Sent away to die …
How post-apartheid South Africa failed its most vulnerable
Three years ago, 1,700 patients from a mental health institution in Guateng province were suddenly transferred to unlicensed care homes. Months later, many were dead from starvation, cold and severe neglect.
In September 2016, Phumzile Motshegwa received a call from an unknown number. The woman on the end of the line said Motshegwa’s brother, Solly, was dead. His body was at a funeral parlour in Atteridgeville, a township in South Africa. Did she want to collect him? The address the woman gave was a disused butcher’s shop. When Motshegwa arrived, a man busy hosing down blood-stained floors, handed her a pair of rubber gloves.
“Do you know your brother?” he asked.
“Yes,” she answered. “Choose your brother, then.” Motshegwa put on the gloves. Before her stood metal tables stacked high with decomposing corpses. “I counted 36 bodies,” she says. “I was shifting all these ladies and guys around until I saw Solly. I saw his head, I saw his scar, so I said, ‘OK, this is my brother’.”
Solly had lived in hospital since a 1989 machete attack during political clashes left him brain damaged. Yet he had been happy and healthy, and had recently celebrated his 54th birthday. Now his body lay in front of
her, emaciated, mutilated and missing both eyeballs.
Motshegwa took the shawl from her shoulders and draped it across Solly’s bony frame.
What happened to Solly – and hundreds of other mentally infirm patients who died in similarly gruesome circumstances – has come to be known as the worst human rights scandal to hit democratic South Africa. Over eight months between 2015 and 2016, around 1,700 vulnerable and mentally impaired people – including Nathaniel “Solly” Mashigo – were moved from Life Esidimeni, a cluster of privately run mental healthcare facilities in Gauteng province, to various unlicensed care homes – many of which were simple suburban residences hastily repurposed.
Health authorities described it as a “project” to de-institutionalise patients and save money. But 144 people – nearly one in 10 – died in the aftermath, from causes including starvation, dehydration and cold. At one home, Precious Angels, 23 of the 57 patients transferred were dead within a year.
Solly Mashigo was one of them. Survivors have told the Observer how they were gathered together, many with their hands tied, and bundled into buses and bakkies (pickup trucks) for new homes. A significant number were transferred without files, medication or identity cards. Families were largely left in the dark over when or where loved ones had gone. Authorities admit they struggled to keep track of everyone. Three years on, 44 people are still missing.
The day after Motshegwa found Solly’s body, she returned to the adhoc funeral parlour – which was trading as PutU2Rest mortuary – just to confirm that what she had seen was real. She had known that the unit where Solly lived was closing. But she did not know that he had been transferred to an unlicensed charity with no qualifications or infrastructure to accommodate mentally ill people.
He was moved without Motshegwa’s knowledge or consent. Solly had also been dead for a month before she was told.
“I was driving to my mother’s home when I got the phone call,” she says, from her home in Pretoria. “I went to the NGO: it was an old house in Danville. I saw my brother on 2 June [at Life Esidimeni] and he died on 2 August. But nobody told me anything. I said to her [the manager], ‘You know, I live here in Danville too. Why didn’t you call to tell me my brother was here?’ She said, ‘I didn’t have your number – Esidimeni didn’t give me the files’.”
Warnings were given over the planned relocations. Psychiatrists at Life Esidimeni raised the alarm when the healthcare provider’s 30-year contract was terminated in September 2015.
Advocate groups including Section 27, a public-interest law centre, and the South African Depression and Anxiety Group threatened court action to stop Gauteng’s health department from moving patients, warning of “relapse and death following the relocation of users”. Authorities agreed they wouldn’t move anyone to “inferior facilities”.
They broke their promise, says Joyce Orritt, a mental health worker who tried to stop the transfers: “We knew full well that Life Esidimeni patients would never cope. They were there under the Mental Health Care Act. They were committed. They couldn’t care for themselves. They couldn’t be ‘deinstitutionalised’.”
Orritt knew the NGOs well because she visited them often. She had evidence of kitchens with no food, patients tied to bedsides, and deaths. Two weeks shy of her retirement, she was suspended and asked to hand over all incriminating files and photographs of problem NGOs. Soon after, the relocations began.
“I’ve been working in mental health for 39 years. But what happened with Esidimeni …” she trails off. “I sobbed for a year.”
South Africa is the continent’s richest and most advanced state, and its 2002 Mental Health Care Act is laudable. But officials joke that the nation’s first-world policies are stymied by third-world implementation. Although more than one in three South Africans are believed to be living with some form of mental illness, 75% are likely never to get treatment – a tragic combination of paltry budgets, inadequate facilities and widespread stigma.
The tragedy has exposed a longknown secret: nationwide, many patients are held in appalling conditions.
Psychiatrists from other institutions around the country have warned that the Life Esidimeni tragedy is merely the tip of the iceberg.
Despite a lengthy, televised arbitration that included senior health officials, the exact motive behind the Esidimeni transfers remains a mystery. Cronyism, corruption and fraud – painfully characteristic of the disgraced presidency of Jacob Zuma, who faces 783 charges himself – seem to be at the heart of the tragedy. Authorities claimed the move would save money. But state payments to the NGOs totalled 47.5m rand (£2.5m) and continued long after patients had died and the NGOs shut down.
Dr Makgabo Manamela, the former director of Gauteng’s mental health services, drew up the relocation plan and was present at removal sites. She also allowed the NGOs to begin operating even though they had not signed service contracts, which meant they went unpaid and were unable to buy food or supplies for the new patients. Still, she testified that she was unaware of the presumable repercussions. “I didn’t know they would be dying, and in our plan we didn’t plan for anybody to die,” she said.
Gauteng’s former head of health, Tiego Selebano, admitted to signing and backdating NGO licences – even after patients had died – as well as to being “fearful” of his boss, the former provincial health minister Qedani Mahlangu. At his testimony – during which even retired deputy chief justice Dikgang Moseneke, who chaired the hearing, was in tears – Selebano apologised for his negligence, telling the families: “You have every right not to forgive us … We made a mess.”
In his final judgment, Moseneke
Doctors across the country warn that this is the tip of the iceberg
found that the officials had acted unconstitutionally and had behaved, literally, as though they would “get away with murder”. “The death and torture of those who died in the Life Esidimeni [tragedy],” he told the hearing, “stemmed from arrogant and irrational use of public power.”
Perhaps, then, it is no surprise that many family members feel like no one in power is taking what happened seriously. Not a single official has been fired (Manamela and Selebano were suspended, while Mahlangu resigned) and there are no indications that anyone will face criminal charges. Even Cyril Ramaphosa, who recently replaced Zuma as president and has vowed to combat corruption, came under fire after he was photographed meeting Mahlangu, whom he described as a “comrade” and a “human being, like all of us”.
“Our government, the one we chose, killed our people, [while] the [apartheid] government we hated took care of our people,” says Luleka Khunjwa, whose sister Maureen, 62, died at Takalani, a home in Soweto for disabled children, where reports of abuse, rape and death made national headlines.
“What happened is no different to the Nazis shipping people off to the camps,” says Christine Nxumalo, whose sister Virginia had Alzheimer’s and was among those who died at Precious Angels. “There was no food. There was no staff. There were no facilities.
“Some NGOs used their discretion to bury bodies without informing the families. They just didn’t care. They act like it’s no big deal, like these lives just didn’t matter. It has been a horrible thing to be part of.”
On a long, nondescript road in Krugersdorp lie eight brick-built residences known as Mosego Home. The NGO bills itself as a “psycho-geriatric care facility” catering for 90 patients, and today operates with a licence. In 2016, when Andrew Pietersen’s uncle Victor Truter, 70, was transferred here with 62 others, it did not.
Pietersen was with his uncle on the day he left Life Esidimeni. Truter, who has chronic schizophrenia, had lived at the hospital for 40 years. Clutching his small bag of belongings, he limped towards the transfer bus. No one could tell Pietersen where he was being relocated. When he finally tracked his uncle down two months later to Mosego Home, says Pietersen, he was a different man. “He was emaciated, he hadn’t eaten and he hadn’t been given his tablets.”
Mosego’s owner Dorothy Sekhukhune extracts Truter’s tattered pink medical files to deny the allegations. “That is not true,” she says, shaking her head at Pietersen. “He’s been going around saying stories that aren’t true.”
Truter’s handwritten files comprise little more than a few pages from a school notebook. Much of the data appears to have been written in one go by someone with a singular, florid handwriting. The first weight measurement is recorded 27 days after Truter was first admitted, then fluctuates by as much as 8kg within weeks. When questioned how this could be, one of Sekhukhune’s staff explains that weights always fluctuate if measurements are taken just after the patient has woken up.
Sekhukhune describes the Life Esidimeni transfer as a “rush” prompted by a visit from the provincial health department. “We were delegated patients. We went from five houses up to eight houses. We hired more staff. We were promised 4,000 rand per person per month” – she wags her pen to indicate this was insufficient – “so you have to go out and fundraise. We’re all volunteers here,” she adds, gesturing towards her staff.
Within months, seven of the 63 people transferred had died. Sekhukhune claims these deaths were from natural causes, and says that Mosego patients were given adequate food, water and medication. But after the health ombudsman recommended that Mosego (as well as a number of other NGOs) be shut down, Truter and other Life Esidimeni patients were transferred once more – this time to a hospital with psychiatric facilities.
“The ombudsman’s report has been very bad for us,” Sekhukhune says. “It has tarnished our relationship with our funders.”
Truter now lives on a multi-patient ward in downtown Johannesburg at Clinix Selby Park hospital, which has since taken in hundreds of patients who were formerly at Life Esidimeni.
“They were traumatised,” says Kate Kumalo, one of Selby’s psychiatric nurses. “We have had to build them back up again.”
Many of the patients were previously under Kumalo’s care at Life Esidimeni – where she watched them loaded on to trucks and transferred without any indication of where they were going. One of them was Julian Holoane, 45, a former plumber from Lesotho who was diagnosed with schizophrenia in 2010. The move from Life Esidimeni has, he says, strengthened his resolve to be discharged “back into the world” as soon as possible.
“I liked Life Esidimeni, they treated us like they were our parents and it felt like we were at home,” he recalls during a cigarette break, his hands shaking uncontrollably from his medication. “Then they said they would be moving us. I was angry because I did not want to move.
“People outside think we are mad but we are not. They don’t know anything about mental illness. All I see here is security, the buildings, the other people I live with. I want to go out, I want to see the world.
“I need to go home.”
In March, Justice Moseneke ordered the South African government to pay 1.2m rand in compensation to survivors and family members of patients affected by the Esidimeni tragedy. To date, many are still waiting.
Far more significant, however, is how long families fear they will be forced to wait until the truth of the tragedy emerges. For Motshegwa, who first lost her husband, then her brother, and then her sister-in-law on the day of Solly’s funeral, all within months of each other, compensation alone can never do her brother’s death the justice it deserves.
“Solly was a good brother. He was happy. He was brilliant and he loved learning. But he left school so we could stay in school and he got a job so he could feed us. He protected us,” she says, wiping away tears.
“Everyone knew what a good guy he was. Everyone.”
Families fear a long wait until the truth of the tragedy emerges
Student Busi Mvundla holds a photograph of Peter Mvundla, her great-uncle. One of the victims of the Life Esidimeni tragedy, he died aged 58.
Photographs by Robin Hammond/ Witness Change for the Observer
One of the houses used by Precious Angels. The NGO received 57 patients from mental healthcare provider Life Esidimeni; 23 of them were dead within a year.
Phumzile Motshegwa with a picture of her late brother Solly Mashigo, 55, who was braindamaged but had been ‘happy and healthy’.