South Africa

Op-Ed: Life Esidimeni – Trial by fire for Health Ombud

By John Stephens 30 January 2017

The new Health Ombud begins office with a trial by fire, pitted against powerful forces that do not want him to fulfil his mandate because his doing so endangers them. By JOHN STEPHENS.

The newly-appointed Health Ombud, Professor Malegapuru Makgoba, will soon face the first test of his recently-established office. On Wednesday February 1, 2017, he will release the report of his investigation into the deaths of mental healthcare users, who the Gauteng health department removed from a well-established facility, Life Esidimeni, and sent to unprepared and risky “community-based” facilities. It is his office’s first major public act and it is a trial by fire – he is pitted against powerful forces that do not want him to fulfil his mandate because his doing so endangers them.

For the families who lost loved ones and the patients who remain in danger, we need the Health Ombud to succeed in fulfilling his mandate. For the good of the healthcare system at large, we need the Office of Health Care Standards Compliance and the Health Ombud to be strong institutions. On February 1, 2017, we will witness the ombud set the course for the future of these important institutions. The ombud’s trial will also not stop with the release of the report – there will probably be fierce resistance and a backlash. The ombud will need our support.

The Life Esidimeni tragedy could have been avoided. In 2015, we heard the first tremors from the Gauteng health department; Life Esidimeni would close and patients would be sent home or to NGOs. As early as June of that year, the Southern African Society of Psychiatrists, the professional association representing nearly all psychiatrists in the country, responded and warned of the tragedy that would follow.

The Gauteng health department, under orders from the MEC, ignored the warnings and the policies.

Families, too, asked for reason and mercy; they pleaded with the department, explaining the vulnerability of their loved ones, predicting in painful detail what would happen. Father Maboe said in an affidavit about his son Billy:

I am almost 80 years old. I am a pastor and will retire at the end of January 2016 and then receive a small pension. My wife has passed away… [Billy] needs lots of care and attention. I am elderly and cannot take care of him. I fear that if he were to come home, he would relapse and potentially be a threat to himself and my family. He needs the services of Life Esidimeni or a place like it.”

Ten months later, Father Maboe wrote in an affidavit sent to the ombud:

I last saw Billy at Life Esidimeni at the beginning of June 2016. He was happy and looked well… My heart sank when I saw Billy [at the NGO on 16 July]. I saw death in his face. He was hungry. We sent someone to the store to buy him some snacks – he was so hungry he licked clean the plastic the crisps came in. One of the staff said they were not giving him much water because he would wet himself.”

Billy died six days later.

In December 2015, families and organisations supporting them brought litigation that led to a settlement agreement in terms of which the health department would consult stakeholders and establish proper alternative facilities before moving patients from Life Esidimeni. The department flouted the agreement and rushed the closure of Life Esidimeni. Billy is now dead.

In later litigation, brought by the same parties in April of 2016, the department claimed it had assessed patients and found they no longer needed any mental healthcare services and were thus ready for “discharge”, which, the department claimed, in essence meant they were cured – these patients in particular would be sent to Takalani Home only because they had no families.

Yet the evidence, including Life Esidimeni’s patient records, said the patients had diagnoses like “psychosis”, “severe intellectual disability” and “schizophrenia” and were entirely dependent on others for care; many even had “regular family contact”. The court, however, accepted the department’s word and dismissed the application to stop the patient transfers.

The department then sent Caswell Mosiane to Takalani Home; his mother, Yvonne, would later write in an affidavit sent to the ombud that the medical assessment form for Caswell says he “cannot speak and is cognitively impaired … He is unsuitable for placement due to disability and he is dependent” on caregivers. The form says the department should “continue to provide for his needs and safety”. Yvonne wrote to the ombud, “When we visited Caswell [at Takalani] he was hungry and we could tell he was not happy. Caswell could not properly pronounce words and speak clearly.”

Caswell died in Takalani Home on July 10, 2016. He had been there only a few weeks.

After the Takalani court case, the department sent buses to Life Esidimeni, unceremoniously loaded patients up and quickly scattered them to NGOs across the province. It lost track of many people and families spent months searching one NGO after another for their loved ones. When their families found them, if they did, former residents of Life Esidimeni were often emaciated, dirty and delirious. Some families still haven’t yet found their loved ones, and some never will. Many others found their loved ones dead. They are now struggling to ensure inquests into the deaths.

Many died in the ravages of the MEC’s decision – the MEC reported 36 in Parliament, but the toll is higher, some leaked media reports pegging it over 80 – hundreds more people were so shaken their stability remains uncertain.

The Office of Health Standards Compliance (OHSC) is meant to ensure compliance in health facilities with established norms and standards – it is meant to ensure quality and equality. The Health Ombud is meant to receive and respond to complaints from the public. He is, in a way, the public protector for the health system.

The stakes are high in the ombud’s first test: all signs point to fault, even criminal liability, at the highest level of the Gauteng health department, where a powerful and protected health MEC, Qedani Mahlangu, scurries to consolidate power and protection. We will soon see what her response will be.

Much depends on the content of Wednesday’s report and the outcome of the battle that will probably ensue. In this moment of contingency for the ombud, the OHSC, the families who’ve lost loved ones and patients who remain in danger, we must question how much we value the institutions meant to guard against injustice such as the Life Esidimeni tragedy. We must each answer of ourselves and, then, if we answer correctly, are called to make the answer come into the world. We can do the latter by demanding that the ombud and his institution have courage in the Life Esidimeni matter and, then, support them when they do. DM

Photo by elycefeliz via Flickr

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