By Dr Sophia Kisting-Cairncross
The closing of the Q(h)ubeka Trust marks both a celebration of what can be achieved through the collective quest for a better humanity, and an opportunity to use the learnings to enable a better measure of redress and social justice for workers who are sick from preventable occupational lung diseases.
By the date of closing, the Trust had awarded roughly R422 million to 2 280 beneficiaries. The amount awarded represents 99.2% of the total amount due to 2 301 beneficiaries.
The remaining 0.8%, worth R3.5m, is due to the dependants of 37 claimants, 16 of whom have received their first tranche of payment. These families still need to supply legal proof that they are the heirs of the original mineworker claimants.
The Trust was established following the successful conclusion of a lengthy compensation battle by lawyers, Richard Meeran and Zanele Mbuyisa, who represented former mineworkers who had contracted silicosis as a result of working for various mines owned by Anglo American and/or AngloGold Ashanti.
Qhubeka means “go forward” in Xhosa and was chosen as a way of recognising, and honouring, the thousands of men and their families – our claimants – who have struggled for decades with the debilitating effects of silicosis and the ever-associated tuberculosis (TB) from their work in South Africa’s gold mines.
Silicosis is essentially caused by the scarring of the lung by tiny silica particles inhaled as the claimants worked in the gold mines. Such scarring of the lung is incurable and progressive, and greatly raises the person’s risk of contracting TB.
During the seven years of the Trust’s existence, we not only managed to pay more than R420m in compensation to these mineworkers, but also assisted claimants to apply for statutory benefits under the Occupational Diseases in Mines and Works Act (ODMWA), thereby securing potential additional compensation for the claimants.
Moreover, being the first silicosis compensation trust in the public domain in South Africa, there is an opportunity for other compensation systems to build upon the valuable lessons learnt.
Compensation trusts born out of settlement agreements (Asbestos Relief Trust, Kgalagadi Trust, Q(h)ubeka Trust, Tshiamiso Trust and the Cape Plc settlement) have positively impacted the burden and payments of occupational lung diseases. The payments from settlement trusts to sick former mineworkers and their families is edging to more than R2 billion over a 20-year period.
These trusts, however, can never replace the importance of an adequately financed and well-resourced compensation system for occupational diseases and injuries in the public domain and that is what we collectively should support. We hope to continue to contribute to such an important process, which can be a catalyst for greater prevention and help to reduce the heavy burden of disease in our public sectors.
Some important lessons learnt:
– The high percentage (60%) and severity of silicosis among the older group of workers of the Q(h)ubeka Trust cohort is of great concern. This suggests that the burden of silicosis may well be higher than is currently diagnosed. It requires a collective effort to have ongoing and standardised medical education with standardised criteria, quality assurance and the rigour of scientific research to arrive at that true burden of disease. The ongoing training and effective use of the ILO International Classification on Radiographs of Pneumoconiosis is but one pillar in this process.
– Similarly, the histories of repeated episodes of TB with consequent extensive scarring of the lungs was startling, making the medical process more complex and more difficult than initially envisaged. The trustees co-ordinated workshops with Consultative Occupational Medical Panel members as well as medical advisers, to discuss these challenges and develop a standardised approach for the assessment of claims. This approach can be adopted by other organisations responsible for the compensation of TB and silicosis.
– Of all the mineworkers who passed on after lodging a claim, only one single claimant had written a will. Mineworkers and ex-mineworkers must therefore be encouraged to make a will. The Department of Justice has at times run excellent and informative workshops on how to do this, with the Deputy Master in the Mthatha office, among others, having run such workshops in the past year.
– Doctors and nurses should take the time to obtain a good occupational history at the benefit medical examinations. Workers should be allowed to have their own work history recorded as they know best what work they have done. Research on the Q(h)ubeka Trust data has shown it is among the most trustworthy information we can obtain.
– Forty-two percent of Q(h)ubeka Trust claimants passed on during the settlement process and after the Trust was registered, making their families beneficiaries of compensation due to them. Compensation processes must be sensitive to the realities facing widows, especially in rural areas, and to the realities that come with dual families that frequently result from the migrant labour system. The challenges are exacerbated in the absence of a will and make access to compensation a real struggle. It is imperative for these aspects to be recognised and fully integrated into trust systems from inception.
– There were numerous problems with banks and bank accounts which complicated the lives of beneficiaries. We found that there was co-operation and almost always some improvement once banks were approached to collaborate in order to address the challenges.
– Mineworkers and their families need to know their rights in terms of occupational diseases and social benefits available to them, and how to access these benefits. Many are uncertain or at times are misinformed. This knowledge should start at the mining companies and at the various medical examinations.
– Research is of great importance to share knowledge gained towards greater prevention of silicosis, TB, and other occupational lung diseases. Using research on Q(h)ubeka Trust data, a team of scientists and researchers from South Africa and abroad developed a robust predictive model, which made it possible to pay the families of 457 sick mineworkers who passed away before they could be examined by the Trust medical teams. This pioneering work, reported here, can assist with the administration of such claims in other settings. It is a good example of how we can utilise aspects of the cumulative scientific knowledge of our common humanity to assist workers disadvantaged through history and legacy concerns, such as apartheid.
– Mineworkers and ex-mineworkers should be an integral part of the writing of any future settlement trust deeds and of their board of trustees. Their lived experience and knowledge of the realities, the issues and possible solutions is invaluable.
Collaboration and information sharing is essential. The work of the Trust was enriched by the support and sharing of information with the Medical Bureau for Occupational Disease, the CCOD and with sister settlement trusts: Asbestos Relief Trust, Kgalagadi Trust and the Tshiamiso Trust. It is imperative for such organisations to work together in order to achieve more.
It remains our fervent hope that measures for the greater prevention of silica-related diseases and TB will be implemented on an ongoing basis. This is one way to learn from and honour the enormous sacrifices made by mineworkers.
By Dr Sophia Kisting-Cairncross, Occupational Medicine Specialist and Chairperson of the Q(h)ubeka Trust