The untouchables: Why there will be more Esidimenis
The national Health Department was powerless to prevent the tragedy
It’s easy to remember the tragic parts of the Life Esidimeni hearings – the person who testified that he found his son, in his faeces, alive and tied to a bed in Tembisa Hospital only metres from a dead body.
The report of the stomach contents of a patient who had eaten plastic – perhaps because he was starving – and the stories of a family identifying a body with its eyes inexplicably missing.I will never forget how Reverend Joseph Maboe prayed for one of the main characters implicated in the decision that led to Maboe’s son’s death: former Gauteng head of department Dr Barney Selebano.
These tragic stories are ingrained in my mind. Not only those moments but also the more technical parts of the hearings. Because those are crucial in showing what in the health system needs urgent fixing.One point that was not widely reported on, was the way in which the provincial health departments ignored the national Health Department.
The day the national director general of health, Precious Matsoso, testified at the hearings she spoke of a butchery converted to a mortuary where bodies were piled up. We journalists chose to report only on that aspect of her testimony.
But she also testified to something else: the fact that provincial departments act on their own accord, even if it is ill-advised, egg-headed and likely to kill patients. She testified how powerless the national government felt.
Advocate from Section 27 Adila Hassim asked Matsoso about the Esidimeni saga: “Is it your view that the national department had no power to intervene?”
She replied: “We had no power to stop it. We relied on court action.”
Matsoso was one of the officials who spent a weekend trying to shut down the most deadly NGO, Precious Angels, and to find missing bodies in a converted butchery, working till after 11 pm.The Gauteng health department waited until there was a widescale tragedy before it would work with the national department.
So broken down was the relationship that one of the world’s experts on de-institutionalisation, Professor Melvyn Freeman, a qualified psychologist and senior member of the national Health Department, tried to contact the Gauteng department of health. He asked in a letter about their plans to move severely ill mental patients outside of institutions. He received no response.
Health Minister Aaron Motsoaledi said that when he went overseas, people asked about the tragedy – but the world did not understand that health care in South Africa “is a federal system”.
A senior professor once looked at me and said, cryptically, that he blames Nelson Mandela for the country’s health problems. What he meant was that the constitution, which Madiba was so involved in writing, gives the provinces so much power to run things ... and to ruin health systems.National government can write policies, provide ring-fenced grants, offer advice – but provinces still run the day-to-day operations.
The late Joe Maila, who was the national Department of Health spokesman, once angrily said to me on the phone: “What do you want us to do [about such and such a province] … put a gun to their head?”
He was right, the national department is legally often constrained in what it can do.
Even putting provinces under administration has its own problems, testified Matsoso under oath.
If provinces continue to ruin as they please and the national department stands by, then, as Mark Heywood, founder of Section 27 puts it, many Esidimeni-type tragedies will continue to happen all over South Africa.