In Zimbabwe, limited access to basic health services in artisanal and small-scale mining characterises the harsh realities of excessive exposure to silica-containing dust, overcrowding and poor living conditions for miners.

Zimbabwe is currently experiencing a high burden of TB, silicosis and HIV among communities of artisanal and small-scale miners. Multi-sectoral and innovative actions are required to stem this triple epidemic in Zimbabwe. The risk of silicosis for people has increased due to the severity of exposure to silica dust.

Silicosis is a lung disease that comes as a result of exposure to silica, which is found in dust. The risk factors among subsistence miners have to do with the work they do—digging, blasting and other related activities.

The burden of respiratory diseases affects artisanal small-scale miners, because of various socioeconomic factors like a lack of protective clothing, limited access to healthcare and a lack of knowledge about the diseases and preventive measures they can take when engaging in their operations. The miners are also exposed to sexually transmitted infections due to the prevalence of sex work in mining communities.

To provide basic healthcare services to the artisanal miners, Médecins Sans Frontières (MSF) is running a medical outreach initiative in Gwanda District, Matabeleland South province, supporting the Ministry of Health and Child Care (MoHCC) in reaching hard-to-reach communities, specifically targeting those occupied in artisanal small-scale gold mining, with a comprehensive basic healthcare programme. MSF selected Gwanda district for an intervention because of poor health indicators in the artisanal mining community.

The outreach programme aims to bridge the health services gap and bring essential healthcare services directly to the miners’ doorsteps. By working hand in hand with the MoHCC, MSF provides access to communicable and non-communicable diseases prevention, screening and treatment.

“We noted some of the main gaps and partnered with the Ministry of Health and Childcare to conduct outreach programmes to artisanal mining sites,” says Dr Munyaradzi Sidakwa, project medical manager. “Our goal is not only to address the immediate health needs of these miners, but also to empower them with the knowledge and tools to protect themselves and their communities in the long run and the screening is for free.”
 
Host communities and artisanal small-scale miners in hard-to-reach areas delay seeking medical care. They do not follow through with referrals; they struggle to adhere to treatment; they also struggle to access affordable care; and they frequently rely on traditional treatments that are readily available and easily accessible.

The miners are also hard to reach with public health information because of their mobile nature; they move from one place to another in search of rich gold deposits. Distance has been one of the major hindrances to access medical care for miners and host communities, and this has ultimately affected their health seeking behaviour. They have to travel for anything between six and 30 kilometres to access the nearest health facility.  

Meandering through the bumpy roads, MSF teams reach the artisanal mining areas. The patients will be waiting, heeding the call after a two-day mobilisation by the health promotion team, two days prior to the medical outreach. Women and children are the first to come. Men trickle in during lunchtime, as they work underground.

Past midday, tired and weary, they join the queue to get screened and medication. 

MSF teams, comprising doctor and nurses, pharmacy technicians, and health promoters, organise mobile clinics to artisanal mining sites scattered around Gwanda district to provide medical care, and on some days, they go to host communities. Clinics are held four days a week, with the teams visiting two different locations per day. Each day, they attend to new patients, seeing a minimum of 70 patients in the mining locations and over 200 patients in communities. 

The medical services include free screening for conditions such as tuberculosis (TB), HIV, cervical cancer screening, hypertension, sexually transmitted infections, and providing family planning services. Medications are provided for free at clinics. Patients that cannot be treated at a clinic or requiring advanced interventions are referred to Gwanda Provincial hospital.

To date, MSF teams have reached over 4,000 artisanal miners and host communities with mobile clinics.

“It is hard for them to reach the facilities, so, during such programmes, we go to the mining sites,” says Dr Sidakwa. “We provide a comprehensive package and address the health challenges being faced by the artisanal miners, which include HIV, TB, silicosis, limited access to condoms and family planning methods, STIs, drug and substance use and mental health issues.”

The demand for services is high, with the mining community appreciating the efforts by MSF teams to bring healthcare services closer to where they are.

“I find it hard to visit the clinic, even when I feel sick. During the day, we will be busy in the mining holes, so I better sacrifice to get money to fend for my family. We suffer from the inside with generalised aches and pains but we just ignore them, but chest pains are severe. Now that we are getting medical services here, it is easier for me,” said Amon Ndhlovu, one of the artisanal miners.

Effective control of TB, silicosis, and HIV among miners requires addressing the identified knowledge gaps and barriers that are faced by miners in accessing personal protective equipment and healthcare services. This will require multi-sector collaboration and the involvement of miners in co-designing a package of healthcare services that are tailored for them.

To ensure sustainable access to healthcare services by artisanal miners, MSF recommends stakeholders to collaborate with MoHCC to ensure that artisanal miners access health services with the establishment of health posts in places nearer to mining communities.