Sent away to die …

How post-apartheid South Africa failed its most vul­ner­a­ble

The Observer - - News - Kate Ho­dal re­ports

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’.

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