‘Shine, Doctor, Shine!’ The Doctor who spoke truth to power during Life Esidimeni case

When Dr Mvuyiso Talatala first heard about the closing down of Life Esidimeni, he had recently been appointed as the President of the South African Society of Psychiatrists (Sasop). His goal upon taking the role of president was to make sure that psychiatrists didn’t work in silos, that they were part of the broader conversation about healthcare. Little did he know that his term as president would be characterised by fighting against the closing down of Life Esidimeni and trying to ensure justice for patients and their families.

Dr Talatala is deeply passionate about mental health. He went to study medicine after his late sister had said that because he had been so good at his studies, he should perhaps become a doctor. At medical school, he took an interest in psychiatry during visits to psychiatric acute wards. 

“There was always some kind of sadness when I looked at the [patients] who’d been there for many years,” said Dr Talatala who was growing a soft spot for the challenges that mental health patients faced. 

He went on to become a doctor and qualified as a specialist in Psychiatry in 2003. He worked at King George Hospital in 2004, before moving to Johannesburg in 2005. He has also worked seasonally at Sterkfontein from 2013 to 2016, where he resigned just before stepping in as President of the Society of Psychiatrists.  

At Sterkfontein, he worked in the pre-discharge ward which was aimed at patients who needed to go on medication for longer periods of time under psychiatric supervision. The patients would get on a six- to nine-month course of medication, after which he would do an assessment to confirm if they were safe to discharge. If they weren’t safe to be discharged, because they needed more medication or treatment, he would send them to the NGO’s he thought would have the capacity to help. If this wasn’t successful, they were sent to Life Esidimeni for more acute care.  

When news broke out that patients were going to be discharged, Sasop, the South African Depression and Anxiety Group (Sadag), the South African Federation for Mental Health and the families of mental health users together with SECTION27 gathered to defend mental health care users against the closing down of the facility. 

“We heard a rumour early in 2015 that the province was going to terminate the contract,” said Talatala. He was particularly concerned because the patients who were about to get discharged were patients needing special full-time care. It was in his professional view, wrong to close down the facility without a real plan for the future care of the patients there.

The closing down of Life Esidimeni would prove to have a devastating ripple effect on mental healthcare facilities because it meant that seriously ill patients had nowhere to go for help. He knew from experience that NGOs were also taking strain and couldn’t take the patients that were being discharged. The last patient he referred to an NGO had struggled because they did not have the capacity to help properly. Closing down a facility that was set up for “the most seriously ill patients” would add further strain on all the psychiatric wards in the province, he said.

In October of 2015 then MEC for Health, Qedani Mahlangu, announced that they were indeed going to end the Life Esidimeni contract. Sasop, SECTION27, Sadag and other interest groups asked for a meeting with the department to explain to them that closing down that facility would be the wrong thing to do. They went on to write to the MEC and the head of the Gauteng department of health asking to have a meeting where they would air their concerns about this decision. 

They had no response.

The department tried to keep Sasop out of the early meetings. The head of the department said they couldn’t attend, Dr Talatala was told after missing the first meeting. He was furious and was very clear he would not be kept out. 

“We really need to fight, I said I will cancel my pay for the next meeting. I will cancel my patients. I was going to attend that meeting”. 

Over the next months Sasop, other civil society organisations and the families struggled to get meetings with the MEC. They were very concerned about what was happening. They decided to take the department to court, which was how they finally managed to meet with the department.

In December 2015, Sadag, Sasop and SECTION27 took the department to court demanding that the termination of the contract be put on hold and curators appointed to protect the interests of mental health care users at Life Esidimeni. 

To settle the litigation the Department agreed not to move any mental health care users without proper consultations and guaranteed that the places they would be moved to would provide “the same or a better level of care as Life Esidimeni”. In February of the following year, the department announced that the contract with Life Esidimeni was to be extended until June. 

In March 2016, Sadag discovered that the department was planning on discharging 50 patients. The NGOs and the families of the patients, represented by SECTION27, applied to court to try and stop the move of 50 people to an NGO called Takalani that they believed wasn’t capable of helping the patients. Talatala remembers driving to court that morning and finding that “the MEC was on Radio 702 already saying that ‘Sadag is trying to sort of run the country and yet they are the ones who are running the country’”. 

The civil society organisations lost the application for an interdict, and soon after that, patients were moved out. 

“The state, in its affidavits, had filed misleading, or, in fact, falsehoods, untruths and that’s what disappointed me all the way,” added Talatala who believes that the state lied about the wellbeing of the patients in order to get rid of them. He knew it was downhill the moment the March 2016 case was lost; he knew that their chances of stopping the forced removal were going to be slim.

The first known death occurred later that same month, in March. In the following months, the families and interest groups were concerned about the future of the patients and were hoping to reverse the decision. When June came, the rest of the patients were loaded into busses, bakkies, and others without their shoes, belongings and medication.

“The patients were severely ill, they could not be taken back to their families because families can’t cope with them, they would endanger themselves or be a threat to those around them”, he said. 

He shared the story of a family that was struggling with an aggressive and psychotic patient. The family struggled to get the police to come and get that person. “The man was carrying a screwdriver and I think a hammer or something… tools that are dangerous. So someone [was expected to] go, approach him, maybe even put him on the back of the bakkie and then take him to the clinic”.

Talatala is very clear: the department disregarded the lives of those patients because they didn’t consider mental illness as a serious ailment. “People don't think of mental illness as potentially fatal. They don't imagine that people can die because of the complications related to mental illness,” he says. “There’s a stigma I think, that ‘who will know that would matter?’, and that their ‘families don’t care about them anyway’,” he said. 

“It is not that they don’t care about them, it is the difficulty the families have to look after them that makes them appear like they don’t care,” he added.

“As president [of the Society of Psychiatrists] I used to say that we need to put things on public record,” and so documenting and setting the record clear became their approach to media interactions, something Dr Talatala has done without fear or favour.

Though he was dismayed by the failed court case, Dr Talatala prepared himself for a bigger fight that was on the horizon for these patients and their families. “I was still prepared to fight for as long as we can,” he said.

“I used to have meetings with the families, not just the small group, not just the leadership, sometimes I had bigger mass meetings with the families so after that admission, we started to prepare for the arbitration,” he adds.

During the arbitration, it came to light that some department officials and NGOs had violated the Constitution by mistreating mentally ill patients under their care. He had to give evidence as a witness:

“Government should be government for the people and not for themselves, but for the greater good. There’s too much power in the political leadership,” said Talatala, concurring with the arbitration award. The award mentioned that the death of the 144 patients, with others still missing, “stemmed from the irrational and arrogant use of public power,” said Justice Dikgang Moseneke.

“The patients died when they were being discharged from Life Esidimeni because they were discharged all at once without doing the proper paperwork to make sure that each patient was handed over as an individual, not as a batch of patients,” he explains. “It’s easier to do that at the beginning of someone’s illness. When in 10 years 15 years you don’t have any records and it wasn’t one patient, it was many,” that’s what he believes, put the lives of the patients in danger.

Today, Dr Mvuyiso Talatala remains adamant about using his voice and expertise as a psychiatrist to help the most marginalised. He is a fearless frontline worker who is not afraid to speak truth to power for the mental well-being of South Africans, with hopes that one-day things can turn around. “This is what makes Dr Talatala really amazing,” said Sasha Stevenson “he uses his and his society’s power in the interest of patients. Usually professional associations are not comfortable with taking this approach”. Stevenson recalls how after he gave evidence at the Arbitration, families cheered him as he left the room, and were chanting “shine, Doctor, shine!” That says it all. DM/MC