For the hundreds of thousands of sick former mineworkers the only compensation available for years of work and life lost to lung disease is a token amount of money.
The miner has to apply for compensation – often years after leaving the mine – and those who complete the application process rarely get paid. Many miners do not even know that this option is available to them.
When it is coupled with a higher HIV infection rate among miners than the general population (25% to 30% compared with an estimated 17%), silicosis places South Africa's miners at triple the risk of developing tuberculosis (TB). This group has one of the highest HIV infection rates in the world.
According to Rodney Ehrlich, an occupational health expert from the University of Cape Town, silicosis is a slowly progressing yet debilitating lung disease caused by inhaling microscopic silica dust particles. These particles are mostly found in the ore of gold mines and break down the lung’s ability to function, including being able to fight off diseases such as TB.
Ehrlich said that miners exposed to silica dust are at a greater risk of developing TB for the rest of their lives – even if they do not have full-blown silicosis.
"Our conservative estimation is that 700 000 former mineworkers are suffering from compensable lung disease and remain unpaid,” said Ryan Boyko, from Yale University's school of public health in the United States.
He said that most of these miners have not completed the application process because of the complexity involved and the resources required – including access to medical care for diagnosis and detailed documentation. Those who have completed the process could wait a decade to receive their payment.
Boyko is the lead author of a report published in January by the Global Health Justice Partnership (a joint initiative between Yale Law School and Yale School of Public Health).
The report, titled Fulfilling Broken Promises, details the "century-old broken [compensation] system" in South Africa. The researchers interviewed occupational health experts, labour and health rights advocates, government officials and mineworkers and their families.
Responding to emailed questions, he said that "every step of the process to access this compensation is broken" and that the government agency tasked with certifying occupational lung disease in ex-miners – the Medical Bureau of Occupational Disease – is largely to blame as it is under-resourced and inefficient.
Boyko calls the body’s claim process "heavily bureaucratic, time-consuming and complicated".
Ehrlich, who is head of occupational medicine at Groote Schuur Hospital in Cape Town, said that once workers leave the mine "they almost have no chance of getting back into the system".
"To qualify for compensation you need to be certified with a lung disease by a doctor but most of these mineworkers come from rural areas or neighbouring countries where their access to medical care is severely limited because they have to pay for transport to remote facilities," he said.
The subsequent paperwork is "impossible", said Ehrlich, as most of these men are illiterate and struggle to provide the documentation required, including proof of employment and certified bank records.
"Imagine someone from a rural area in Mozambique trying to find, photocopy or scan all of this paperwork and then posting it to the Medical Bureau of Occupational Disease in Johannesburg; it's actually ridiculous."
Kholakele Vaphi, a 60-year-old ex-mineworker originally from the former Transkei, was retrenched in 2006 when he contracted TB and became too sick to work. His application was submitted by the mine.
"Once he leaves the mine he's not their responsibility any more," said Ehrlich, who is currently following up on Vaphi's seven-year-old claim.
"How are these mineworkers expected to constantly follow up? But it has to be done otherwise [their applications] will go to die in the compensation commissioner for occupational diseases’s office."
During 2003, the only year in which an audit of the compensation fund was conducted, only 400 of the 28 161 claims submitted were paid.
Ehrlich said that the few who are compensated often receive little benefit from the lump sum, which ranges from R48 000 to R180 000 – less than a year’s income, which is "woefully inadequate" considering that these miners are often younger than 50 and too sick to work again.
To qualify for a payout of more than R100 000, the miner has to have two lung diseases, most often silicosis and TB, which means they are usually "extremely sick" and need money for medical care, said Ehrlich.
But the first step is being aware of the right to be compensated, which many former mineworkers are not.
Not on the agenda
This week, heads of mining companies, investors and government officials met in Cape Town for the Investing in African Mining Indaba where they discussed the financial future of the industry. The topics of former mineworkers, occupational diseases or compensation did not feature on the agenda.
Jonathan Moore, chief executive of the indaba, acknowledged that the mining sector is one of the largest employers globally but the indaba "focuses on bringing together investors and mining houses".
The co-director of the Global Health Justice Partnership at Yale, Gregg Gonsalves, said: "This issue has been going on for a century yet for all the talk, reports and meetings, nothing happens to improve the situation for these men and their families. They have paid a steep price for working for these companies and to be left with nothing is a crime."
Tiny payout for lifelong illness
I've just come from hospital now," said Philemon Mkhatshwa (58) over a crackling telephone line from Swaziland.
"I have to go to hospital every two months to get my medication for tuberculosis [TB] and silicosis, but unlike in South Africa, I have to pay for this medicine," he said.
Mkhatshwa also has to pay more than R100 for the 40-minute bus and taxi rides to and from the hospital.
He is sick and unhappy, but Mkhatshwa is actually one of the "lucky" few to have received compensation for the occupational disease he acquired while working on the mines. He received a R48 000 lump sum payout for contracting TB on the job.
"When you are sitting at home unable to work from the age of 38, R48 000 is nothing. I used the money for transport and treatment, and it helped me a lot at the time, but when the money was finished that was it, I couldn't even afford to pay my son's school fees."
Mkhatshwa said applying for compensation was difficult.
"We didn't have any lawyers, we just tried to help each other."
He said that he knew many former mineworkers in Swaziland who had experienced similar hardship.
"I'm weak and can't do anything. Those of us with this illness have a tough life."
Have something to say? Tweet or Facebook us on @Bhekisisa_MG
Silicosis claims and the gold mines: To settle or not?
Anglo American settle silicosis suit
Miners turn to SA after UK court refuses Anglo American silicosis case
Work at a non-profit media house? Then you know your job is not just reporting anymore.
As deaths mount, take an inside look at the detectives working around the clock to solve the country’s medical mystery.
Until now, the national and provincial health departments have not been able to say where services are provided. Here's how we found them.
Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.