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South African gold miners are at greater risk of developing TB due to the heavy presence of silica dust in their working environment

This past Saturday, the Deputy President of South Africa, Kgalema Motlanthe, spoke at an event held at the Driefontein Gold Fields mine, located in the Gauteng province of South Africa. The event was being held in observance of World Tuberculosis Day–a bacterial disease that has become all too common among South African mine workers. Individuals within this particular profession have been known to have a greater risk of contracting the disease due to the heavy presence of silica dusk within their working environment. Although silica is nothing more than a mineral found in rocks and soil, repeated inhalation of the mineral can lead to serious implications. In fact, a staggering 22,000 mine workers are infected with the disease yearly. However, TB is not the only illness in which these mine workers must battle daily; there is that widespread virus that occurs outside the workplace: HIV. Between 60%-70% of mine workers who have been infected with TB have also been infected with HIV as well. But these startling statistics have not stopped South Africa from doing all that it can to combat these two life-threatening illnesses.

Standing before an audience that included Gold Fields mine workers and their mining managers, union leaders, community development agencies, health workers and government representatives, Motlanthe vowed that the South African government would continue its initiative in supplying its citizens with the programs needed to successfully thwart TB and HIV. As a matter of fact, Motlanthe states that within the last few years, South Africa has made testing for TB and HIV more of a regular initiative, as opposed to an initiative that arises only during emergency outbreaks. Nick Holland, CEO of Driefontein Gold Fields mine, has also hopped on the bandwagon in making TB testing more readily available for his own mine workers. At the event, he spoke of the necessity of Gold Fields mine being able to diagnose TB in its earlier stages, as well as being able to develop more efficient means for testing for TB.

Even so, the progress that South Africa has made in their fight to stop the spread of TB has been incredibly noteworthy thus far. Just last year, South Africa embarked on a new approach in actually traveling to the homes of individuals who have had contact with a TB infected person. Furthermore, individuals were also tested and educated about HIV. During that mission, roughly 160,000 people were screened, where 3,000 individuals tested positive for TB. What is more, another 3,200 individuals actually tested positive for HIV. In addition to home screenings, since last year, South Africa has also been utilizing the GeneXpert machine, enabling the successful diagnosis of drug-resistant and drug-sensitive TB patients. At the moment, South Africa is number one in the manufacture of GeneXpert tests, having completed roughly 300,000 tests.

I think that it is important to acknowledge here that although South Africa is still in some aspects a developing nation, the initiatives, however, that the Country appears to be taking in the prevention of TB and HIV, in my opinion, would illustrate its advancement into a developed nation. When a nation’s own government makes it their endeavor to provide the utmost care to their citizens, a sense of unity transpires between all. As we saw in class during our attempts to revise TRIPS, it was difficult for us to come to an agreement on how high-income and middle-income countries could not only efficiently provide foreign aid to low-income countries, but also continue to recognize some of their own personal goals as well. In my opinion, South Africa sets a wonderful example of the potential that developing and also underdeveloped nations have in terms of the combat of life-threatening epidemics.

When most Americans imagine Tuberculosis, they think of a disease that was active over 100 years ago.  They imagine people coughing, becoming frail and being sent to warm, dry climates as the disease progressed.  It was then often called “consumption” or “white plague”.  It is a bacterial infection that invades the lungs and destroys the lung tissue.  The bacteria can be spread when people cough, and is airborne.  

Bacille Calmette Guerin (BCG) is the vaccine that is now in use to protect against tuberculosis. It was first used in 1921.  BCG was first used as a vaccine in 1921. It was given to infants orally. Since 1921, this has been the standard treatment against TB and has been used extensively.  Today, it is estimated that more than 1 billion people have received BCG.  

A startling new finding has many people concerned:  Documentation of a “totally drug resistant strain of TB” has been found in India.  Last week, the World Health Organization convened to discuss these findings and to determine if a new classification must be added to the first TB description:  this new classification would be ‘totally drug-resistant TB,’ or TDR-TB. This means the disease has changed from one that could be treated with a six month course of antibiotics, to the emergence of MDR-TB, then extensively drug-resistant TB (XDR-TB). The most disturbing aspect of these new discoveries, says Lucica Ditiu of the WHO’s Stop TB Partnership, is the fact that drug-resistant TB ‘is a totally man-made disease.'”

Bacteria, while simple creatures, are highly adaptable and can evolve to resist the drugs meant to destroy them. Mycobacterium tuberculosis is no exception.  In many areas of the world, TB is a major problem due to lack of vaccination and inability of the people of certain countries to obtain the antibiotics needed to cure them.  To explain this new strain of TB as being man made:  if a person has access to the TB antibiotic, and begins taking the recommended course, then stops for whatever reason—lack of access to the medicine, becoming too ill to travel to obtain the medicine, or simply feeling better and stopping the course of treatment on their own—the bacteria still present in their bodies begins to adapt to fight the antibiotic introduced.  This leaves the person uncured of the original infection, and now able to transmit a new strain of the adapted bacteria to others. 

 Dr Zarir Udwadia, a specialist in TB at the Hinduja National Hospital in Mumbai, recently published a paper in the Clinical Infectious Diseases journal examining four cases of TDR-TB. He told Reuters that he has now seen 12 cases of TB where all known TB drugs were applied and none were successful. Three of the 12 cases are already dead.

The powerful TB drugs he tested on each patient, one after another, were first line treaments–isoniazid, rifampicin and streptomycin, and then a range of second line drugs like moxifloxacin, kanamycin and ethionamide. Each medicine did not work.

“If you add it all up, they were resistant to 12 drugs in total,” said Udwadia.

TB can lie dormant in a patient for many years before showing signs of infection.  As TB can now be considered an untreatable disease, the world needs to gear up for epidemic that may be crippling.

 

 

Doctors Without Borders has put together a useful summary of the ten key stories from 2011 on the struggle to obtain essential medicines in developing countries.  As they describe, one of the critical faultlines is India, a country that produces “the most quality affordable medicines used in the developing world, but which faces attacks by drug companies and wealthy countries who continue to clamp down on generic production.”