A graduate of the School of Public Health won an award honoring his film, which uses personal stories, not statistics, to show the plight of South African mine workers.
Jonathan Smith SPH ’11, a recent graduate of the School, of Public Health, was awarded the Tuberculosis Survival Prize on Oct. 28 in Lille, France, for a documentary he produced on tuberculosis among South African mine workers. The documentary, titled “They Go to Die,” follows the lives of four men infected with the disease and highlights the bureaucratic challenges they face in seeking treatment.
“The purpose of the film is to educate decision-makers in global health and civil society to place accountability on the mining industry and the South African government,” Smith said. “This is a problem that is readily solvable – TB is a curable disease.”
The prize, awarded annually by the Tuberculosis Survival Project, recognizes one individual or group whose work has made a meaningful difference in the global fight against TB.
The documentary does not include a single statistic, Smith said. Rather, it portrays the lives of the four mine workers with whom Smith spent his six weeks doing research. These men had come from different countries across sub-Saharan Africa to work at the mines and contracted TB. The documentary grew out of thesis research Smith conducted at Yale on the high incidence of TB among workers in the South African mining industry – the population with the highest TB infection rate, according to the World Health Organization.
Smith said many thousands of men in sub-Saharan Africa seek jobs in South African gold mines, where health conditions are highly conducive to the spread of the disease. Smith attributed the high prevalence of tuberculosis to two main factors. The high levels of silica dust present in the mines lodge themselves in the lungs of workers and compromise their immune system. Additionally, the HIV rate among mine workers, which Smith estimated to be approximately one in three after 18 months working at the mines, further compromises workers’ immune systems.
When a mine worker grows ill, the South African government is legally permitted to terminate his contract, effectively “sending him home to die,” Smith said. Treatment exists, though accessing it is difficult in rural areas, and the government rarely responds to requests for aid. Smith said that at one point 28,000 sick people asked the government for TB treatment, and only 400 received help.
The government is responsible because it allows the private companies to terminate their contracts, Smith said. Though treatment is inexpensive, he added, the government would have to support an ill worker who is incapable of work for months on end.
In all, the U.S. Agency for International Development estimates a TB prevalence rate of 7,350 cases for every 100,000 individuals in South Africa in 2007. By contrast, the U.S. saw a rate of five cases per 100,000 individuals.
“When it comes to statistics with more than a few zeros,” said Paul Thorn, project director of the TB Survival Project. “It is easy to forget that each individual unit of a statistic is a person, with a husband or wife, with parents, with brothers and sisters, with children, with friends and people who care about and love them.”
Much of the film was captured on Smith’s iPhone, as he attempted to document the moments and interactions that colored his subjects’ stories. Smith believes these idiosyncratic moments, such as a father joking around with his son, are the points at which audiences truly connect with the people portrayed.
“While I was there, I bonded with the men on our common threads of humanity, so the film really focuses on their lives rather than on their deaths,” Smith said. “I tried to express why we should want to change their lives.”
Only one of the four men Smith highlighted had access to medication, as his wife, who worked at a bank in the capital city, returned home once a month to deliver the medication. Soon after leaving, Smith learned that the other three had not survived the illness.
Elizabeth Bradley, professor of public health and Smith’s thesis advisor, said that the documentary is successful because it is driven by such careful ethnographic research.
“He’s a filmmaker, an ethnographer, but most of all he’s an epidemiologist,” Bradley said. “I think he is going to shift the paradigm on the communication of public health — he is able to influence people’s views on how we think about these diseases through a new and powerful medium.”
In the months since graduation, Smith has presented clips of his work to audiences across the globe, in a campaign to spread awareness about the disease and the bureaucratic hurtles miners face in seeking treatment.
Smith was appointed as a lecturer in the School of Public Health earlier this year and is the director of the Visual Epidemiology Project.