Looking back on the last moments with Nelson Mandela, the head of his medical team, former surgeon-general of the SANDF
Vejay Ramlakan, has written his own account of those days. This is an extract from his book, Mandela’s Last Years.
While a prisoner on Robben Island, I had been part of the central political education committee. I was privy to some of the more sensitive debates among the leaders there. One of the most animated debates among the youth on Robben Island had been the annual celebration of Madiba’s birthday and the focus in the anti-apartheid platforms on this event.
The youth had felt that all leaders’ birthdays should be celebrated, and they could not understand why Madiba had been singularly honoured. As there were political prisoners on the island who were older and who had been in the Struggle longer than Madiba, some young members felt that if a symbolic focus was necessary, then it should have been Govan Mbeki or Walter Sisulu, Mandela’s seniors.
Over time, through painstaking and patient discussion, the decision to celebrate Mandela’s birthday was ratified. In Madiba, the movement had a charismatic symbol of the guerrilla revolutionary. His actions expressed the fortitude and fierce determination of all leaders of the Struggle, and in his demeanour he was a model for responsible and popular leadership. By focusing on Madiba, the Congress Alliance had created an image of the South African Struggle with which all freedom-loving people throughout the world could identify.
Although the origin of the idea of a post-freedom global Mandela Day is difficult to pin down, its roots lie in the earlier Madiba birthday celebrations. Over time, the concept of selfless and effective service to one’s fellow man replaced the concept of support for the demise of apartheid. When the idea was taken to the Non-Aligned Movement summit in Egypt in 2009 and lobbied by Jacob Zuma, the entire 156-member body supported the resolution. Its passage through the UN General Assembly in November 2009 went unhindered, as Madiba was now respected globally. It was the first time in its history that the UN had declared a day after a named individual - an unprecedented honour.
Ayanda Mkhize then 7, writes a get-well message on a painting of Nelson Mandela during his stay in hospital. Picture: AP
“It is going to be a busy and chaotic day,” I said to myself as I prepared to leave for the hospital after my walk that morning. The Mandela family had planned a birthday party at the hospital and VVIPs had been invited. President Zuma had also planned to visit, and the chief of the defence force had asked the army band to play Happy Birthday for Mandela when Zuma arrived. South Africa and the rest of the world wanted to show the great man how much he was loved, even if he was in the ICU!
The challenge was how to allow as much of the emotion to flow as possible without compromising the strict protocols of an ICU ward or jeopardising the care of the patient.
This was going to be a very difficult exercise.
Downstairs, the hospital staff were showing their enthusiasm by decorating the lobby with messages of support and banners and ribbons in the ANC’s colours of black, green, yellow and white.
Would his extended family be able to celebrate his birthday at his side? Just two days earlier, this would have been possible without any undue concerns.
But that day would register a decline in his overall state, despite the early “all okay” signals.
In a new book, Mandela’s Last Years, Vejay Ramlakan recounts moments shared with Madiba before his death in December 2013.
The early-morning panel decided that respiratory muscle weakness prevented a full weaning off the ventilator. Also, some tests indicated an early sepsis. The situation remained fragile.
Nevertheless, after five weeks in an intensive care unit, Madiba’s general health continued to astound us all. It was as if a determined and fierce resolve was being exercised. We were witness to an unfolding miracle.
President Zuma arrived to convey his good wishes soon after the panel meeting ended. Along with my colleagues, I briefed him on the situation and then, in surgical cap and mask, he went through to Mandela’s ward. The band struck up a hearty Happy Birthday.
Madiba was in bed but alert and able to greet the president. Zuma then told him briefly what he had been doing that morning - handing over houses to former shack-dwellers as part of the nation-building that he, Madiba, had initiated. It was a poignant meeting and Madiba acknowledged the goodbye with his eyes and a slight nod.
In accordance with military protocol, I accompanied President Zuma to his car and stood to attention as the convoy drove off. As the visit had been official, the media had plenty of opportunity to photograph the moment.
Outside the hospital, a steady throng of people came to the boundary walls and either shouted their greetings or sang a birthday song. Many of the well-wishers left posters and flowers, and a small floral mountain was building up at the eastern entrance. The media had their cameras trained on both entrances, and one photographer had rented a flat that overlooked the hospital parking. You could see his telephoto lens mounted in the window.
The hospital fills a block. The media vans with their satellite dishes had all been moved to one of the adjacent streets and, given the good weather, journalists were interviewing those who came to visit. Minibus taxis disgorged thousands of well-wishers, and people on their way to work paused for a minute or two. Even the traffic police were being tolerant of the “chaos”. The mood was festive and respectful. South Africans are known to dance and sing in the midst of any major event or crisis, and this day was no exception as groups of people broke into song and dance from time to time. When a few entrepreneurial flea market traders started selling Madiba paraphernalia within the cordoned-off areas, they were gently shooed away by security.
At midday, members of the Madiba clan - some 30 strong - from all generations and branches had gathered in their stylish attire in the ward and were spilling into some of the side wards. They were attended to by an enlarged medical and police security team and were waiting for Mrs Machel to arrive. The scheduled time had been noon to accord with the ward and therapeutic routines.
The largest side room had been set aside for the “party”. Adjacent to this was a ward with chairs for the family’s guests. In it, Minister Jeff Radebe and his wife Bridgette Motsepe, Minister of Intelligence Siyabonga Cwele, and Minister Lulu Xingwana, together with a few members of the abaThembu royalty, were patiently sitting.
Children hold balloons and flowers as they gathered outside the hospital to wish Mandela happy birthday. Picture: Reuters
Outside, the traffic and the crowds of well-wishers delayed Makaziwe Mandela and Mrs Machel, who arrived at 2pm.
As everyone understood the need for infection control, they realised they had to remain some distance from their beloved father and grandfather. We also had to ensure that no close visitor had a cold or was sick or infected with some contagious disease - not an easy task when all they wanted to do was celebrate Madiba’s birthday.
One of the major risks we faced was the family’s singing of Happy Birthday, as the “clinical window of opportunity” for this was closing with the scheduled approach of his therapy.
With (Bishop Don) Dabula’s help, we managed to have everyone gather in the ward. There they found Madiba sitting in a lounge chair, awake but drowsy, most of his face uncovered but his tracheostomy connected to a ventilator. Drips and other intravenous lines were fastened to his left arm and hung from overhead frames. For many in the group, this was their first exposure to Madiba in a long time and it must have been alarming. Facially, he looked better than he had done in the April television clips, but he was clearly a sick man.
As the group sang Happy Birthday, Madiba, he tried to move his legs in time to the singing. Obviously, he could not talk because of his tracheostomy, but his lips had moved during the song. The group then left and the party continued in the side rooms. The event had not created any clinical developments and the medical team heaved a sigh of relief.
The family’s party was superbly catered for and every guest received a vanilla cupcake on which “95” had been written in chocolate icing. By four in the afternoon, the guests were all gone and the hospital staff were clearing up the rooms, while outside some items had to be removed from the mountain of flowers and posters.
That evening, the panel noted that, despite the celebrations, it had not been a good day for Mandela.
For one thing, his blood pressure had not been holding during the renal dialysis.
For another, a diagnosis of sepsis from his lungs was now clearer. If there was a positive sign, it was that his respiratory system was performing as well as on the previous day.
Madiba watched the evening news on TV and saw footage of the hospital surrounded by an adulatory crowd.
At times, people were clustered 15 deep and there was constant singing and toyi-toying. What he did not see were the YouTube and social-media posts that told of people’s happy participation in this day of goodwill.
In celebration of the day - which now encourages people to spend 67 minutes doing good deeds - trees were planted, storm-damaged homes were repaired, children at adoption homes were entertained by youngsters and nursery schools sang Happy Birthday, Madiba.
Mac Maharaj - the man who had smuggled the first drafts of Mandela’s autobiography off (Robben) Island - posted on social media: “Get well, get better, we need you. Stay forever young at heart.” However, Madiba’s other close friend Ahmed Kathrada saw the passage of time: “It was a traumatic experience to see this very strong man a shadow of himself. And that was very painful,” he said.
From elsewhere in the world - including from the UN secretary-general (Ban Ki-moon) - came congratulatory messages.
In New York, the South African ambassador hosted a party at which the city’s former mayor, David N Dinkins, recalled the Mandela ticker-tape parade in New York more than 20 years previously. “As I say to him every year at this time, ‘Happy birthday, Madiba! When you are 109, I will be 100, and we will meet and toast each other!’ With God’s grace, we are aiming to do just that!”Later, (Dr Steve) Komati and I visited Madiba and noted signs of rapid deterioration. We summoned other team members and concluded that the sepsis was back. It was a turbulent night.
Mandela’s Last Years, by Vejay Ramlakan is published by Penguin.
* Ramlakan was born in Durban in 1957 and joined Umkhonto we Sizwe in 1977, undergoing military training in South Africa and Swaziland. He studied medicine at the University of Natal and served as president of the Medical Students Representative Council from 1979 to 1980. He was a founding member of the United Democratic Front, and was involved in MK’s Operation Butterfly in Natal. From 1987 to 1991, he was imprisoned on Robben Island, and after his release he served as medical commander at the 1991 ANC National Conference, at Codesa and for the President Mandela Guard. In 1993 and 1994, he served as deputy chief of the MK Health Service and led the MK military health team for integration into the National Peacekeeping Force and later the SANDF. From 2005 to 2013, he served as South Africa’s surgeon-general, and in 2011 he was appointed as chief of corporate staff in the SANDF. He retired from the military in 2015.