Their Silent Screams
World Mental Health Day 2016
Aslam Dasoo
We watched from a distance as it unfolded – the machinery, the coordination, the wilfulness. But the nagging fear that things would not turn out well, that the moving parts formed a sinister pattern, persisted. Until it all went horribly wrong and 37 people died.
For survivors, the smoke never quite clears. The horror looms large, a chilling embrace that expels the breath, leaving everyone silent. No solace. Just blood, death and the grim accounting of the morgue.
The state behemoth that is responsible for this atrocity trundles blindly on, sacrificing the useful idiots and plunging the innocent into the nightmares of what political theorist Hannah Arendt describes as “the banality of evil”.
The people shall … die
I am, of course, referring to the appalling deaths of at least 37 people who were part of about 1 500 mentally ill patients in long-term care in the facilities of Life Esidimeni, a long-standing and reasonably well-functioning public-private collaboration.
We watched with growing unease how the Gauteng department of health, citing cost concerns, cancelled the contract, transferred the patients to a disparate group of social welfare organisations and thereby brought about the deaths, by omission and commission, of dozens of vulnerable people.
Make no mistake. The deaths of these patients were violent. They were thrust into the rough hands and stained cots of the unqualified and unprepared. Their inexplicable rendition to strange, ill-suited surroundings and exposure to the tender mercies of unfamiliar and unskilled attendants will have exposed their fragile psyches to intolerable stress and will have aggravated their physical infirmities.
The state has, of course, already swung into action, reflexively diverting responsibility for the investigation to the health ombudsman. And so the examination of the tragedy is relegated to a stultifying bureaucracy, purpose-built to dilute, attenuate or, when conditions permit, avoid accountability.
Government’s attempt to draw Life Esidimeni into the investigation may be no bad thing, but it is a red herring.
It is obvious that deaths would occur at Life Esidimeni in the normal course of events. Terminally ill patients will have different end-of-life experiences in different settings, whether in terms of longevity or degree of suffering. If life expectancy was curtailed as a result of this transfer, or if clinical mismanagement contributed to greater infirmity, then the patients’ rights were clearly violated. So the test for the department escalates to it now having to prove that the patients would have died anyway, in the same way, if they remained at Life Esidimeni.
Those in charge knew, or should have known, that an operation of this nature and magnitude required deft clinical management and skilful logistics, as well as diligent and continuous clinical surveillance. That is what the duty of care means. Since the duty of care remains constant, any accelerated demise, or increased clinical severity prior to death, is material to whether the duty of care was exercised.
Marikana redux
The principle of personal accountability in public life derives from the need to keep the public safe from further depredations being visited upon it by the incumbent. Although this principle is routinely spurned by government, there is no getting around it for Health MEC Qedani Mahlangu.
The tragedy of Marikana has been reprised by another arm of the state under the control of another hapless appointee, with the same terrible consequences and, if past experience counts, with little future prospect of restorative justice.
Mahlangu authorised this ill-conceived, probably unwarranted and possibly unlawful project. Her lack of medical credentials resulted in her failure to appreciate the clinical risks inherent in such an endeavour.
The cack-handed relocation of the patients to facilities unsuitable even for basic social care pre-figured their deaths as certainly as if it came from the barrel of a gun. In any decent democracy, Mahlangu would have long been shown the door if she had not first walked the plank.
Release the hounds
Acts of cruel neglect resulting in high rates of death occur with almost metronomic regularity in public healthcare.
Those who appointed Mahlangu, the political barons who placed in her medically unqualified and unfit hands the management of the most complex and sophisticated healthcare infrastructure on the continent, bear a concomitant responsibility for this morbid debacle.
There is a difference between taking collective responsibility for a poor electoral showing and taking collective responsibility for the mostly preventable deaths of 37 citizens.
As a start, law enforcement agencies should charge and prosecute Mahlangu and the others for criminal medical neglect. At the very least, these decidedly unnatural deaths must be examined by inquests as provided for in law. Parliament and Cabinet should also accede to the demand from patient advocates and civil society for the institution of a judicial commission of enquiry.
The traumatised families of the deceased should ignore the state’s phony piety and mealy-mouthed condolences. They should instead sue to the fullest extent of the law all those who executed the whole sorry enterprise.
That, too, will be an act of justice for those whose screams still do not find voice.
Dr Dasoo is the CEO of Health Equity Partners and former executive committee member of the SA Health Workers Congress. He writes in his personal capacity
