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| A bed net programme is one of the methods
employed in an effort to combat malaria in Morila. |
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Case studies
East and West Africa |
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| 7.6 Stamping out malaria for good |
Malaria is a life-threatening parasitic
disease that is endemic in many of the areas where AngloGold
owns and operates mines. Malaria has a significant impact on
both the productivity of employees and the functionality of
surrounding communities.
Says Dr Dave Barnes of AngloGold Health Services (AHS), ?There
are about 153,000 people living within the vicinity of mines in
the East and West Africa region, of which 3,840 are employees.
By putting in place the necessary measures to combat malaria, we
can have an enormous impact on our employees? health, as well as
that of the people in the local community.
?AngloGold?s malaria intervention programmes draw on
international standards and best practice. To ensure that the
programmes benefit the countries and regions in which we operate
and that they are sustainable after we have left, we actively
pursue partnerships with the Roll Back Malaria (see
box) Global Partnership and the Medicines for Malaria
Venture (MMV). Added to that, country-specific co-operation and
consultation with the World Health Organisation and local
governmental offices are integral to our approach.?
Says Dr Dave Barnes, ?An exemplary approach to malaria control
is apparent at the Morila Mine in Mali. Here, a committed mine
management team has been instrumental in reducing the malaria
incidence rate among employees from a peak of 32% of employees
in August 2000 to 6.3% in August 2003, despite August
traditionally being the month with the highest incidence rate.?
The multi-faceted programme adopted incorporates all the
recognised elements of a malaria control programme, including
vector (mosquito control) and the provision for early diagnosis
and correct treatment of malaria cases. Epidemiologically-guided
monitoring of programme effectiveness is important.
Dr Fanie Jute, Manager, Medical Services who is responsible for
the malaria management programme at Morila explains, ?During
February 2003 we conducted research among employees, on the
chemoprophylaxis usage patterns and other methods of personal
protection. We used the information as part of our ongoing
education campaign which includes posters in English and French,
articles in Morila Morale, our monthly newspaper, information
sent via email and through personal contact during visits by
employees to the mine clinic.
?The importance of taking responsibility for one?s own health is
emphasised in all our programmes, with a great deal of emphasis
placed on educational awareness and measures to avoid being
bitten, as these are the areas that will be sustainable once
mining ceases,? says Fanie.
The programme is based on what is commonly known as the ABCD of
malaria protection, namely: |
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Risk Awareness |
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Avoidance of being Bitten |
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Chemoprophylaxis |
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Early Diagnosis and
treatment |
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| ?Unfortunately,? says Fanie, ?compliance
among expatriates, in particular with regards to malaria
chemoprophylaxis, remains a problem so the ongoing educational
campaign is important.? |
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| Malaria
threat increasing in Africa |
Malaria is a
life-threatening parasitic disease transmitted by
mosquitoes. The parasite is transmitted from person to
person by the bite of the female Anopheles mosquito, the
most efficient and deadly of mosquitoes, which requires
blood to nurture her eggs.
Although this disease was once widespread, it was
successfully eliminated from many countries with
temperate climates during the mid-20th century. Today,
the vast majority of malaria deaths occur in Africa,
south of the Sahara. There are at least three million
acute cases of malaria each year, resulting in more than
one million deaths. Around 90% of these occur in Africa,
mostly young children. Malaria is Africa?s leading cause
of under-five mortality (20%) and constitutes 10% of the
continent?s overall disease burden.
Not only is malaria a significant health risk in Africa,
but it also has an enormous cost ? estimated at more
than US$12 billion each year in lost GDP. It accounts
for 40% of public health expenditure, 30-50% of
in-patient admissions and up to 50% of out-patient visits
in areas with high malaria transmission. |
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Another important element of the programme
to combat malaria is the bed net programme that began in 2002,
with about 1,000 nets having been distributed to date. A
follow-up net programme is currently being planned to ensure
that every employee (and their dependents) has a bed net. To
this end, the company?s revised net policy will provide a net to
cater for all employees during the first year of their contract
and subsequent nets will be made available at a subsidised rate
to employees and contractors.
In terms of environmental control, so called malaria ?hot spots?
were identified and the areas were filled with laterite to
eradicate freestanding water puddles. This was a particularly
problematic area during 2003 as there was much more rain than
the previous year.
During the year ahead, the problem of water seepage below the
fresh water dam will be addressed to reduce the number of
puddles or potential mosquito breeding habitats. The fresh water
dam itself does not pose a problem as its edges are kept clear
and the dam is stocked with fish that eat any mosquito larvae
that hatch in the dam.
Says Dr Jute, ?Professor Richard Hunt of the School of Animal,
Plant and Environmental Sciences, University of Witwatersrand
was commissioned by Morila to conduct research on insecticide
resistance patterns in mosquito populations on site and in the
villages surrounding the mine. The final report is being used to
drive the vector control programme and will ensure that
appropriate and environmentally friendly insecticide is used at
the mine and in the local villages immediately adjacent to the
Morila mine. A malaria and public health control specialist was
commissioned by AngloGold to assist in the practical aspects of
insecticide spraying. This has ensured appropriate training and
the use of the correct equipment. His recommendations will form
an integral part of the vector control programme in future.?
Feedback on the incidence of malaria is given bi-weekly at mine
management meetings, as well as in a monthly departmental
report. The structure of reporting incidences has been adapted
to ensure accurate assessment of the efficacy of the new vector
control programme as it now also includes high-risk groups such
as pregnant women and children under five.
Similar programmes are now being planned for implementation at
other mines in the region. |
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| Roll
Back Malaria – a global initiative |
| The Roll
Back Malaria (RBM) campaign is a global partnership
founded in 1998 by the World Health Organisation
(WHO), the United Nations Development Programme (UNDP),
the United Nations Children?s Fund (Unicef) and the
World Bank with the aim of halving the world?s
malaria burden by 2010. RBM promotes four main
strategies: |
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Prompt access to
treatment |
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Insecticide-treated
mosquito nets; |
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Prevention and control
of malaria in pregnant women; and |
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Malaria epidemic and
emergency response. |
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| 7.7 A model occupational health centre
at Navachab |
The Navachab mine in Namibia is one of the
smallest of the AngloGold operations, but its size and remote
location belie its efficient operation. This applies equally to
its small but efficient occupational and primary health care
centre, which has made enormous strides in recent years and is
now viewed as a model for other similar operations. The mine is
situated in the central Erongo region about 10km from the
tranquil town of Karibib, surrounded by mountains. The nearest
small state hospital is 30km away at Usakos.
Permanent employees are accommodated in company housing with
their families and are all on a co-contributory medical scheme.
Some contractor employees are accommodated in hostels. A trade
union agreement is in place with the Mine Workers Union of
Namibia (MUN). Following recent expansions, the life of mine has been
extended to 2013.
Excellent safety performance has been recorded at the mine for
many years, but occupational health practices were lagging. To
address this, AngloGold Health Service was contracted to oversee
the planning and coordination of occupational health in 1999.
This has proved to be a recipe for success, says Dr DB de
Villiers, the Occupational Health Practitioner at AHS who
oversees this function.
Where necessary, external experts are brought in to provide
professional advice. For example, when it was found that a
number of procedures were lacking during mill relining, Dr Johan
Kielblock, Consultant - Occupational Hygiene for AHS, visited
the mine and produced a code of practice for mill re-lining. Dr
Kielblock is an internationally recognised expert in heat stress
management and has wide experience in drawing up guidelines for
South African legislation.
Says Dr De Villiers, ?When AHS first got involved, local
general practitioners conducted occupational medical
surveillance examinations at great cost to the mine. These
examinations were not risk-based and records did not meet
accepted Occupational Health standards. No exit medical
certificates were issued and no formal medical surveillance
programme for contractors was in place. Not all the necessary
equipment was available on the mine and few links existed
between occupational hygiene and occupational medicine.
Documentation in regard to emergency preparedness was
rudimentary. The only available ambulance was in a poor
condition and the availability of emergency equipment was
inadequate. Patient records were patchy and unreliable and
occupational health reporting was rudimentary.?
To address these issues: |
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Several guidelines for occupational
health matters were introduced. |
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Occupational risk exposure profile
documentation was initiated, resulting in risk-based
medical surveillance being carried out for the first
time. |
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Periodical and exit medical
certificates were introduced. |
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The Clinic Sister visited the South
African operations to observe occupational health
programmes in practice. |
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| Since those first days significant strides
have been made: |
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Health performance reporting has
developed from a rudimentary primary health care and
basic medical surveillance activity report to a fully
integrated occupational health, safety and primary
health care report. Annual reports are produced in line
with the South African legal requirements, although this
is not yet mandatory in Namibia. |
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Regular audit of the occupational
health system is in place. |
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An agreement has been reached with a
local occupational medical practitioner to assist with
day-to-day occupational health problems which may arise
and cannot be dealt with telephonically or timeously by
AHS. |
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Cyanide emergency training has been
completed for all plant, maintenance and laboratory
personnel and has also been extended to staff from Usakos State Hospital. Contact has been established with
Windhoek State Hospital, should the unlikely need arise
to evacuate mine personnel to Windhoek. |
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Occupational and primary health care
record systems have been streamlined. An investigation
into more efficient electronic record keeping is being
undertaken. |
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Codes of Practice for Minimum
Standards of Fitness to work, Medical Surveillance and
Substance Abuse Screening have been finalised and are in
practice. |
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Initial (1999) action plans and goal
setting have evolved from a long list of problem areas
to a manageable short list. |
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A comprehensive HIV/AIDS programme
is in place. (See case
study). |
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Says De Villiers, ?The mine clinic has
been extended to accommodate the necessary occupational medical
surveillance equipment and allow adequate space for the primary
health care function.
A new ambulance was recently commissioned so Navachab is now
suitably prepared to address any expected medical or surgical
emergency.
None of this would have been possible without dedicated
attention and commitment from the Navachab management team,
especially the General Manager, Frank Bethune and the Safety
Health and Environment Manager, Elsabe Farmer. |
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