4.1 - Geography (see map)
4.2 - Demographic Description4.2.1 - Ga-Segonyana Municipality, North-West Province and Northern Cape Province4.3 - History of the Asbestos Industry in the Northern Cape and North-West provinces
4.2.2 - Moshaweng, North-West Province
4.2.3 - Confusion Regarding Provision of Municipal Services
4.4 - History of Asbestos-Related Disease Research in South Africa
4.1 Geography
(see map)
We visited the town of Kuruman and several nearby villages, namely Ga-Mopedi,
Ncweng, Seven Miles, Sedibeng and Lekalang. Until 1994, the town and the nearby
villages were divided by the border of Bophuthatswana and South Africa. The
villages were in Bophuthatswana, while the town of Kuruman was in South Africa.
Although official segregation has ended, the boundary endures as the border
between the Northern Cape and the North West Province. Furthermore, discrepancies
between the living conditions in these two areas continue. This area is remote
from larger population centres and the total number of people is relatively
small. Therefore, its division between two provinces poses an administrative
burden.
Tarred main roads connect Kuruman to the other larger settlements in the region, Mothibistad and Batlharos, formerly Bophuthatswana territory. Secondary gravel roads serve Ncweng, Ga-Mopedi and Sedibeng, as well as most of the communal territories. The gravel road are heavily travelled and not always adequately maintained. Kuruman and the surrounding towns are situated on the Ghaap plateau, which stretches one hundred and fifty kilometres from the Harts River valley in the east to the Kuruman Hills in the west. The Ghana plateau surface is calcrete set upon bedrock of dolomite or calcium manganese carbonate. The soil is thin, patchy, and stony. The bedrock contains caves, sinkholes and underground waterways. The Kuruman Hills form the northern portion of the Asbestos Hills, which rise over the western side of the Kuruman River valley. Kuruman itself is at 1342 meters above sea level.
The Kuruman region is situated in the Kalahari Thornveld. This region receives little rain except in the months of October through March. Average yearly precipitation is approximately 400 millimetres. Despite the green lawns of Kuruman, the towns and villages around are much dryer. Cattle and small stock are dominant and the communal land is largely uncultivated except when irrigation is possible. Goats, sheep and donkeys roam the roadsides or across fenced areas. Some cultivation occurs in the river valleys.
The majority of the villages we visited are in the valley of the Kuruman River rising at the Eye of Kuruman. The Eye is among the largest springs in the country and produces some twenty million litters of water a day. There is great inequity, though, in its distribution, and the town uses most of the flow. The Ghaap plateau also contains a number of minor springs and streams, but these minor eyes do not provide sufficient water for the only two substantial rivulets of the plateau (Kuruman and Matlhwareng)(5).
4.2 Demographic
Description
The greater Kuruman area is divided between two provinces. This division is
an enduring legacy of separate development - areas once in the homeland of Bophuthatswana
are currently in North-West Province, while the town and lands formerly restricted
to whites are now part of the Northern Cape Province. This is a cumbersome and
problematic division, and the government has attempted to ameliorate it by creating
cross-border entities. The two areas where we did research are Ga-Segonyana
Municipality, which straddles the Northern Cape and Northwest Provinces, and
Moshaweng Municipality, entirely in the North-West Province. Both municipalities
are under the jurisdiction of another cross-border entity, the Kgalagadi District
(6).
4.2.1 Ga-Segonyana
Municipality, North-West Province and Northern Cape Province
The Ga-Segonyana Municipality encompasses Kuruman town in the Northern Cape
Province and Mothibistad, its former township in the North-West Province. It
is demographically divided between Kuruman town and other wards. There are many
whites living in the town of Kuruman, but the villages in the area surrounding
it are almost entirely black. There is a large difference in the language used-78.4%
of people in town speak Afrikaans as their first language, but in most wards
over 90% of people speak Setswana. In Kuruman town, illiteracy was 8.8% in 1996,
but illiteracy is near 20% in other wards. Unemployment is only 4.2% in town,
while it ranges between 25 and 67% in other wards. Service delivery to residences
within the district also varies greatly: the percentage of people who have a
telephone at home ranges from 0.4% to 70.6% and those with sanitation services
at home varies from 0.2% to 99.2%.
4.2.2 Moshaweng,
North-West Province
More rural than the neighbouring Ga-Segonyana Municipality, Moshaweng Municipality
was formerly part of the Bophuthatswana homeland. The villages of the Moshaweng
Municipality are almost entirely black. Illiteracy is higher in this district
than in the Ga-Segonyana Municipality, with rates between 20 and 32%. Unemployment
is higher than the national average, between 56 and 76%, depending on the ward.
At least 95% of people in each ward speak Setswana as their first language.
The number of people with a telephone at home according to the census of 1996
was from 0-12%.
4.2.3 Confusion
Regarding Provision of Municipal Services
Although the border between the Northern Cape and North-West provinces in the
Kuruman area is cartographically precise, it causes much confusion. We were
told that the border between the Northern Cape and North-West provinces in the
Kuruman area is a "soft border," however, the national and provincial
governments have not yet determined its functioning. Currently, the Northern
Cape provides some municipal services for villages and townships in the North-West
Province, which are far from Vryburg, the nearest city in the North-West Province.
Yet the specifics of this power-sharing arrangement between the two provinces
are still being delineated. The neighbouring municipalities have placed members
on each other's councils, but are unsure of their responsibilities in providing
services such as roads, water, and health care. The Northern Cape has been charged
with providing basic municipal services for villages in the North-West, but
it is unclear exactly which services fall under their jurisdiction. With health
services being decentralised to the district level, as outlined in the White
Paper on the Transformation of the Health System(7),
this lack of clarity will cause further problems. For example, employees at
Kuruman Hospital told us that at least 50% of their patients are from the North-West
Province, but the budget does not include funding for them. The details of the
jurisdiction of cross-provincial entities should be addressed, because the confusion
detracts from the ability of the local government to provide necessary services.
4.3 History
of the Asbestos Industry in the Northern Cape and North-West Provinces
"This town was built on asbestos. As children, we played on it, and in
later years, we mined it and lifted it up onto trucks. If it was not for asbestos,
this town would not be here."- Kuruman Resident and Ex-Mineworker
The first recorded commercial mining of amphibole asbestos began in the early 1880s. By the mid-nineteenth century, the South African industry produced 97% of the world's crocidolite and asbestos constituted one of South Africa's most valuable base minerals. When the last amphibole mine closed a century later, the South African asbestos industry had created an occupational and public health tragedy that has devastated many parts of South Africa(8).
The Northern Cape Province, home to both the first and last South African amphibole asbestos mines, was renowned for producing the finest quality crocidolite fibre in the world(9). When mining and milling in the Prieska area ended in the late 1960s, mines in the Kuruman region became South Africa's prime producers of crocidolite asbestos. Most of these mines were owned by Cape Blue, a subsidiary of the British multinational Cape Plc. In 1981, the Griqualand Exploration and Finance Company (Gefco) bought out most other companies in the area. Gefco closed Merencor, its last operating asbestos mine in the Kuruman area, in the late 1990s.
Before the 1950s, asbestos mining near Kuruman was largely informal. For the most part, families worked as units, the men blasting holes and digging the asbestos, while the women and children used hand tools to cob the fibre. Often, these workers were not even formal employees; companies purchased asbestos from workers through a "free-lance tributor" system(10). This allowed undercapitalised companies to avoid paying for services, such as medical care and worker rations, which were generally required of larger mining operations. Informal production also allowed asbestos companies to avoid regulation. Although inspectors found the conditions at the asbestos mines to be appalling and, by 1928, had evidence of some of the negative health affects associated with asbestos inhalation, government was slow to enforce any safety standards(11).
It was not until the 1950s, when a rise in world-wide demand for amphibole asbestos prompted mining companies to industrialise, that the government made any efforts to control asbestos dust levels or to require compensation for ARDs. By 1961, Dr J.C. Wagner had established the carcinogenic potential of asbestos in the lung (See Section 4.4 for history of ARD research). However, even then, government failed to adequately regulate dust limits or to ensure proper medical surveillance of workers(12). Indeed, with some patients, companies were allowed to encourage deliberate misdiagnosis of ARDs, especially among their black workers(13, 14). As a result, thousands of workers, if not tens of thousands, fell sick and never received any compensation.
While all asbestos workers suffered under apartheid law, the negligence of asbestos companies hurt workers classified as black and coloured the most: companies gave black workers not only the most dangerous jobs and the worst health care, but also the least compensation(15). Female asbestos workers also suffered disproportionately; although there is a general perception that after 1950 women no longer worked in the asbestos industry, there is substantial evidence that, in fact, they continued to work in the mines up until the early 1990s. A woman's work in the asbestos mines was dangerous, since it involved handling dry, loose fibre. Women would also clean the clothes of the miners, a process which leads to additional exposure. Moreover, a female worker was often officially invisible, because her wages and identity as an employee were generally subsumed under those of her male counterpart. As a result, women who fell sick often had no legal claim to any compensation at all(16).
In 1987, four years after black unions regained legitimacy and the right to organise, the first significant improvements in mine conditions were made. Even then, statutory limits on asbestos dust concentrations lagged far behind those imposed in other countries and were not well enforced(17).As one elderly ex-miner told us, the Kuruman region "was built on asbestos." Indeed, asbestos was incorporated into all parts of the area's infrastructure, from the cheap building materials in the houses to the gravel spread over many of the roads. Large quantities of fibre have also crept into gardens and water sources. In the Kuruman region, strong north-west winds carried fibre from the mines in the nearby hills to the town centre and outlying townships. Several of the villages in the former Bophuthatswana, such as Ncweng, had open asbestos mines near the village. Crushing mills, often located in or near the town, also added to the asbestos cloud that enveloped the area(18).
When world asbestos prices dropped in the late 1970s and early 1980s, most South African amphibole mines were forced to close. In the absence of stronger legislation, fleeing multinationals were not forced to rehabilitate their asbestos mines and dumps. Today these contaminated areas continue to pollute and cause disease in many parts of South Africa, including the Kuruman region.
4.4 History
of Asbestos-Related Disease Research in South Africa
Although the first studies examining the prevalence of ARDs in South Africa
occurred as early as the late 1920s and 1930s(19),
ARDs research has occurred in bursts, followed by "long periods in which
people sink into a comatose state about the issue," according to one asbestos
researcher. In the early 1960s, Wagner and Sleggs investigated pleural thickenings
and mesothelioma incidence in the Northern Cape(20).
This research was followed by the work of Sluiss-Cremer and the NCOH in the
Transvaal and Cape asbestos fields(21).
These studies were instrumental in verifying the correlation between exposure
and mesothelioma and asbestosis.
Industry control of the research process retarded investigations into ARDs through the early 1980s. Mining companies used their influence to withdraw funds from government research bodies and to pressure local doctors from reporting ARDs, in some cases setting up extensive "TB" clinics to treat ARD victims(22, 23). Research was often subject to prior consultation with industry, as was the case with Talent's study of black miners in the Northern Cape(24). In other instances, industry retained the right to view results prior to publication, which itself could be delayed as much as 10 years by company objections. Other research and surveillance efforts were stopped in the planning or early implementation stages by the state security services who perceived community health studies on asbestos a threat to the established order(25, 26, 27).
In contrast to the politically and logistically constrained research of the 1960s and 1970s, new forms of research on disease prevalence appeared in the 1980s. The 1985 study of stevedores by Myers et. al, showed that those who transported asbestos for international export were also at high risk for ARDs, while the 1989 study by Zwi et al that found South African mesothelioma rates were the highest in the world(28, 29). The late 1980s and early 1990s saw the emergence of Felix's work in the Pietersburg Asbestos Fields in the Northern Province, which showed ARD prevalence of 52% for occupationally exposed people and 34% for those exposed environmentally(30). During the same period, studies in the Northern Cape, detailed below, revealed high levels of mesothelioma and other ARDs(31).
Recent research has focused on the health status of current and former mineworkers, often in close collaboration with the workers, unions and community organisations. At the request of NUM, the IHRG has completed extensive audits in the last ten years on the extent of ARDs among mineworkers. These reports, which include the Penge mine closure in 1992 as well as multiple audits in the Northern Cape crocidolite fields and Mpumalanga chrysotile fields, have consistently found high levels of ARDs among workers, as well as "inadequate record keeping, inadequate occupational histories, poor quality X-rays and lung function tests, inadequate training of medical staff, varied availability of industrial hygiene measurements, and poor information on compensation outcomes"(32, 33). A 1992 IHRG study of retrenched workers at Penge mine in the Northern Province found an asbestosis rate of 45% (34).
Beginning in 1994 at the Msauli chrysotile mine in Mpumalanga, the IHRG and NUM examined more than 2000 current and former workers, both re-assessing the analyses of mine doctors through exit examinations, and determining the individual's potential for retraining and re-skilling upon retrenchment. Building on this work, they are now involved in a larger scale mortality study to determine the impact of chrysotile mining on a mineworker population. Likewise, Roberts' study of the effects of asbestos mining in Sekhukhuneland and the compensation efforts of Davies in the Northern Province have both shown the extraordinary extent of ARDs among former mineworkers(35). Roberts' thesis details the burden of asbestos through a review of the recent and historical literature and through 22 selected case studies of former asbestos miners(36).
At the request of the Construction and Allied Workers Union (CAWAU) Drs Jeebhay, Kisting, Naidoo and Adams of the IHRG and Industrial Health Unit (IHU) audited the medical surveillance programmes of current and retrenched asbestos-cement workers. These audits were done between 1995 and 2000 and involved workers from factories in Durban, Bloemfontein, East London, Klipriver and Cape Town. The prevalence of ARDs recorded at these different audits ranged between 10% and 24%. The higher prevalence was recorded among the longer-serving workers(37).
Epidemiologic research in the crocidolite-producing regions of the Northern Cape and North-West provinces, our research area shows high rates of ARDs. Initial findings in 1962 by the NCOH in Johannesburg showed that "people who live or have lived in the areas of Prieska, Koegas, Kuruman and Penge are in danger of contracting asbestosis even though they have no industrial exposure to asbestos dust inhalation."(38) Despite significant political and financial obstacles from the mining industry, these data were published in 1965 by Sluiss-Cremer(39). Of non-industrially exposed examinees, 4.8% showed changes in the lung consistent with the effects of asbestos(40). Total rates of pleural changes in the Northern Cape for those exposed to asbestos because of their occupations or because of their exposure to industrial pollution of the environment, were 29% for men and 11% for women(41). The same series of studies found "an alarmingly high number of cases with mesothelioma . . . among people who live or have lived in the North Western Cape area."(42) Of the 489 reported cases of mesothelioma reported in South Africa in 1975, 178 were from the Northern Cape, and 97 of these were classified as exposures to the contaminated environment(43). These studies focused primarily on white populations, although occasionally coloureds were included. A study of asbestos mine and mill workers in the Northern Cape found a 19% rate of pleural abnormality in coloureds and a 5% rate in whites(44).
In contrast, Talent et al studied 1185 current and former black asbestos miners working in the Northern Cape crocidolite mines and living in the former Bophuthatswana homeland within 100km of Kuruman. This study is particularly noteworthy, both for its relative rarity in focusing on black workers and because the population studied is closest to those rural areas we interviewed in the North-West Province. Despite methodological difficulties in tracking a rural and often mobile population, the study was able to show the presence of asbestos bodies in 16% of the sample, pleural abnormalities in 25% of the sample and a prevalence of mesothelioma of 0.5%. Given that 69% of workers reported less than five years of overall occupational exposure and less than twenty years since first exposure, these figures are likely to be low, if the latency period for ARDs is considered. Moreover, the Talent study observed high mesothelioma rates in the overall population, reporting 61 unsolicited cases at one rural clinic from 1974 to 1979. While 25 of these had mined asbestos, 12 were women formerly employed as cobbers and 24 reported only exposure to the contaminated environment(45).
More recently, attention has focused on Prieska, a former mining and milling centre at the southern end of the crocidolite belt in the Northern Cape. Kielkowski, Nelson and Rees studied a cohort of whites born from 1916 to 1936 for evidence of mesothelioma and other cancers, incorporating both occupational and industrial environmental exposures. In their results, they documented mesothelioma rates thirty times higher than the national rate for South Africa, as well as elevated rates of lung cancer. Moreover, they found evidence that the former mill regularly exceeded contemporary international standards for asbestos fibre counts by factors of ten or more(46).
The 1997 Randeree study of the Prieska area found similarly high rates of ARDs, and documented significant environmental exposures in inhabited areas such as schools, playgrounds and homes. Randeree found that the prevalence of ARDs in many areas in the Northern Cape ranged from 25 to 50%, depending on the occupational history of the area and proximity to the mine dumps(47). These figures supported the findings of IHRG audits of retrenched crocidolite workers in the Kuruman area, which showed ARDs prevalence rates of 21 to 39%(48).