During the past few weeks of the Life Esidimeni inquest Daily Maverick asked Christine Nxumalo, who is on the Life Esidimeni families’ committee, to share her thoughts specifically on the inquest testimony of former Gauteng premier David Makhura, former Gauteng finance MEC Barbara Creecy and former Gauteng health MEC Qedani Mahlangu who is at the centre of the tragedy in which 144 mental healthcare users died. 

“As much as the former premier, Mr David Makhura, cannot be charged criminally… they still need to be held accountable for not doing their part and ensuring that governance and their oversight roles with early warning processes [were] in place,” Nxumalo told Daily Maverick.

Referring to Mahlangu, Nxumalo said: “She claimed she was going for counselling and had suffered… she does not know what suffering means nor does she understand what it means to suffer. She did not lose a loved one under the most horrific circumstances brought about by a decision that she took and stuck to, despite several warnings. And even when people died there was no care or interest to do the right thing…

“Her apology meant nothing… she showed no remorse and still cannot accept that it’s her decision, and it’s her sticking to the decision regardless of being taken to court by the very professionals that she claimed she trusted, warning letters from professionals, families protesting, memorandums, media coverage, etc.” 

The indictment by Nxumalo rang through all of last week as outgoing health ombud, Professor Malegapuru Makgoba, reflected on his seven-year term in office as the inaugural health ombud. According to Makgoba, South Africa’s health system is “a dysfunctional mess”.

He was particularly scathing regarding the Life Esidimeni tragedy and Mahlangu’s role in it, saying: “What I found very strange about that was when the MEC and her senior people said it was normal for people to die. After all that, I thought that was careless and I couldn’t believe that.” 

Makgoba was appointed by former health minister Aaron Motsoaledi in 2016, following a more than 500% spike in medico legal claims, and was tasked with enforcing health and safety standards in the department. 

“It is no longer going to be business as usual. When the ombudsman office is established we are going to make sure that there are consequences,” said Motsoaledi at the time of Makgoba’s appointment. 

Read more in Daily Maverick: Looking back on Life Esidimeni – ‘Mental health still comes last in healthcare’

The Life Esidimeni tragedy was the first high-profile case by the ombud to enforce consequences for the actions of health officials who presided over the deaths of mental healthcare users, and presumably, to set an example. 

While the case, now in its seventh year, may appear to be plodding, it is an example of justice in action and that negligence, particularly negligence that results in the death of the most vulnerable, cannot happen with impunity.

Lack of understanding

Makgoba, a medical doctor himself, described the Eastern Cape as an “embarrassment”, the Free State as having “disorder and no harmony” and Gauteng as “problematic” – in fact, of the more than 10,000 cases that the office of the ombud dealt with, half were from Gauteng. In March this year, nearing the end of his term, he had just delivered a report on and recommendations for the deplorable conditions at Rahima Moosa Mother and Child Hospital, which were brought to the public’s attention by Dr Tim de Maayer. The report spotlighted a crisis of leadership when it came to the Department of Health, especially in Gauteng.

Former Gauteng health MEC Qedani Mahlangu testifies at the Life Esidimeni arbitration hearings in Johannesburg on 22 January 2018. (Photo: Gallo Images / Alet Pretorius)

The Life Esidimeni tragedy demonstrates this exact point, with a leadership cohort that took decisions that did not demonstrate a sound understanding or appreciation of patient needs and well-being. Political and administrative appointments, particularly in health, still need to have an appreciation of the power they have over people’s lives and have measures in place to ensure that these lives are safeguarded at all times. 

Mentioning Life Esidimeni in an interview earlier this year, Makgoba said: “This for me was a revelation of the health system… How it interacts with politics, and how political power and lack of accountability can result in human rights abuses to the extent that vulnerable people, such as mental health patients, could be treated the way they were treated, resulting in deaths and so forth.”

Read more in Daily Maverick: Former Gauteng Health MEC Qedani Mahlangu: Moving 2,000 mental health patients was not my decision

In her reflections on the inquest, Nxumalo quite aptly put it, that what happened to the 144 people who died during the Life Esidimeni transfer of mental healthcare users to ill-equipped NGOs was not only a moral but a systemic failure: “Monitoring and evaluation in each department, especially in Gauteng Health, need to be urgently beefed up. Each region with its districts must have a team monitoring and evaluating plans and programmes being implemented, otherwise this type of tragedy will continue to happen.”

Makgoba was rightly appalled at the callousness of health officials’ attitude towards the deaths of mental healthcare users. You do not have to be a doctor to value people’s lives and dignity, it is a human imperative. DM