Does anyone remember Life Esidimeni? Of short memories, public service and truth telling

23 Jun 2020

Throughout much of 2017, South Africa was gripped by a health disaster of another type – the Life Esidimeni tragedy. It seems that its lessons are being forgotten already.

Between October and December 2017, the Life Esidimeni Arbitration, conducted before former Deputy Chief Justice Dikgang Moseneke, unfolded a tale of the inhumane treatment and torture of mental healthcare users that had led to the deaths of at least 144 patients during 2016.

One of the questions that puzzled Justice Moseneke was why responsible healthcare workers and senior officials didn’t speak out about the crisis or refuse the “unlawful orders” of then Gauteng Health MEC, Qedani Mahlangu. During his examination of witnesses he had asked this question repeatedly.

In his lengthy written award at the conclusion of the arbitration, Moseneke was at pains to stress that the first and final duty of public servants in the health system is to the Constitution, and not to their superiors. He questioned how senior public servants like Dr Barney Selebano, then Head of Health in Gauteng, could ignore warnings of civil society and other health professionals; he rubbished their claims that they were intimidated by and “afraid” of Mahlangu and described Selebano’s excuses as “an extraordinary tale ... a medical doctor turned a government chief executive of provincial health pleads fear in decision making”.

In response to the disgraceful behaviour of Selebano, Manamela and others who feigned ignorance or fear of Mahlangu, he wrote that:

“Our Constitution hopes for public servants who listen to the genuine and reasonable grievances of citizens and other people within our borders with concern and a readiness to respond to and alleviate their concern and certainly protect and promote the rights the law affords them. This did not happen here. The public service motto of Batho Pele was ignored.” (para 200)

In the wake of the Esidimeni award, politicians, including the President and then Minister of Health, Dr Aaron Motsoaledi, were quick to welcome Moseneke’s order and to promise “never again”. But, as so often happens, when the dust settles it’s very quickly back to business as usual. None of the lead actors in Esidimeni has yet been prosecuted. Mental healthcare remains grossly underresourced.

Where is Qedani Mahlangu now, one wonders? Not in prison, you can be sure.

There appears to have been little learning from Life Esidimeni. Consequently, light-fingered politicians and heavy-handed senior bureaucrats continue to proliferate in parts of the administration of our public health system. Despite serial non-performance and clear evidence of failure to ensure access to quality healthcare services they pick up their substantial salaries, particularly if they are politically connected. Meanwhile, those who labour at the coalface of healthcare face medicine stockouts, staff shortages and poor infection control as a result of the mismanagement of their higher-ups.

Now we have yet another painful example of officials who choose bullying over responsiveness.

In early June, Professor Ebrahim Variava, a Chief Specialist and Head of Department of Internal Medicine at Klerksdorp Tshepong hospital, received a letter notifying him of his immediate precautionary suspension. Variava was told to immediately hand over his laptop and asked to vacate the hospital he has served and developed for the last 19 years.

In the letter he received from Polaki Mokatsane, the DGG of Hospitals and Clinical Support Services in North West, Variava was told that his conduct had “compromised the principles of medical ethics” and “brought the NW Health department into disrepute”.

The former is a most serious accusation to bring against a doctor. But in truth it seems that what really irked the DGG has been Variava’s ceaseless demands that those responsible fix the NW health system. In addition, his occasional public complaints to the media had also been making him a nuisance to the powers-that-be.

On 22 May, for example, just a few weeks before his suspension, an article appeared about chronic drug shortages in the province. According to the journalist:

“Doctors who spoke to Spotlight asked not to be identified for fear of being singled out as ‘troublemakers’ and ‘complainers’. There is also a fear that being identified will make them easy targets for officials who would rather go after them than addressing the problems.

“But the four doctors who spoke to Spotlight say they ‘cannot in good conscience remain silent’. They say they have followed all the official channels to raise their concerns.”

The journalist has since confirmed that Variava was one of those doctors. Variava doesn’t deny it. He says that all other means to try to fix the supply of medicine fell on deaf ears and patients' health and lives were at risk.

Health workers strike back

In a rerun of the Glenda Gray saga, Variava’s suspension provoked an immediate uproar among his colleagues in the medical profession. A petition was launched calling on:

“... the North West province to immediately withdraw his suspension, and urgently establish a constructive dialogue to resolve their differences without putting any patients at risk”.

It got over 250 signatures in 24 hours, many of them leaders and experts in health.

A petition of health workers at the hospital where Variava is accused of being a “bully” also drew substantial support. Other public statements were released by bodies such as the Southern African HIV Clinicians Society and the Infectious Diseases Society of Southern Africa.

Mistakenly, the officials in the North West health department seemed to have thought that they can behave like bantustan despots and root out whistle-blowers without an outcry. Unfortunately, as we will reveal with further reports in coming weeks, suspending whistle-blowers appears to have become the modus operandi in the “reformed” health department.

But it was Variava’s very integrity and commitment to his patients that made many health workers decide enough is enough. One specialist physician and nephrologist, Dr Kagiso Motse, captured the mood when on 18 June she wrote to the MEC and the Premier telling them that:

“The NWDOH does not need help with putting itself into disrepute. It has multidimensional problems which range from historical lack of infrastructure to poor planning and execution of the mandate to provide quality healthcare, inexplicable essential drug shortages, as well deeply rooted corruption and incidences of wasteful expenditure, all of which are within the public domain. The department is under administration because of its gross inefficiencies and whether or not the professor is the alleged whistle-blower is irrelevant. The issues raised by the media and the NGOs are an accurate description of the state of healthcare services in the province.”

Under growing anger from health professionals on 17 June the MEC for Health in North West, Madoda Sambatha, called a press conference in the boardroom of Tshepong Hospital where, under normal circumstances, Variava works. Sambatha admitted that in the face of Covid-19 they were “in need of all our essential health workers” but “where there is ill-discipline the department will take action …”

At that point Prof Variava had still not received any more detail of the charges against him (other than the vague allegations contained in the 12 June letter). However, having been “briefed” by Jeanette Hunter, the administrator of the Provincial Health department, the MEC alleged that Variava had:

“Acted against against current Covid-19 guidelines, compromised limited number of test kits and acted in a manner suspicious of unapproved research,

“Failure and disregard of administrative protocols, e.g. requesting computers from NGO and instructing that they be installed in the wards without any approval.

“Obstructive to management of the hospital in all meetings planned to prepare for Covid-19.

“Failure to act as part of management through a tendency to write emails to stakeholders including external ones such as media, Section 27 and different national government departments without any effort to engage internal problems solving mechanisms or allowing management time to resolve issues.”

It is safe to say that each one of these charges is both defamatory and spurious, concocted by Mokatsane to justify his action. A letter from Kerrigan McCarthy, a senior official at the National Institute for Communicable Diseases (NOCD), has already provided an accurate picture in relation to the allegation concerning improper Covid-19 testing. But that is a matter best left for Variava’s lawyers and the Labour Court to pronounce on.

However, the issues go beyond the suspension of Variava and points, once again, to a troubled provincial health department that is failing to meet its constitutional obligations. As a result, the health rights NGO, SECTION27, has written to the Minister of Health requesting an investigation into the administration of North West during the Covid-19 epidemic.

SECTION27’s letter includes an email from Variava to the administrator and DDG, sent on 31 May, drawing attention to continued chronic medicines shortages as well as the lack of readiness of district hospitals for Covid-19 despite the two months of lockdown and referring to an “ugly exchange between himself and the DGG” and complaining that no one wants to accept responsibility for the failures.”

Join the dots ...

Today, 23 June, Prof Variava is still suspended. So, what lessons should we draw from this sorry saga?

In our Constitution, access to healthcare services is a fundamental right belonging to everyone. Good health is inextricably linked to other core rights such as life and dignity. So, too, are the rights to freedom of expression, to impart information and to just administrative action.

According to the Rural Health Advocacy Project, speaking out internally about deep-rooted problems of management or corruption in the health system is an ethical obligation for all who work in it; and, when raising the alarm internally fails (as it clearly has done in Variava’s case), then speaking out publicly via the media is also an ethical obligation.

We are coming out of a time when parts of our health system were captured and treated by corrupt officials as an object for plunder and theft. Life Esidimeni was one manifestation of this.

But as we enter a time when the health system and health workers are under enormous strain we cannot afford short memories about what it taught us. Truth telling is more important now than ever. The Covid-19 pandemic is growing rapidly all over the country, including in North West, where the number of confirmed cases is escalating (2,315 on 22 June) and where hospital outbreaks point to systemic weaknesses complained of by Variava and others. Corruption, unfortunately, has not miraculously gone away.

This is not the time to be suspending honest hard-working health professionals. But it is a time to insist on a culture of openness, transparency and delivery.

That is why the best thing for the health department to do now would be immediately reinstate Variava, apologise for defaming him and let him and all other health workers get on with the job of saving lives. DM/MC

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