws that are in place to protect workers from occupational lung disease including tuberculosis, or protect the population in general, the infrastructure and the will to enact the policies doesn’t exist.
The miners have one health care system when they are with the mines, because the mine companies provide some level of health care, but when they go back home they have little access to health care. Anyone with TB is allowed free medicine, but there is very little infrastructure to enact that in the rural areas. Somebody that has TB that is entitled to free medicine might be a three hour walk away from a clinic. This makes it very difficult for someone trying to survive and raise a family to get to the clinic every day or every week for medicine.
Q: What is the relationship between TB incidence and HIV/AIDS in the country?
A: TB is an opportunistic disease it can enter your body and stay dormant for a long time until your immune system is compromised and has an opportunity to come out. As a result of the rise of the HIV epidemic people had compromised immune systems so the TB that was already there became more active and TB rates shot up. You see the TB and HIV rates rising at parallel rates. They say when you have HIV the first opportunistic infection you’ll get is TB. If someone with HIV gets TB, you think that there will be more opportunistic diseases to come.
Q: In what kind of mines are the problems the worse?
A: There’s a lot of mining in South Africa that ranges from coal to platinum to diamond to gold. The real problem is in the gold mines. When you’re talking about TB in the mines you are really talking about TB in the gold mines.
One of the problems in the platinum mines is that because there has been a contraction of the gold industry in South Africa there is a lot of unemployment. A lot of former gold miners are going to the platinum mines. Because TB and silicosis can lay dormant for up to 10 to 15 years the gold mines are exporting their occupational lung diseases to the platinum mines.
Q: How aware are the miners of the health risks they are facing?
A: They don’t seem to be aware at all. They are very aware of safety risks; tunnel collapse, fires, things falling on them, equipment injuries, etc. They don’t seem to have a coherent idea of what lung disease is and how they get it. In practically every mine they are given an entry education seminar about lung disease, but many times it’s a one time three hour seminar that doesn’t do very much good. In talking to miners and ex-miners I didn’t speak to one person who knew what silicosis was; which is an important foundation to understand TB and lung disease. Anytime people had any chest problems they called it TB. Most people understood that there was something bad about inhaling dust, but they didn’t understand that could cause silicosis, and they didn’t understand the relationship between silicosis and TB. There didn’t seem to be a very good education on what is TB and how do I get it and secondly how do I treat it?
There is one study in the mines right now called the Thibela study that is looking at preventative treatment for TB. They have a very big educational campaign in various mines about silicosis, tuberculosis and treatment. They’re employing famous local soap stars. They created a new soap opera about the mines and lung disease. Miners who have had contact with that program seem to have a better understanding.
Q: You spent five weeks in South Africa working on this story. What was the toughest challenge you had to face?
A: The red tape and bureaucracy of getting into the mines and hospitals was very difficult. I contacted four different mining companies and only two returned my calls, and one gave me access in the end. Talking to people outside the industry it seems that’s indicative of the lack of health infrastructure in many of the mines to deal with TB. The mine that gave me access actually has a good health infrastructure and is partaking in a study to reduce silica dust. So at least on the surface they are doing the necessary things to contain the problem. People have told me the other mines are not doing nearly enough.
Seeing the important elements of the story was difficult: seeing the work conditions, the living conditions of the miners in the mines, and seeing the health care that is available. None of the main TB hospitals or major hospitals in major cities that deal with TB gave me access and none of them gave me a real reason why I couldn’t get access either.
There is a big stigma in South Africa with HIV and because so many people with TB have HIV it was a bit of a challenge to get people to talk to me.
Q: What is the future of the mining industry in South Africa regarding health conditions for the miners?
A: It’s very problematic. It seems that if the mining industry acts on its own to address the problem it’s not enough. The country, the government, health infrastructure, everybody needs to address the problem; not just of TB, but of HIV, silicosis and general access to health care. It’s a very difficult problem to tackle. Treatment in of itself is not enough, you need to prevent the disease and they don’t seem to be doing an adequate job of understanding how to prevent the disease. It will be very challenging to reduce the TB rate without a new TB vaccine, with the current tools that are available and current infrastructure it is a very big problem to address.
Q: Is there a role for the global community?
A: TB is a problem across the world, especially in Sub-Saharan Africa where it is a big problem. According to the World Health Organization (WHO) half of the necessary funding is available right now to effectively deal with the TB problem. As far as a global solution I think more money is necessary, more research and more development. As I mentioned there hasn’t been a new vaccine in 80 years; the current vaccine doesn’t really work. Without more funding I don’t know how there will be significant developments to deal with the problem. South Africa alone can’t do it. No country alone can do it. Everybody needs to be working on the problem: academic institutions, private sector, and government.