The chaotic and ultimately deadly transfer of the Esidimeni patients was a slow-motion accident that could have been stopped, writes Kerry Cullinan.
The deaths of 94 mentally ill patients transferred from Esidimeni centre is the biggest recorded mental health scandal in the history of South Africa.
The transfer of the 1 371 patients was “rapid” and “chaotic”, and the 27 “mysteriously and poorly selected” non-governmental organisations (NGOs) that they were transferred to had “invalid licences”, according to the Health Ombudsman Professor Malegapuru Makgoba’s report.
Some of these NGOs “rocked up in open bakkies” to fetch patients, while others selected them like “an auction cattle market”, according to the hard-hitting report.
Professor Makgoba has given the Gauteng health department 45 days to ensure that all remaining Esidimeni patients transferred to NGOs are “urgently removed and placed in appropriate health establishments”.
Former Gauteng MEC of Health Qedani Mahlangu resigned after being lambasted in the report. It is unlikely that Mahlangu resigned willingly, as she had stalled the release of the report for almost a month, asking for “more time to respond”.
Qedani Mahlangu resigned as Gauteng Health MEC after a report exposed the appalling conditions in which psychiatric patients died last year. Picture: Dumisani Sibeko
More heads will roll in the coming days. Disciplinary proceedings against Head of Department Dr Tiego Selebano and Mental Health Director Dr Makgabo Manamela - for “gross misconduct”, including “tampering with evidence” during the investigation - has already begun.
Manamela is the one who issued the NGOs with licences despite lacking the authority to do so and without checking their premises. The report says both must also be reported to their professional bodies.
The report recommends action against a further nine officials.
Criminal charges are likely against Mahlangu in her personal capacity as well as the Gauteng government. The report details three-and-a-half pages of legal violations of the patients’ rights.
“Former MEC Mahlangu cannot simply resign and walk away from this. She, and other officials in the department, have to be held accountable,” said Dr Mzukisi Grootboom, chairperson of the SA Medical Association.
Meanwhile, human rights organisation Section 27, which has acted for the families in the past, is consulting its clients about possible legal action.
Section 27 also wants “an official inquest into the deaths of all patients”.
Some of the patients died of dehydration, hunger, septic bed sores and uncontrolled seizures, which indicates that they were not on their epilepsy medication, according to the report.
The worst offender was an NGO called Precious Angels, where almost one third of the patients transferred there died within a matter of months.
According to the report, the NGOs were only given R112 per patient per day and - worst of all - the department took three months to transfer the first payments. At Esidimeni, where patients were getting adequate care, the department was paying R320 a day.
Health-e News has covered the scandal over a number of months, and produced numerous articles and three TV documentaries - one of which, Dignity Denied, was used as evidence in the ombudsman’s report.
During our investigations, we witnessed poor conditions, overcrowding, a lack of basic care and no activities - not even radios or TVs to entertain the patients.
One of the patients we filmed, 23-year-old Sophia Molefe, who had moved back home, became violent towards her family although she had been stable at Esidimeni. Shortly after we filmed her, she overdosed on her medication and died.
Jabu Mackenzie, 34, was transferred to Siyabathanda in Braamfischerville, Soweto. “I am unhappy and hungry and can’t sleep. Please, please let me go home,” she begged.
Jenny Mbarati’s bipolar brother, David, was simply discharged with about 10 days’ worth of medication. It was a “very big shock” to his family.
Meanwhile, Caroline Ncube’s aunt ran away from the NGO she was moved to because there were no blankets and she was cold. Although she turned up at Ncube’s home, no one bothered to phone Ncube to find out whether her aunt was safe. The chaotic transfer of the patients was a slow-motion accident that could have been stopped. Section 27 brought legal action against the Gauteng health department in April last year on behalf of some of the patients’ families.
“In their current structured placement, patients with chronic mental illness are able to cope due to the 24-hour care and supervision they receive - but upon discharge without the same level of structured care and supervision there is a high probability of relapse and disintegration of the rudimentary coping skills, resulting in a need for more intensive mental health treatments than previously required.
“Ultimately, the cost of care will be higher,” warned Professor Anthony Pillay, president of the Psychological Society of SA (PsySSA), in a letter to Mahlangu before the mass transfer.
Meanwhile, Section 27 has called for a review of mental health-care service provision, “in all its forms, not only in Gauteng but the entire country. Those institutions that are found to be illegal must be shut down”.
May this never happen again anywhere in South Africa.