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Lynette Manzini : Correspondent

Jacob Pasipanodya, aged 28, swings his right leg back and forth while lying on an old wooden bench positioned under a tree. He sits up occasionally to cough displaying signs of agony. Pasipanodya – an artisanal (korokoza) miner who hails from Midlands province’s Zhombe rural has been a gold panner in the gold rich ghost Empress Mining area since he failed his ordinary level examinations in 2006.Despite being diagnosed with tuberculosis in January 2016 in Harare and currently under treatment, he still thinks witchcraft had something to do with the deaths of members of his family.

He narrates how he lost both his wife and his two month old son in a space of a week.

“I am convinced that my colleagues bewitched me because less than a month after I hit the jackpot my family became ill and died,” Pasipanodya says as he coughs and desperately gasps for breath.

His wife’s friend who identified herself as Chihera described Pasipanodya’s late wife as a chubby and jovial woman who had trouble eating which contributed to her drastic weight loss when she got pregnant.

Still in denial Pasipanodya is like other uninformed artisanal miners scattered around the country who are unaware of the fact that any contact with the silica dust produced in the process of mining exposes the subject to tuberculosis.

Artisanal miners operate in unventilated areas which make the spread of tuberculosis easy. This facilitates for the spread of the bacteria which causes the disease to unsuspecting family members and work mates of the infected as its spread requires close prolonged contact.

The case of Pasipanoya’s late wife typifies women in mining communities who have no knowledge of the signs and symptoms of tuberculosis especially in remote areas like Empress Mine were clinics are ill equipped.

Associating diseases with witchcraft, superstition, religious beliefs is common not only in Zimbabwe but across the continent particularly in the rural communities.

In the past signs and symptoms of cancer were attributed to sorcery until the recent years when health stakeholders intensified awareness campaigns.

This situation, according to the director of The Union, the organisation dealing with TB issues, Dr Christopher Zishiri, stifles progress in the fight against TB in Zimbabwe.

“We have some traditional healers or herbalists who believe that they can cure TB and we have religious leaders who also think that also they can pray for TB to disappear,” he said.

“However, I would like acknowledge that there are some traditional healers and religious leaders who really put the health system in its place and they need more health information from us, on how they can best identify TB patients for us and not for them to attempt to use their traditional means of treating patients,” he said. Zishiri recognised the importance of community groups in tackling misconceptions that may arise within communities.

“We are strengthening the community TB component, where we have village health workers working with relevant clinics and health care workers assisting them with full support in terms of identification of TB,” said Zishiri.

“Health care workers are a part of community groups championing through traditional leadership and community leadership.”

However there is a sharp contrast between what happened to Pasipanodya’s wife and Vimba Kwembeya of Kadoma’s Rimuka township. Kwembeya is a member of the TB and HIV Tsungai community support group that has been in existence since 2009.

The group had 15 active members upon inception but the number has been reduced to seven as others have passed on. The community group was established to encourage community members living with HIV on adherence, to follow up on patients defaulting on treatments life and to ensure members are on the lookout for opportunistic diseases such as tuberculosis.

“We meet twice every month to share personal experiences and encounters with other people from the communities and we encourage each other from time to time,” she said.

“However, we are in the process of recruiting more members but as you know disclosure is the problem with many, one cannot be a peer educator without sharing their personal story”, narrated Kwembeya.

“Our job is not easy because at times we meet with people who have given up and don’t want to take their medication and others who stop taking medication as soon as they look and feel better” she said.

“Being part of a community support group which works with health institutions enlightened me on the dangers of opportunistic infections such as tuberculosis”.

“Two years after I was diagnosed of HIV, when I was eight months pregnant I began sweating and losing appetite, but I did not lose weight, because I was well informed I suspected it to be tuberculosis and sort for medical attention immediately,” she said.

Kwembaya has since recovered from tuberculosis and her one and only one year old child is both HIV and tuberculosis free a success story that illustrates that TB in pregnant women is treatable and the medication is safe for both mother and baby.

According to the World Health Organisation TB is one of the top five killer diseases of women adults aged 20-59 years.

It also estimates that in 2014 3.2 million women fell ill with TB of which 480 000 died of tuberculosis including 140 000 deaths among women who were HIV positive.

WHO established that TB in pregnant women living with HIV increases the risk of maternal and infant mortality by almost 300 percent and almost 90 percent of the HIV associated TB deaths among women were in Africa.

Unfortunately statistics of pregnant women diagnosed with tuberculosis in Zimbabwe’s mining communities is not readily available as the information is collected all under the national tuberculosis programme without breaking it down to specific demographics.

“We have statistics but they are not necessarily for pregnant women or those in mining communities, the format of the data is not easily accessible because to get the information one would have to go through different types of registers”, Dr. Charles Sandy, deputy director HIV/AIDS and TB programme in the Ministry of Health and child care.

However, Sandy said a pilot project for pregnant women to be rolled out in Manicaland late this year would ensure that the data collection tools will enable ease of obtaining specific data.

Dr Zishiri concurred with Dr Sandy, “In terms of pregnancy status this a new venture which the ministry is championing.

The Union with support from USAID Challenge TB is has partnered with OPHID Trust in implementing the utilisation of Gene Xpert machines among pregnant women irrespective of their HIV status.”

“In terms of pregnancy status this a new venture which the ministry is championing, I know The Union is doing something on TB in pregnant women with OPHID Trust in implementing the utilisation of Gene Xpert machines irrespective of their HIV status.”

Zishiri said while the ministry of health through the National Tuberculosis Program has got health promotion officers working in collaboration with The Union’s communication officers in promoting TB awareness, there is need for more education on TB awareness.

Vivian Chitiyo the Knowledge Management Officer of the Organisation for Public Health Interventions and Development (OPHID) said they are providing support which is aimed at strengthening health care services in public health facilities throughout the country.

“ The program works with artisanal miners in so far as they come into the public health facilities and receive quality HIV care and treatment, as well as TB care services”, Chitiyo said.

The 2015 Multiple Cluster Survey indicates that around 20 percent of women aged between 15- 49 delivered in the absence of a skilled health care worker. This scenario suggests that thousands of women are missing out on antenatal care.

This number could also include the expecting mothers from the apostolic sects and wives of the nomadic illegal gold panners who do not subscribe to visiting health care facilities.

Antenatal care is the care expectant mothers receive from healthcare professionals during pregnancy.

A random selection of women between the age of 21 to 30 interviewed to assess their knowledge of TB, shows that most of them professed ignorance of the disease. Tendai Moyo (30) registered her pregnancy at Avondale clinic when it was eight months old .She says that she only came to know about TB during her antenatal visits at the clinic.

“I only heard about TB when my child was immunised with the BCG injection meant to prevent the disease in newly born babies but nothing about how it could affect me during pregnancy and its effects”.

Harare city health director Dr Prosper Chonzi said their clinics are currently screening HIV and TB on expecting mothers.

“Booking pregnant women into the clinic is a process that rolls out a full package, which enlightens them not only about their pregnancy but also about other conditions including tuberculosis”, he said.

“We are implementing Prevention of Mother to Child Transmission (PMCT) within the clinics so we cannot talk about HIV and not talk about tuberculosis.

HIV and tuberculosis have co-morbidity, when one is HIV positive they have 80 percent chance of developing TB and vies versa so there is no way you can separate the two for now,” said Chonzi.

Dr Chonzi said at the moment they are verbally interviewing women who come to book their pregnancies on signs and symptoms of TB and those with suggestive symptoms are either encouraged to produce sputum for testing with the Gene Xpert machine or for chest Xray.

Zimbabwe is one of eight countries in Africa belonging to all the top 30 High burden lists of TB, TB/HIV, DR-TB in the world.

In 2014 69 percent of the patients notified to have TB were HIV positive and about 87 percent with Multi Drug Resistance TB were HIV positive.