Jonathan Smith: Hope at the Epicenter: Overcoming the TB Emergency in Sub-Saharan Africa

I met her while conducting research in 2011. She had never had tuberculosis (TB). She was HIV negative. But sitting on her bed beside her husband in the Eastern Cape of South Africa, she quietly asked,

"Do we have hope?"

I paused -- partly because I was stunned, partly because for a moment I had no idea how to answer. In my brief reverie, I could hear the wheezing of her husband's advanced silicosis -- a debilitating fibrotic disease of the lung caused by years of working in the underground mines. I could see the absolute emaciation caused from the TB in his lungs.

If she had of asked me if he had hope, my reply may have been unfortunate, perhaps a bit crass, but simple.

But that's not what she asked. She asked if we had hope. So after a moment of hesitation, I responded with the most complicated phrase I could imagine.

"Of course, madame."

For well over a century, South Africa miners, their families, and communities have been decimated by tuberculosis. The South African mines have the highest recorded rates of TB in the world and an entrenched system of migrant labor bridges these areas of high concentration with the rural home areas. This link between mining and TB among the general public is palpable: mining contributes to an estimated 760,000 cases of TB in the southern African region.

Just two years ago, my response to the miner's wife was born out of pure optimism and a commitment to bring this human tragedy to an end. But, the current momentum in the region suggests that we may have had good reason to be hopeful.

In August 2012, the Heads of State of 15 Southern African Development Community (SADC) member states signed a Declaration on TB in the Mining Sector, which could be regarded as one of the largest acts of political will the TB community has ever seen. Unlike typical political rhetoric, this declaration specifically calls on civil society, international governments, and the corporate sector as partners at the table.

It recognizes the need for cooperative leadership among these groups, and embraces accountability. It avoids the intellectually lazy trap of demonizing the mining industry, recognizing that though they are part of the problem, they are also part of the solution. It calls of partners from around the globe to come together and be more than the sum of their individual parts for a collective impact response.

The declaration is not enough on its own.

First, it must be backed up with targeted investments. That means a fully funded Global Fund. The Fund provides the vast majority of international financing for TB programs and without it the fight against TB will grind to a halt. But we also need new streams of financing. As the WHO and Global Fund stated earlier this week, there is an annual gap in international financing for TB of at least $1.6 billion a year.

Second, the Declaration must lead to real partnerships. It was heartening to see industry come together with the mining industry and government in Swaziland yesterday and commit to accelerating action on TB and HIV in the next 1,000 days. This was backed up with funding from organizations including the Global Fund and the Stop TB Partnership which is now helping to track down and treat former miners whose TB might otherwise have gone undetected.

It is even more encouraging the South Africa government, in partnership with the World Bank and others, will hold a summit on TB and Mining later in the year. The SADC governments are showing sustained dedication on this issue, and are clearly working to ensure that the Declaration does not lose its momentum like so many political acts of will throughout history.

Does this mean that the saying of migrant miners in Southern Africa "returning home to die" is no longer accurate? Sadly, not yet. But the two years since I responded to her with my cautious optimism have been accompanied by unprecedented progress on the issue. So I'll stick by my first response to the miner's wife. Yes, we do have hope.

This post is part of a series produced by The Huffington Post, The Global Fund, and the Stop TB Partnership in recognition of World TB Day. For more information on The Global Fund, click here. To read more posts about The Big Push -- The Global Fund's effort to eradicate HIV/AIDS, malaria and tuberculosis -- click here.

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Source: http://www.huffingtonpost.com/jonathan-smith/tb-in-sub-saharan-africa_b_2936394.html

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