Two men lay in the sun on a concrete driveway in Danville, Pretoria. Through a small hole in the gate, I asked if there was a staff member I could meet. Both men had mental disabilities. One remained on the ground while the other rose and motioned – keys? He wandered off, perhaps to find keys for the stranger. A young man approached the gate as nurses watched from the living room. Only two patients there had died, said the security guard.

Precious Angels was registered as a non-profit organisation in June 2016 and almost immediately started taking patients with acute mental illnesses as they were transferred out of Life Esidimeni. When I visited in September, 36 patients had died in three months since over 1,000 people had been moved from Life Esidimeni to 122 NGOs across Gauteng. Eight of the deaths reportedly occurred at one NGO: Precious Angels. Its Atteridgeville facility had since been closed but it continued operating in Danville, terrifying relatives of patients who had been shifted there.

This is one event in a timeline of failures the health ombudsman must shed light on in his soon-to-be-released investigation into the Gauteng health department’s decision to cancel its contract with Life Esidimeni and shift 2,000 patients with severe mental illnesses to NGOs, government facilities, and homecare. Officially, 39 patients have died since being transferred when the Life Esidimeni contract ended in June, but a report on Sunday said the number of fatalities may be as high as 80. Disabled People South Africa has compared it to the Marikana Massacre.

The department’s decision to move patients into community-based care was established in policy; its decision to accelerate the move, because Life Esidimeni was too expensive, caused the problems. Challenges, and warnings, occurred at every stage throughout the process, with deadly results.

The South African Depression and Anxiety Group, the South African Federation for Mental Health, and the South African Society of Psychiatrists went to court last year to prevent moving Life Esidimeni’s patients to other facilities until the provincial government meaningfully engaged stakeholders and had a sufficient plan in place to ensure patients receive adequate care in their new homes. They lost.

For almost 40 years Life Esidimeni provided healthcare under contract from the Gauteng provincial government for chronic mental patients before the deal was terminated last year as MEC Qedani Mahlangu said the private provider had become too expensive. The MECs’ plan to transfer patients to NGOs and homecare was in line with policy, but a policy meant to be implemented over years rather than months. The issue came up in court and the MEC agreed patients would be placed in institutions that could deliver at least the same level of care as Life Esidimeni.

That wasn’t the case and it was pointed out repeatedly for the MEC and her department to see. In the lead-up to the patients’ relocation, family members repeatedly raised their fears. Some patients had been at Life Esidimeni for much of their lives. Their family members understood and were satisfied with the care. Relatives were told they would have to be moved, but not where or how, or when. Many of the patients at Life Esidimeni were chronic, and would be institutionalised for life. When relatives were told they would be relocated, they panicked – there was no clear plan in place for where they would go.

“Everyone is aggrieved by the way the department is handling this,” Christine Nxumalo told me in February last year. Relatives had accused the Gauteng department of acting unlawfully, callously, and immorally. All they wanted was a proper plan for the future of their loved ones. “It just doesn’t sound right. It just doesn’t sound fair,” said Nxumalo. Nxumalo’s sister later died at Precious Angels. She was only told about the death a week after it occurred.

About 1,000 patients were moved to NGOs and professionals and family members warned they weren’t ready. The court agreement reached between the provincial government and the families led to a few site visits, but only a handful of the 122 NGOs, and even some of them were clearly not prepared. Family members have cited a deterioration in care for their loved ones – the lack of proper food, clothing, security and overcrowding. A number of family members didn’t even know when their relatives were being moved, or where to.

“As the government, we acknowledge upfront what happened in Gauteng was wrong, the intentions were good but the execution was a disaster,” said Deputy Minister of Social Development Hendrietta Bogopane-Zulu, whose own brother died after the patient relocation. “Patients’ medical assessments were not done. The referrals were not done properly.”

The Gauteng department has accused Life Esidimeni of exacerbating the problem. It said the private healthcare provider refused to release patient records and provide sufficient equipment to the relocated patients. Life Esidimeni denied the allegations. When reports emerged about the patients who died during their time at Life Esidimeni, they were countered with claims that the NGOs saw at least double the number of average deaths than under the private healthcare company.

Throughout the saga, Mahlangu and her department have remained arrogantly indifferent to criticism. “Should it be found that government officials acted improperly or negligently, I will act without fear or favour,” said Premier David Makhura. According to the Sunday Independent, the health ombudsman’s report lays the blame on Mahlangu and two department officials. Health Ombudsman Malegapuru Makgoba’s report was scheduled for release last week but was delayed after the Gauteng health MEC asked for more time to respond.

The report may offer some solace for the relatives of the dead if it describes what happens and who is responsible. It won’t quell the pain, however, as the deaths could have been avoided if the state had listened to the many, many warnings. DM

Photo: MEC Qedani Mahlangu (Photo by SA Tourism)