SA apartheid-era practices haunt ex-miners
By Vuyisile Hlatshwayo
Sibangani Alfred Nkhambule, a 66-year-old former mineworker, has been fighting a battle against the odds since returning to eSwatini after years of labouring in South Africa’s mines. Stripped of his dignity and his right to health care when he was forced to leave his medical records behind, Nkhambule has faced insurmountable challenges in accessing proper medical treatment and securing his tuberculosis (TB) compensation.
His situation is compounded by the fact that the Medical Bureau for Occupational Diseases (MBOD) and Tshiamiso Trust, two South African bodies responsible for processing TB claims for ex-mineworkers, are inaccessible to him due to his missing medical records. Both organizations provide the benefit medical examinations (BMEs) and process compensation claims for TB and other work-related diseases. But for Nkhambule, these avenues remain closed.
Despondent and feeling forgotten, Nkhambule, who hails from Maliyaduma, a rural area just north-east of Manzini City, reflects on the plight of many African mineworkers. He describes how medical records were withheld from workers during the apartheid era, adding that, “I started working in the SA mines during the apartheid era when black miners had no right to health information whatsoever. We’re forced to surrender our medical records to the mine bosses when we returned from the hospital. I swear any ex-mineworker who claims to have theirs must have stolen it,” he laments.
Vama Jele, the regional coordinator of the Southern African Miners Association (SAMA) and a member of the Country Coordinating Mechanism (CCM) Eswatini TB Constituency, agrees that the absence of medical records is a major obstacle for ex-mineworkers seeking TB compensation. In an interview with Inhlase, he revealed that 98% of ex-mineworkers are without their medical records, leading to a backlog of unclaimed benefits. The lack of these records has meant that many ex-mineworkers cannot access their pensions, provident funds, or compensation for illness, injury, or death.
Jele points to South African law, specifically the Mine Health and Safety Act (No. 29 of 1996), which mandates that mining companies retain medical surveillance records for 40 years. According to the law, these records must be kept for 40 years from the last date of the employee’s medical examination, after which they can be destroyed. Moreover, the law requires that an exit medical examination be conducted by an occupational medical practitioner, who must provide the employee with a certificate stating whether or not they have an occupational disease. But as Nkhambule and many other ex-mineworkers have shared, their former employers failed to comply with these legal obligations.
Alternatively, Jele notes that ex-mineworkers can invoke the Protection of Personal Information Act (No.4 of 2013) to request the release of their medical records. However, the complex application process is a significant hurdle, particularly for those who are illiterate or unable to navigate the legal system. When Inhlase reached out to the South African Department of Minerals and Energy for comment, their spokesperson, Makhosonke Buthelezi, did not respond.
Nkhambule, now struggling with TB-related vision loss and living in poverty, often finds it difficult to access medical care from healthcare facilities because of the missing medical records. Clinicians complain that without his health history, they cannot provide adequate treatment. He recalls a recent visit to Raleigh Fitkin Memorial Hospital (RFM) for a waist operation, when the doctor asked for his medical records. “I told him I didn’t have it because my former mine boss took it,” he explains, recalling the doctor’s surprise and his clear condemnation of the practice.
Siphiwe Ngwenya, Acting National TB Programme Manager, echoes this concern, highlighting the difficulty faced by medical practitioners in treating mineworkers and ex-mineworkers without their medical records. Ngwenya explains: “When mineworkers return from South Africa in critical condition but without medical records, we have to start their treatment from scratch. It’s a frustrating and time-consuming process.”
Nkhambule’s own history is a testament to the ongoing struggle. He began working in South African mines in 1975 and contracted TB twice during his time there. His medical records show that he was hospitalized for six months for TB treatment between 2000 and 2001. However, after his diagnosis was confirmed and he was certified for TB compensation, he was dismissed without receiving a penny in compensation. Despite promises from his employer, he has not seen a cent in the 24 years since.
Once back in eSwatini, Nkhambule received free TB treatment from one of the Global Fund-financed Occupational Health Service Centres (OHSCs) located within the RFM Hospital. But with the closure of these centres, his access to care has become increasingly difficult. He now relies on a meagre government social grant of E500 per month, from which he must cover the cost of medication, food, and transport. His only source of additional income comes from raising and selling chickens and goats.
Adding to his frustration, Nkhambule’s application for TB compensation through the MBOD Programme was thwarted when he learned that the programme ran out of funds in 2017.
“I submitted all the required documents, including a certified copy of my identity card and fingerprints, but I haven’t received a single cent,” he says bitterly
His frustration continues as he waits for the outcome of his Tshiamiso Trust BME, which he underwent a year ago. The Trust’s delays in the claims process have left Nkhambule feeling hopeless. Worse still, his visual impairment means he is unable to read any updates sent to him via SMS. He worries that other claimants are also receiving negative results from the Trust’s BME outreach programme, despite qualifying for compensation.
Another ex-mineworker, Lizwi Dlamini, from Siphofaneni, shares similar concerns. Dlamini, who worked for AngloGold Ashanti from 1992 to 2014, was diagnosed with silicosis but is now being told by the Tshiamiso Trust that he no longer has the disease. He believes the Trust has incorrectly classified his condition and is trying to use his lost exit certificate to challenge the outcome.
Tshiamiso Trust spokesperson Lusanda Jiya explains that discrepancies in diagnoses are possible, but claimants can dispute the Trust’s determination within 30 days of receiving the notice. However, Jiya stresses that the Trust only compensates for permanent lung damage caused by diseases like TB or silicosis, not for the diseases themselves.
According to the Tshiamiso Trust figures, out of 4,974 claims filed in eSwatini, only 1,022 have been paid, totaling E89.3 million. Many ex-mineworkers, like Nkhambule, remain in limbo, waiting for compensation that may never come.
The situation is exacerbated by incomplete clinical records, which prevent the Trust from assisting claimants like Nkhambule. Dr. May Harmanus, chairperson of Tshiamiso Trust, notes in her 2024 Annual Report that these gaps in personal information make it difficult for the Trust to process claims.
One potential solution is the Cross-Border Referral System (CBRS), introduced by Southern African Development Community (SADC) health ministers in 2012. This system would allow for the digitization of ex-mineworkers’ medical records and facilitate seamless information exchange across borders. Jele believes digitizing medical records is essential for ensuring that ex-mineworkers’ health histories are preserved and accessible, while Ngwenya expresses optimism that the system will eventually provide a solution to the challenges faced by ex-mineworkers.
As Nkhambule waits for compensation that seems ever more unlikely, his case stands as a powerful reminder of the systemic issues faced by ex-mineworkers across the region—issues rooted in apartheid-era practices that continue to affect their lives today.
