Makgabo Manamela, the former head of Gauteng Mental Health, told the Life Esidimeni inquest on Thursday that there were instances where NGOs engaged by the Gauteng Department of Health to transfer patients did not have food, linen and clothes for patients as they had not been paid by the department.

The inquest aims to establish the cause of death of 144 mental healthcare users as well as who was responsible for their deaths during the Marathon Project to transfer patients from Life Esidimeni facilities to various NGOs.

“Our powers were to support or work together with the NGOs to stop the deaths. That is why we had to adopt an NGO strategy. I allocated my staff so that if patients need things urgently, they can help. It was tough on my staff. They felt I should not allocate them to adopt NGOs, but it was necessary,” Manamela told the inquest during cross-examination.

Precious Angels deaths

Manamela said that she, former Gauteng Department of Health deputy director-general Richard Lebethe and former Gauteng health MEC Qedani Mahlangu had visited the NGO Precious Angels when they heard about the deaths that had occurred there.

They found patients in unsuitable living conditions and the NGO was experiencing food shortages as a result of not being paid on time.

“We went to clothing and food companies in order for patients to have a well-balanced diet and asked them to meet with NGOs to let them know what they could offer,” and NGOs could make their choices on what they needed.

Asked by her lawyer, Ndivhoniswani Makhani, to explain what measures were put in place to safeguard patients’ lives after placement, Manamela said: “After people were moved from Life Esidimeni we asked Sassa [the South African Social Security Agency] to enable NGOs to take money [disability grants] for the people to assist with food and clothes, and those who didn’t get a disability grant, I wrote a letter for NGOs to go to the nearest Sassa branch to ask for them to be paid.” 

She said that her team asked the Department of Social Development to assist with food parcels.

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Manamela said there were two teams to help with the transfer of patients from Life Esidimeni hospitals. Staff from Life Esidimeni travelled with patients.

After the placements, she sent five staff members from her directorate to visit hospitals and NGOs where patients had been placed, to provide support and conduct monitoring and evaluation of the facilities. She said that the CEOs of the facilities where patients were placed reported to her if they had any problems.

Manamela said that the MEC had asked the department’s psychiatrists and a multidisciplinary team from the various districts to assess how the patients were settling in and that the Mental Health Directorate asked the Mental Health Review Board to assist doctors at Life Esidimeni with the transfer.

‘Adopt an NGO plan’

She said that when patients started dying, the department implemented an “adopt an NGO plan” as part of monitoring and evaluation.

“Whenever there is a death we don’t just let it [go]”; we investigate and the type of investigation is to ascertain the cause of death. 

“There were deaths that were reported during and after placements from our institutions, from Life Esidimeni, deaths reported from NGOs after placement.

“I didn’t mislead the MEC,” said Manamela and reiterated that staff were scared of Mahlangu and that “even qualified people like psychiatrists did not raise concerns in the meetings. They were scared to speak.

“If the MEC believed we misled her, she should have listened to those outside the department, those who wrote letters to her.”

The inquest continues on Friday, 21 October. DM/MC