By: Dr Ntando Makatini, Business Unit Manager at Platinum Health Medical Scheme
Mining communities have typically required focused TB management, highlighting the importance of strong health programmes, regular screenings and sustained preventative care. These measures play a critical role in early detection, consistent treatment and protecting long-term community health – demonstrating that prevention works.
The progress made in reducing TB within mining communities illustrates the practical impact of an integrated Health Maintenance Organisation (HMO) and Occupational Health model. Using the integrated model and leveraging the deep understanding of the daily realities of mineworkers, our clinic teams can appropriately and holistically respond to symptoms immediately, instead of treating issues in isolation. This means illnesses like TB are caught earlier, treatment starts sooner and families face less disruption from prolonged sickness. Over time, this practical, context-aware care has helped shift TB from being a dominant threat in mining communities to a condition that can be actively managed – protecting livelihoods, strengthening households and supporting a healthier mining industry and its communities.
Mining environments have traditionally been linked to high TB risk, for several reasons. For one, if somebody has HIV, this weakens the immune system and can create a breeding ground for opportunistic infections like TB. Furthermore, underground working environments are confined and have limited ventilation, which easily facilitates transmission of the TB bacteria.
Meanwhile, long-term exposure to silica, platinum or coal dust can make the lungs more vulnerable, increasing the susceptibility of contracting TB, and since mineworkers generally live in high density environments, this too can accelerate the community spread of TB.
TB is a high-risk disease which can have a major impact for medical schemes, if it is not controlled and the correct preventative measures are not in place. Therefore, we need to play our part to ensure that all staff are screened effectively, employees who are at risk of contracting TB are identified and treated early and that they continuously monitor the progress of the treatment.
Mining operations work closely with us in our efforts, as they benefit too – these programmes reduce absenteeism, help increase productivity, and ensure that the mineworkers are healthy and safe in the workplace.
Screening plays a crucial role as a frontline defence in the management of TB. This includes using screening tools to interrogate the symptoms associated with TB; taking chest X-rays and spirometry assessments during a mandatory annual medical surveillance programme and continuous health promotion to the employees, to help them understand and identify symptoms early. It also encourages screening during all consultations at its clinics.
Continuous monitoring of employees infected with TB allows us to keep track of employees to limit the spread of the disease.
We’ve taken a proactive approach in managing the risk factors associated with TB, implementing an aggressive anti-retroviral therapy programme, for effective and successful management of HIV. We also work closely with the mines to ensure that dust exposures are minimised and that there are sufficient controls to improve the ventilations underground.
We don’t manage TB in silos. It’s woven together in Occupational Health, which looks at everything from fitness to work assessments to the tracing of employees who may be exposed. Occupational clinics serve as primary healthcare sites where medication and treatment are standardised across all our clinics.
We ensure effective chronic disease management, to prevent the weakening of immune systems and reduce the potential for contracting opportunistic diseases. We also focus on health education, which is integrated into both Occupational Health and Primary Healthcare, to improve awareness and eradicate any stigma.
Our approach to TB is a well-integrated and holistic approach that encompasses the involvement of all stakeholders. This includes the monitoring of workplace exposures; the risk assessments associated with limiting these exposures; and the diagnosis and further treatment, as well as monitoring the employee.
We are proud of the successes, but we continue to look ahead and are always studying what’s new in this arena and working closely with other agencies that operate within the mining communities to constantly improve education around this topic.
Ultimately, our goal is to decrease the TB incidence rate every year, over the entire mining work force, ideally by at least 10% year-on-year. And while we aim to achieve the Minerals Council of SA’s target of lowering mining sector TB rates below that of the national rate by 2034, we remain focused on affecting consistent year-on-year reductions through our work with all other stakeholders in this critical environment.