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Timothy Omuya spends most days chipping away at stones in search of gold and inhaling fine particles of dust without protective gear in western Kenya's mines. It was not a huge surprise, therefore, when he tested positive for tuberculosis.
His local hospital put him on TB medication, but his long working hours meant he did not stick to the schedule.
"At times I fail to take them because I don't go in good time to take new ones from the hospital when I finish the ones I have," he told IRIN/PlusNews. "Here at the mines, we work both day and night, so the time you are supposed to go and take your medicine, you are deep down in the mine."
What Omuya did not realize was the risk to his family; his wife and youngest child are now both infected. His wife Peres says she and the child adhere to their medications strictly, but fears that if Omuya continues to miss doses of his medication, he may re-infect them.
Fatalism
According to Ruth Muga, a senior nursing officer at the Nyatike District Hospital, many miners have a fatalistic attitude towards death because of the dangerous nature of their work.
"We counsel many of them who come here and they tell us the reason they default is because they are busy; also many of them cite the dangerous nature of the mines as the reason they don't take drugs," she said. "They will simply tell you that the mines can collapse and kill them any time. To them, death is always lingering somewhere."
Julius Owino, another gold miner in Nyatike, is HIV-positive and knows that he risks death every day in the mines, but says mining is the only way he knows how to feed his family.
"We risk our lives to earn a living and we must earn it until we no longer live; I think we are careless with our lives," he added. "Many of us are very sick and do not seek treatment... at times I ask myself why we are so busy chasing money until it kills us."
On top of widespread TB, Nyatike, where most residents earn less than US$1 a day, also has one of the country's highest levels of HIV; it is located in Nyanza Province, with an HIV prevalence of over 15 percent. Sex work is prevalent around the mines.
High risk
Joseph Sitienei, head of Kenya's National Leprosy and Tuberculosis Control Programme, says miners and their families are considered a high-risk group for TB.
"The dusty conditions there increase chances of getting tuberculosis amongst miners and the crowded nature of mines and poor ventilation provide a perfect ground for the spread of TB; remember, these people go back home and interact with others and therefore they can very easily spread the disease in big communities."
According to a 2010 study published in the American Journal of Public Health, mining for gold was associated with considerably higher TB incidence than other mining.
"The implication for policy is not to close mines but to reduce levels of risk," said the authors, who recommended that healthcare programmes for miners facilitate earlier diagnosis and improve working conditions to reduce the risk of incident infection, for example by reducing poor working conditions, cramped hostel living quarters, or exposure to silica dust.
Sitienei noted that the government was working to build awareness of TB in high-risk communities, to encourage people to visit health centres for screening and to ensure those who began treatment adhered to it.
"When people don't get full treatment, they risk developing drug resistant tuberculosis and even those who are on medication can be re-infected by those who default on treatment," he said.
Kenya ranks 13th on the list of 22 high-burden TB countries in the world and has the fifth-highest burden in Africa.
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This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions