“There’s a river of disease flowing out of the mines” – Professor Tony Davies

Emeritus Professor Tony Davies is walking through the narrow corridors of what was the original Wits Medical School in the 1920s, and is now the National Health Laboratory Service of the National Institute of Occupational Health (NIOH).

“This is where the lungs get cut by pathologists,” he says, gesturing through glass doors into a laboratory. There is a sign warning: “TB masks should be used in this room.”

A few twists of the corridors later, Davies stops in front of a large glass case. It’s an unnerving sight: slices of lungs are displayed with a small card giving information as to their provenance.

“Sarah P.,” reads one card.

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“Born in Kuruman in 1931. Worked on an asbestos mine for two years. Died of mesothelioma aged 46.”

It’s a haunting reminder of the toll that mining has been taking on South African workers’ health for well over a century. Here in the National Health Laboratory Service, they are on the frontline. It’s been the job of the institute’s scientists and researchers to perform autopsies on the lungs of dead miners since 1956.

“It’s mandated by law that, with the consent of relatives, deceased miners’ cardio-respiratory organs can be submitted to this unit to be examined,” Davies explains. “We now have a data store of 105 000 autopsies done over the course of the last 38 years, and we can display the prevalence of disease in deceased miners for all sorts of things, all the commodities and the diseases. And almost without exception the curves have risen continuously since 1975.”

The diseases that they see most of are silicosis and tuberculosis (TB). There’s an example of a silicosis-infected lung in the unit’s display case. At the risk of sounding crass, it resembles a mouldy cut of meat, marbled with white and grey. A specimen of a TB-infected lung is also on display. It has what appears to be a large cavity.

Silicosis is a disease most prevalent in those who work underground in gold mining, because gold-containing rock has high quantities of silica dust in it. “When you are blasting, crushing, moving the thousands of tons of rock that you need to do in order to get one ounce of gold, you inevitably generate very fine particles of silica dust,” explains Dr Jill Murray, the unit’s pathology manager and herself a professor at the school of Public Health at the University of the Witwatersrand.

The dustiest work on South African mines has historically been done by black workers: drilling, blasting and mechanical loading.

Chronic silicosis, which occurs 15 to 30 years after exposure to silica dust, causes symptoms like chest pain, fatigue and respiratory failure. Accelerated silicosis can manifest between five and ten years after exposure, and entails weight loss, weakness and a shortness of breath. The most extreme form is acute silicosis, which can occur only a few months after exposure, and can lead to death.

The South African mining industry has known about silicosis for an awfully long time. The disease was originally known as “phthisis” – a term you’ll still hear some miners use – and a commission of inquiry was set up to investigate as far back as 1902. Milner’s Commission, as it was known, calculated that the average working life of a machine-driller on the Witwatersrand was seven years, and their average life-span was 37 years.

In The White Death: Silicosis on the Witwatersrand Gold Mines, 1886-1910, Elaine Katz notes that white immigrants working on the gold mines before the South African War failed to return to the Witwatersrand in large numbers after the war. Silicosis took many. “Almost an entire generation, whose skills pioneered the South African gold mining industry, died from silicosis,” Katz writes.

But silicosis alone was not the only problem. It was soon realised that a complicating factor was that having silicosis rendered you much more likely to contract TB.

“The scavenger cells of the lung, which protect against bacteria and foreign bodies and dust, are so preoccupied with mopping up the silica dust, and the other dust that goes with it, that they tend to overlook the TB bugs,” Davies says. An estimated 15 400 new cases of multi-drug resistant TB were diagnosed in South Africa last year alone.

Professor Rodney Ehrlich, of the school of Public Health at the University of Cape Town (UCT), explains that around 3 000 miners per 100 000 are diagnosed with TB annually in South Africa. To put this into perspective, the TB rate of the USA’s general population is about 32 per 100 000. “The reason it’s so high [in South Africa] is silica, and silicosis, lifted by the rising tide of HIV,” Ehrlich states.

“HIV rates are very high among miners because of the sexual networks which accompany the migrant labour system, where you have half a million men living single sex lives,” he says. HIV increases the relative risk of contracting TB by 3 to 5 times. Silicosis increases the relative risk of TB by 2 to 5 times. If you are HIV-positive and have silicosis, your risk increases by 16 times.

South Africa’s current TB crisis is thought to have its roots squarely in the mines. The original South African mining population was drawn from Cornwall and South Wales. “In the early years, the people who were imported to teach us how to run our mines were heavily infected with tuberculosis,” explains Davies. They worked in close contact with black labourers, and the disease quickly spread, aided by the humidity and dust of conditions underground.

A “river of disease”, as Davies puts it, has flown from the mines to labour-sending areas like the rural Eastern Cape and beyond South Africa’s borders, to Lesotho, Swaziland and beyond. “One of the things about this country is that we’ve failed to control tuberculosis,” Davies says. “This is partly because we don’t understand the epidemic, but secondly because we have too many silica-exposed people, I think.”

Any public health expert will tell you that it is enormously difficult to calculate with any precision how many current or former miners have silicosis. There are a number of contributory factors. One is that former miners can be hard to trace: many left the mines to return to remote locations, where healthcare services may be desultory at best.

“Black men were migrants and when they got disease they were dismissed from the mines and they went back to the ‘deep rural areas’, as we call them, from whence they came, and nobody confronted that issue,” says Murray. “Miners have a nice phrase: they say ‘we were sent home like parcels to die’.”

Another is that there remains “incredible confusion”, in Murray’s words, among miners about silicosis. One of the miners interviewed by the Daily Maverick for this project knew only that he had contracted what he called “underground disease”. A myth which has circulated among miners, for instance, is that drinking milk will clear dust from lungs. A mistrust of the medical services of the mining industry is also widespread, in Murray’s view. Fear of losing jobs due to illness may also have led workers to avoid lung X-rays as much as possible.

It was not until the 1990s that any serious attempts were made to research the prevalence of silicosis in ex-miners. The study which is most often cited was carried out by researcher Anna Trapido in 1998, which looked at former workers in Libode in the Eastern Cape. Its findings estimated the prevalence of silicosis in these ex-miners as between 22 and 36 percent.

In 2003, the Mine Health and Safety Council published a study commissioned to investigate silicosis prevalence among older black mineworkers. Researchers looked at the chest X-rays of 520 mineworkers who were 40 years and older – selected at this age because it was believed they would be more likely to have had 20 years’ exposure or more to silica dust.

They found that only 43,5% of the chest x-rays read as “completely normal”. Almost one in five had evidence of silicosis “at the 1/1 level of profusion” (in simple terms, more severely), and almost a quarter at a less severe level.

Davies says that around 30% of the deceased miners’ lungs that the NIOH performs autopsies on have silicosis or TB. “As we get more and more data, the display over time is eloquent. Very eloquent,” he says.

UCT’s Ehrlich is currently heading up a project at the university which aims to provide an up-to-date projection of silicosis and TB rates among former miners. The 'Mapping and Modelling the Distribution and Health Needs of (Ex)Miners in Southern Africa’ study’s unique selling point is that it utilizes, for the first time, the employment records of TEBA (The Employment Bureau of Africa). This gives the researchers access to an anonymised database of most miners recruited to gold mining over the past 40 years, with their age, location, whether they died in service, and whether they worked on the surface or underground. It’s hoped that this will allow them to model disease rates more accurately than has been previously possible.

Does he have any predictions for its findings? “We genuinely don’t know,” he responds. “They’re going to be highly educated guesses.”

The findings of the study may be highly significant for future lobbying – and litigation – towards the payment of adequate compensation to sick ex-miners. Murray asks: “The real urgency is: what are [mining houses] going to do about all those disabled, jobless, hopeless victims of a multinational, technically sophisticated industry that has produced countless wealth?”

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MAIN IMAGE: An x-ray showing a pair of lungs infected with TB (tuberculosis) in the mobile X-ray unit screening for TB in Ladbroke Grove in London January 27, 2014. Luke MacGregor, Reuters