They hide things like that from us. The Hidden Epidemic Amongst Former Miners: Silicosis, Tuberculosis and the Occupational Diseases in Mines and Works Act in the Eastern Cape, South Africa

The aim of the research was to assess current and historical surveillance of the pneumoconioses in former miners, in particular silicosis, silico-tuberculosis, and tuberculosis, and to assess the functioning of the Occupational Diseases in Mines and Works Act (ODMWA) surveillance and compensation system which is a responsibility of the Department of Health. The research also aimed to assess the impact of the burden of lung disease and disability on the public health system and on the labour-sending communities from which the miners come and to which they return. The main objective was thus to investigate health systems surveillance of the pneumoconioses in former underground gold miners, and to assess diagnostic and compensation systems under the legal framework of the Occupational Diseases in Mines and Works Act 78 of 1973 as Amended (ODMWA).

An assessment of available research findings from research undertaken since 1997, along with data from official sources, strongly indicated that this is a historically neglected subject which is a vastly under-researched and undocumented area of occupational disease and ill-health in South Africa.

Chapter One introduces and gives contextual background to the research. Key considerations are the migrant labour system, disease latency, the centralization of services, and the lack of health surveillance in rural areas. The 1994 Leon Commission of Inquiry into Safety and Health in the Mining Industry noted that the most recent research on the health of black former miners was from the 1930s. This gap of seventy years of neglect of the epidemiology of silicosis and silico-tuberculosis started to be closed by the research efforts, starting in 1997, of a few dedicated occupational health professionals. The pulmonary ill-health of black former miners was no longer deeply hidden in the hills of the homelands or other rural areas. The strongly mounting evidence of an epidemic of silicosis and tuberculosis amongst former miners, and of the undocumented legacy of disease, is presented in Chapters Three and Four.

Chapter Two provides a detailed description of the applicable legislation in the form of the Occupational Diseases in Mines and Works Act 78 of 1973 as Amended (ODMWA). This chapter includes a short history of the emergence of silicosis and the development of the first occupational lung disease legislation in the early part of the twentieth century. Chapter Two then describes in some detail the different sections, clauses and provisions of the ODMWA.

Chapters Three and Four are, in essence, a literature review of the available data and evidence to date from recent research studies on silicosis and tuberculosis in both miners and former miners. Chapter Three, focusing on silicosis, assesses the silicosis prevalence research that has been undertaken in the past decade amongst both in-service and former miners, and includes a two year review of autopsy data from the National Institute for Occupational Health. Chapter Four, focusing on tuberculosis, starts with a summary assessment of the historical intersection of mining and tuberculosis in South Africa, and presents a review of recent studies on tuberculosis in miners and former miners, as well as presenting some data from autopsy records.

Chapters Five to Fifteen comprise the main body of the research report, and present the findings of the current research. Chapter Five describes the research design and methods of the study, as well as detail on the operational planning and fieldwork. It is noted that a methodology is generally not a straight line from A to Z, one that is pre- Summary of Report determined, but rather that research methods are adjusted as initial and pilot research findings are revealed.

Chapter Six sets out basic demographic information on the sample of former miners (n=205) This includes age range, marital status, numbers of dependent children and receipt of state grants.

Chapter Seven presents the occupational labour history of the former miners, giving detail on type of underground work, length of service, retention of documentation, provision to them while employed of information on health risks, and the means used to address such health risks. Throughout the report quantitative data is presented alongside qualitative data.

Chapter Eight describes the experiences of former miners in terms of their medical surveillance history while in mine service, medical surveillance at the time of exit from mine service, and medical surveillance subsequent to leaving mine service. A section of this chapter focuses on those former miners who departed mine service from 1996 onwards when the new Mine Health and Safety Act took effect. The intention here was to assess the legal requirement of full Exit Medical Examinations on departure from mine service.

Chapter Nine presents findings on levels of knowledge of the ODMWA amongst the former miners both through mine employment and departure, as well as any knowledge gained subsequently through their local public and private health services. Chapter Ten describes the current health status of the former miners, and their interactions with both public and private sector health facilities.

Chapter Eleven is an extension of the focus on health status in, specifically, presenting the findings on Tuberculosis amongst the sample of former miners, both in mine service and subsequent to leaving mine service. Within this chapter on tuberculosis further findings are presented from a sub-sample (n=14) of former miners who were in-patients in a dedicated TB hospital.

Chapter Twelve describes the socio-economic status of the sample of former miners. It presents findings on the substantial reliance on state provided social security in the form of state Old Age Pensions, Child Support Grants and temporary TB disability grants, as well as on some marginal income generating activities. Findings on experience of hunger are also presented, as well as information on those study participants who died during the course of the research fieldwork. Chapter Twelve also includes a section which presents some concluding remarks from the former miners themselves.

Chapter Thirteen presents the findings of the health sector survey and interviews. This includes health sector experience of the presentation of former miners at health facilities, an assessment of knowledge of silicosis and of the ODMWA amongst health personnel, and an assessment of the functioning of the ODMWA.

Chapter Fourteen presents the conclusions of all the chapters, and concludes the report.

Chapter Fifteen presents the recommendations that emanate from the conclusions of the research.