Clash of Cultures: Autopsy or no compensation?
By Vuyisile Hlatshwayo
EmaSwati mineworkers diagnosed with silicosis and cardio-respiratory or pulmonary tuberculosis (TB) that they contracted in mines have started accessing compensation from the Tshiamiso Trust. While this is a significant step forward, the requirement for an autopsy report on mineworkers who die while still on TB treatment is a serious stumbling block.
Sticking to SiSwati traditional beliefs and cultural norms, surviving spouses and close relatives are reluctant to have an autopsy carried out on the deceased mineworkers. Yet, the Tshiamiso Trust has made it compulsory for them to produce a postmortem report to access compensation for deceased mineworkers.
According to Lusanda Jiya, the Tshiamiso Trust’s executive for stakeholder relations and communication, it is the dependants’ responsibility to submit the postmortem report showing the cause of death of the deceased mineworker to access compensation.
“BMEs cannot be conducted while claimants are on TB treatment, or if they are suspected of having active TB. If they are on TB treatment, claimants are advised to complete the treatment and submit proof of completion so they can be rescheduled for their BME,” Jiya says, adding: “In the event that a claimant dies while waiting for the BME to be completed, the claim can be taken over by someone appointed by the court as an executor of the deceased’s estate. In this case, the Trust relies on the submission of documentation showing that the cause of death was silicosis or work-related TB, or that the mineworker was diagnosed with silicosis during life.”
Jiya updated the Inhlase Centre of Investigative Journalism on the Tshiamiso Trust Benefit Medical Examination (BME) programme piloted in eSwatini late last year. It is meant to help emaSwati mineworkers undergo tests for silicosis and work-related TB to access compensation from the Trust. She emphasizes that the onus lies with the dependants of the deceased mineworkers to obtain and submit the documents to the Tshiamiso Trust. She adds that the Trust engages the relevant Ministries to align with the Trust Deed document requirements. But the ministries do not have to submit any documents on behalf of the dependants. She also explains that the postmortem examination report assists in identifying the presence of silicosis and the medical cause of death.
“Autopsies can be performed by a qualified medical practitioner (pathologist) in the footprint of the Trust. The specimen is then sent for analysis to the National Institute of Occupational Health (NIOH) to perform the requisite laboratory analysis. Arrangements to get the specimen sent to the NIOH will be done on approval of the Trust’s medical director,” she explains.
A glance at the records of eSwatini claimants on the Tshiamiso Trust website shows that out of 1,353 mineworkers, only 480 have qualified to get compensation, whereas 873 have been unsuccessful. At the time of compiling this report, the Trust payment had reached R44,043,873.00. However, the high number of unsuccessful claimants is cause for concern.
The clash of Western and African cultures arises in the Tshiamiso Trust. The requirement for the postmortem report has disadvantaged dependants of deceased mineworkers who die while still on TB treatment or before completing BMEs. Representatives of eSwatini mineworkers’ bodies often complain about ex-mineworkers dying like flies in the media. Unfortunately, many dependants do not perform autopsies on them to find out the cause of death due to traditional beliefs and cultural norms.
Ncamsile Dlamini, a widow of an ex-mineworker of Kutsimuleni area in the Manzini region, is one such case. In a recent interview, she told Inhlase that the thought of carrying out a postmortem on her deceased husband never crossed her mind. This is despite the fact that he died of an unknown disease which warranted a postmortem to be performed to determine the cause of death. She made it clear that no amount of money could tempt her to do that.
“It’s just inhumane to cut up the body of a dead person as we honour and respect the dead in our culture. It’s worse when you remove his organs because our ancestors won’t accept him in the other world. It’s our strong belief that when one dies, he goes to the ancestors who want him to come intact,” she says, adding: “Yes, we need money in life, but that doesn’t mean we have to harvest parts of our people. I feared that he would punish me severely for dismembering his body.”
Interestingly, her elder daughter, Nozipho Dlamini, sees things differently regarding carrying out an autopsy. She does not hold the same belief as her mother about the afterlife. She argues that it is important to perform the autopsy, which enables access to the deceased mineworker’s funds. She brings into sharp focus the younger generation’s love for money above cultural mores and norms.
Swaziland National Ex-Miners Association (SNEMA) leader, Henry Mdluli, echoes the widow’s words. He points out that emaSwati find an autopsy completely unacceptable to their traditional beliefs and cultural norms. He recalls that SNEMA once tried to perform an autopsy on a Mavimbela ex-mineworker suspected to have died from silicosis at the Luke Commission in 2011. Eventually, they abandoned it when they discovered that it was costly. Worse still, there was no law, bar the police law, permitting private autopsy to be performed in the country.
“It’s not an easy thing to do by emaSwati who are rooted in cultural beliefs. Take a person with diabetes whose leg is amputated. We ask ourselves what will he tell the ancestors when he goes there with a leg missing. When my father loses his lungs and heart, I just wonder how we will communicate because the heart is no longer there. Once you have removed the essential parts, I cannot talk to an empty vessel. We need to be educated about the importance of the postmortem. It must start with the old people and then trickle down to our children who still hold the same cultural belief in emadlotini (gods).”
Swaziland Migrant Mine Workers Association (SWAMMIWA) executive secretary, Vama Jele, shares the same sentiments. He believes that there is an urgent need to overcome the challenge of performing an autopsy on deceased mineworkers. He believes that this will ensure that their dependants access compensation from the Tshiamiso Trust. He fears that the resistance will result in emaSwati losing millions of rands to the Trust.
“The issue of cutting up bodies and removal of lungs and hearts does not sit well with emaSwati. It’s a huge challenge because it is against our traditional beliefs and cultural norms. We can all blame it on how we were raised in a society with strong cultural beliefs. Many people are against carrying out a postmortem on their deceased relatives,” he says.
The executive secretary reveals that emaSwati mineworkers have no choice but to perform the postmortem. He cites the Occupational Diseases in Mines and Works Act (ODMWA) No.78 of 1973 enacted in South Africa. It covers payment or compensation for lung diseases contracted in the mines. He says SA has legislated autopsy to be carried out on mineworkers to determine the cause of death before claiming the compensation. This comes at no cost to the dependants and government because South Africa, where the NIOH is based, bears the costs.
Jele uses the example of ex-mineworker Mzimba Dlamini of Ntshanini in the Shiselweni region to highlight the benefits of carrying out a postmortem. His widow received the compensation twice. After submitting the postmortem report to the mine, she received one as per the ODMWA. When the Tshiamiso Trust was set up, she got the second compensation.
“In the 2000s, we handled a postmortem case of ex-mineworker Mzimba Dlamini. When he died, the medical staff of Hlathikhulu Government Hospital agreed to perform the postmortem though there was no legal instrument,” he vividly recalls, adding: “We didn’t have any problems because of his consent and family. We applied for an exportation permit to the police to take the lungs outside the country. The NIOH discovered that he had second-degree silicosis. His widow received his compensation twice.”
When probed about the autopsy challenges facing ex-mineworkers, Dr Velephi Okello, who is director of health services in the Ministry of Health, reveals that the Health Act 2023 was passed last year to regulate the health sector in the country. She mentions that Section 58 (1) states that the Minister may approve the removal, storage, and body tissues and organs by a health facility. Subsection (2) says any removal of a body tissue or organ from a deceased or living person shall be allowed only with the consent of the individual. However, she hastily points out that the absence of regulations is a challenge as it renders the Health Act 2023 ineffective. She laments that without the regulations, the Act cannot be enforced.
SWAMMIWA executive secretary echoes her words that an Act without regulations can never regulate the health sector. He appeals to the government to show political will and commitment in tackling issues affecting the mineworkers in the country. He also appeals to the mining companies to educate the claimants about the negative postmortem results.
“We must be mindful that the results might not be in favour of compensation. How do we then advise the family? The family must be informed in a very clear and transparent manner that there are times when we use the heart and lungs only to find the results not showing any symptoms of the diseases. The family can be very angry if you come and tell them that he doesn’t have any occupational disease. He, therefore, does not deserve to be compensated. The people must understand these issues,” he concludes.
