Tuberculosis in health workers is legally accepted as an occupational disease in South Africa in settings where there are infectious tuberculosis patients. This commentary draws on the authors’ previous work and the voices of health workers to consider the implications of this legal status for the experience of health workers and their protection from occupational tuberculosis. Despite compensation and prevention legislation and numerous guidelines on protective practices, occupational tuberculosis is undercounted and the implementation of control measures inadequate. Important contextual causes are budgetary, staffing and managerial constraints in public sector facilities, and the limited ability of the state to deliver effective enforcement and compensation services. These factors shape the responses of health workers, such as lack of awareness of their rights as workers; and if diagnosed, fear for confidentiality, reluctance to disclose their illness and a sense of abandonment by the system and colleagues. Mobilisation of health workers for greater involvement in tuberculosis control practices is clearly needed. However, also needed is mobilisation of health workers to understand their rights and responsibilities as workers, despite the many burdens on health care delivery and vocational pressures to accept risk, and to demand both practical and psychosocial support if diagnosed.

在南非，在有传染性结核病患者的地方，卫生工作者的结核病在法律上被视为职业病。该评论借鉴了作者先前的工作以及卫生工作者的声音，以考虑这种法律地位对卫生工作者的经验及其对职业性肺结核的保护的意义。尽管制定了补偿和预防立法，并制定了许多保护措施准则，但仍未充分考虑职业结核病，并且控制措施的执行力度不足。重要的背景因素是公共部门设施中的预算，人员和管理约束，以及国家提供有效的执法和补偿服务的能力有限。这些因素决定着卫生工作者的反应，例如缺乏对工人权利的认识；如果得到诊断，则担心机密性，不愿透露自己的病情，并且被系统和同事抛弃。显然需要动员卫生工作者更多地参与结核病控制措施。但是，尽管卫生保健提供了许多负担，并且承受着接受风险的职业压力，并且一旦被诊断出需要实际和社会心理支持，但仍然需要动员卫生工作者理解他们作为工人的权利和责任。