In six weeks we’ll know if Qedani Mahlangu will be prosecuted

Content is originally written forBhekisisa
After being awarded damages, distraught families want more: the former Gauteng Health MEC must face criminal charges.

The R135‑million in constitutional damages awarded to claimants in the Life Esidimeni tragedy this week — the largest award of its kind in South Africa’s history — could increase to 10 times that amount.

Former deputy chief justice Dikgang Moseneke’s arbitration ruling is also likely to influence future rulings of this kind.

Constitutional damages of R1-million each were awarded to 135 claimants, in addition to funeral-related expenses and R180 000 for shock and psychological trauma.

Moseneke ruled that it was “appropriate relief and compensation for the government’s unjustifiable and reckless breaches” of at least six sections of the Constitution and “multiple contraventions” of the National Health Act and the Mental Health Care Act.

Between October 2015 and June 2016, 1 711 psychiatric patients in Gauteng were transferred from private Life Esidimeni health facilities, for which the state had paid, to largely ill-equipped community organisations with little to no experience in caring for mental health patients.

The move came after the provincial health department ended a 30-year contract with the Life Healthcare private hospital group.

A father speaks out about the terrible conditions his son died in after being removed from state-funded hospital care at Life Esidimeni.

The department ignored repeated warnings from families and civil society organisations that transferring patients to unqualified organisations, which Moseneke referred to as “death and torture traps” in his arbitration ruling, could lead to the death of psychiatric patients.

As a result, 144 patients died, and 1 418 were exposed to “trauma and morbidity” but survived, according to the arbitrator’s report.

Moseneke ruled the sites were “hand-picked” by senior Gauteng health department officials, such as then health MEC Qedani Mahlangu and her head of department, Dr Tiego “Barney” Selebano, with an “irrational and arrogant use of public power”.

All claimants received the same award, regardless of whether their loved ones died or survived.

But the number of claimants is now likely to increase from the original 135, after Moseneke invited those who hadn’t been part of the arbitration — at least 1 350 of those who survived didn’t join — to come forward.

“Not all have joined the process. When they find their voice or way, I trust that the government would choose to meet their claim in terms identical to the award than to set up new litigation of another arbitration process,” Moseneke said in his arbitration award.

Within a day after the ruling, 10 more families and patients had already contacted the arbitrator’s office. “I’ve taken down their details, and sent it through to the mental health director in the Gauteng health department to determine if they qualify for the award,” spokesperson Obakeng van Dyk said.

Historic ruling: Retired judge Dikgang Moseneke said that he hoped the families of affected mental health users, who were not part of the Life Esidimeni arbitration, would come forward and claim the compensation they were due. (Delwyn Verasamy)

In order to qualify, patients should have suffered trauma directly as a result of the transfers and should be able to prove that they or their loved ones were transferred between October 2015 and June 2016.

There have been two major constitutional damages awards in the past, but these were significantly smaller than the Life Esidimeni award and were made in court cases and not by arbitration agreement.

In 2006, the Eastern Cape high court ordered the welfare MEC in the province to pay “Mrs Kate” damages for failing to process and pay her disability grant within a reasonable period”, after the state had taken 40 months to do so.

And in 2005, the department of agriculture and land affairs had to pay constitutional damages to a private company in Benoni, Modderklip Boerdery, after the Constitutional Court ruled that the state had failed to protect Modderklip against the unlawful occupation of its property.

Although the size of the award wasn’t specified, the ruling stipulated that it could not exceed the property’s value, which was less than R1.8‑million.


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A father speaks out about the terrible conditions his son died in after being removed from state-funded hospital care at Life Esidimeni.

Because the Life Esidimeni award is an arbitration award, which is a private agreement between two parties, it can’t set a legal precedent for courts.

But, it will undoubtedly “set a standard”, says advocate Adila Hassim, “because constitutional damages this high have never been awarded before”. Hassim was part of social justice organisation Section27’s legal team that represented 63 of the Life Esidimeni claimants.

Sasha Stevenson, who was also part of the team, agrees: “Because this is such an important and public matter that was decided by the former deputy chief justice, it will have persuasive value to those who are deciding other cases.”

The Life Esidimeni tragedy is also likely to end up in the criminal court. Two parallel criminal investigations — one by the South African Police Service and another by the Special Investigating Unit — have been opened.

Pindi Louw from the National Prosecuting Authority’s Gauteng office confirmed that the office had received 140 inquest dockets from the police for a decision on whether to prosecute.

Mahlangu, Selebano and the director of mental health services at the time of the Life Esidimeni patient transfers, Makgoba Manamela, could all potentially be implicated in charges including murder, attempted murder, culpable homicide, perjury and corruption.

“Deputy director of public prosecutions George Baloyi has assigned a team of prosecutors to work on those documents. They will take between four to six weeks … and will then announce their decision,” Louw said.

The families of Life Esidimeni patients walked out en masse after the testimony of former Qedani Mahlangu at the arbitration.

Moseneke labelled Mahlangu’s and Selebano’s testimonies during the arbitration hearings as “fabricated and patently false”. “All we can hope for is that, one day, the true reason for the conception and implementation of the Marathon Mental Health Project [of which the Life Esidimeni patient transfers formed part] will see the light of day,” he said.

The spokesperson for the Life Esidimeni families, Christine Nxumalo, said, although they accepted the compensation, they still wanted the department to be held accountable. “We see Qedani Mahlangu and her officials as proper traitors, because they didn’t provide us with the answers we asked for in the hearings,” she said.

“You don’t just forgive a traitor. We want to see that justice is done.”

Fears as Durban loses last state cancer specialist – Bhekisisa

Written by: JOAN VAN DYK for Bhekisisa
Only two state cancer specialists remain in the province of more than 10-million people.

Durban loses its last public sector oncologist today as shortages of specialists in the province continue.

The doctor’s departure from Inkosi Albert Luthuli Central Hospital leaves KwaZulu-Natal with just two oncologists, both practising at Grey’s Hospital in Pietermaritzburg.

Chairperson of South Africa Medical Association’s KwaZulu-Natal branch Mvuyisi Mzukwa says these two doctors are swamped and dealing with a backlog of patients, some of whom have been waiting for treatment since 2011.

The closure of cancer services may be the latest symptom of what the South African Medical Association (Sama) and human rights organisation Section27 says are the province’s failing health systems. In May, the duo took to the streets to protest issues such as staff shortages, poor working conditions and deteriorating infrastructure and equipment.

In a five-page memo delivered to KwaZulu-Natal health MEC Sibongiseni Dhlomo, Sama alleged that the provinces had severe shortages of specialists such oncologists but also obstetricians, psychiatrists and orthopaedic and general surgeons. The association also said health facilities operated amid shortfalls of soap, gloves, needles and clean linens. Doctors also complained of rat and insect infestations.

As the province’s shortage of specialists grows, so too will waiting lists for treatments, warns Mzukwa.

But KwaZulu-Natal health department spokesperson Sam Mkhwanazi says the department is already recruiting new oncologists and in the interim, private sector oncologists and radiotherapists will provide cancer treatment at Inkosi Albert Luthuli Central Hospital. These specialists will be overseen by the head of Pietermaritzburg’s oncology unit at Grey’s Hospital.

Meanwhile, the KwaZulu-Natal department of health is running a deficit of more than R1-billion this year, according to information presented at the health budget vote in March. This includes an R500-million shortage for HIV treatment for the 2017/ 18 financial year.

The health systems and policy manager at the Rural Health Advocacy Project, Russell Rensburg says some companies contracted to maintain medical equipment and provide medications have not been paid. He explains that many continue to provide services and credits them with helping keep the health system afloat.

Rensburg told Bhekisisa in January that although provincial health budgets have almost doubled in the past 15 years, they have not kept up with the rising cost of employees.

Employee compensation now accounts for about 65 % of provincial health expenditure, according to a 2016 working paper released by the Rural Health Advocacy Project.

Rensburg warns that the country’s recession and ratings downgrade could topple KwaZulu-Natal’s health system if government fails to adjust current and projected budgets that have largely been based on false assumptions.

He explains: “The current budget is based on a projection that the economy would grow by between 1.2 and 1.5% in the next year. But the country is now in a recession and the ratings downgrade will affect our ability to loan money. The department has its head in the sand.”

The recession is likely to reduce levels of taxable income as companies shy away from investing and creating jobs in the country. Meanwhile, the recent downgrade in South Africa’s credit ratings means there will likely be less money for public expenditure as more cash goes to service debt.

Other provincial health departments will also suffer, he says. In September, South Africa introduced new HIV treatment guidelines that now offer antiretrovirals to anyone who has tested HIV-positive, meaning many more people now qualify to receive the drugs than before. Previously, people would have had to wait until their CD4 counts — a measure of the immune system’s strength — fell to 500.

Rensburg says that government is spending money to increase access to HIV treatment and roll out the National Health Insurance while there may not funds to sustain existing programmes.

He explains: “We are facing a financial crisis in health and it is being ignored.”

Bhekisisa – National cancer drug shortage may last until October

Article Written for Bhekisisa by JOAN VAN DYK
Pharmaceutical companies say that delayed drug registrations by the Medicines Control Council may have played a role in stock outs.

A deadly national cancer drug shortage is approaching its third month and patients may have to go without until October – if they can make it.

In February, Nic Basson was diagnosed with glioblastoma multiforme, a fast-growing malignant brain tumour. The tumour is located in his brain’s language centre and affects his ability to communicate.

He was prescribed the steroid betanoid to help control inflammation associated with the tumour. But in April, his local pharmacy told his wife, Debra, that it could no longer fill his prescription, sending Debra on a frantic country-wide search for the drug – to no avail.

She explains: “Within 24 hours without betanoid my husband had lost his ability to speak.”

She continues, softly: “He also has memory loss, so even when he can find words, he forgets what he was going to say. He is essentially trapped in his own mind.”

Betanoid is not just used to treat brain tumours, the medicine is also prescribed to patients battling leukemia, lymphoma and kidney diseases, warns Michael Herbst, health specialist at the Cancer Association of South Africa. Herbst says he is appalled at the shortage.

For cancer patients, skipping a day of betanoid can be life-threatening.

Betanoid works by suppressing the body’s release of stress hormone cortisol. To be effective, the treatment must be taken at exactly the same time every day to ensure that patients have enough of the drug in their blood at all times. Patients who stop taking betanoid have to be weaned off the drug slowly in order to allow their adrenal glands, where cortisol is produced, to slowly return to their normal function.

Herbst warns: “Patients cannot just stop taking betanoid. They could go into a state of shock – and nothing will be able to get them out of it.”

According to US non-profit the Mayo Clinic, withdrawal symptoms from steroids like betanoid also include severe fatigue, body ache and weakness.

Aspen Pharmacare is the sole manufacturer of betanoid for South Africa and says it cannot resume producing the drug until drug regulator the Medicines Control Council (MCC) approves a new manufacturing facility, according to spokesperson Shauneen Beukes.

Aspen did not say when production will resume, but Cape Town’s Groote Schuur Hospital’s spokesperson Alaric Jacobs said they were told to expect stock by the end of October.

National department of health spokesperson Popo Maja has confirmed a nationwide shortage but says the department has imported alternatives to betanoid — dexamethasone and prednisone — to prevent interruptions to cancer care. These drugs are not registered for use in South Africa and must be procured with special MCC permission.

Director of pharmaceutical company Haempharm Caroline Rich says her company will apply to the MCC to register dexamethasone for use in South Africa as a possible alternative to betanoid early next year.  She says applications to register the drug have  been unsuccessful: “We need to get this drug registered as a matter of urgency.”

Although the country has rushed to import alternatives to betanoid amid stock outages, they may not work for everyone.

Both Rich and oncology pharmacist Carien van der Merwe say that switching patients from betanoid to prednisone is tricky. Van der Merwe, owner of The Oncology Pharmacy, says patients like Nic are often prescribed high doses of prednisone, which is not as potent as betanoid. Patients often suffer from increased side effects as a result.

Nic is now using prednisone but Debra says the medication has left him with side effects such as heart palpitations.

South Africa’s national betanoid shortage comes about one year after Bhekisisa reported a national stock out of common childhood cancer treatments. At the time, doctors complained that the MCC had also been slow to respond to individual requests for special access to generic dexamethasone after the registered provider of the brand name drug, Merck & Company, discontinued production.

SA Health Minister Takes On The President – Bhekisisa





The Article and its contents belong Bhekisisa and the Mail and Gaurdian
Article Written by: MIA MALAN


How to defy Zuma – and survive to tell the tale

Health Minister Aaron Motsoaledi knows the political consequences of firing him weigh heavier than the repercussions of keeping him on in his position; that’s why he reportedly seconded a vote of no confidence against President Jacob Zuma this weekend, says political analyst Steven Friedman.

On Saturday a vote of no confidence is said to have been tabled by ANC NEC member Joel Netshitenzhe at the ANC’s national executive committee (NEC) meeting in Irene near Tshwane. Motsoaledi and his deputy Joe Phaahla apparently backed Netshitenzhe.

This would be the second time that Motsoaledi has supported such a motion. Zuma also faced a motion of no confidence in November, tabled by then tourism minister Derek Hanekom. Zuma dismissed Hanekom in a cabinet reshuffle in April , also removing Pravin Gordhan as finance minister.

“Everything in the ANC at the moment has to be understood in terms of the balance of power between the two rival factions – those who support Zuma and those who don’t,” says Friedman. “Clearly Motsoaledi’s reading, and that of his faction, is that there’s not going to be a second cabinet reshuffle anytime soon, and therefore if he wasn’t removed from the cabinet for taking this position the first time, there is no reason why he shouldn’t support such a motion a second time.”

Friedman says Motsoaledi’s strong SACP connections, as well as his “institutional base” in the ANC, makes it difficult for Zuma to act against him. Motsoaledi’s uncle Elias Motsoaledi was one of the eight men, including former President Nelson Mandela, sentenced to life imprisonment in the Rivonia trial in 1964.

Friedman explains: “If you fire Motsoaledi you’re actually declaring war on a faction, or an affiliate of the ANC, whereas Hanekom doesn’t have that kind of institutional base.

“So clearly Zuma took a decision that it was not in his interest to fire an SACP minister who quite clearly had substantial support. His reading of ANC politics was that he would be taking on too much, he would be inviting too much resistance; if he was getting rid of people like Motsoaledi as well.”

Health activists have been expressing “enormous respect” for Motsoaledi’s “bravery and courage” in his ongoing opposition to Zuma. Executive director of the social justice group  SECTION27 Mark Heywood says his organisation, as well as the HIV advocacy movement, the Treatment Action Campaign, believes the health minister acted “honourably” by seconding the motion.

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Our Laura Lopez Gonzalez asks health minister Aaron Motsoaledi five questions about the National Health Insurance (NHI) and your medical aid.

The ANC had a press conference on Monday afternoon at its head offices to announce the outcome of the NEC meeting. Zuma survived with 18 NEC members supporting the motion and 54 being against it.

But Friedman says he’s not surprised: “The only time the ANC has asked a president to step down, which was [former president Thabo] Mbeki [in 2008], there was a huge majority [in the NEC] supporting it. We’re not there yet.

“All the motion may do, if it has any effect at all, is to give both sides a greater sense of who is on their side and who is on the other side. This they will use to continue to do the main thing they’re doing at the moment, which is to contest who will be running the ANC next year.”

This article was updated on June 3 to include the outcome of the ANC’s NEC meeting. The article was originally published before the meeting happened.

Teachers May be Losing the Battle of the Bulge – Bhekisisa

Original Content from Bhekisisa
A new study argues a teacher’s health habits could influence pupils’choices.

Almost 80% of Western Cape primary school teachers could be overweight or obese, according to results from a study published recently in the BioMedCentral Public Health journal. Researchers argue that this could be trouble for pupils.

The study measured weight as well as blood pressure, sugar and cholesterol levels among 517 educators in 83 schools. University of Cape Town (UCT) researchers found that almost 80% of all teachers were overweight or obese. A third of the teachers had high blood pressure and about 12% had diabetes or high cholesterol.

The research defined overweight as a weight-to-height ratio, known as body mass index, greater than or equal to 25, but lower than 30, whereas the ratio for obesity is considered higher than 30.

Overweight and obesity rates among teachers in the study were almost twice as high as those found among adults in the 2012 South African Nutrition and Health Survey.

Western Cape teachers who were female, older or lived in urban areas were more likely to be overweight and obese, according to the UCT study.

Several studies have found that overweight people are more likely to get cancer, diabetes or suffer from heart disease. According to 2014 research commissioned by the treasury, overweight and obesity are a huge burden on South Africa’s healthcare and the economy, in terms of sickness, underproductivity and higher operating costs, says the study.

Mugwena Maluleke, secretary general of the South African Democratic Teachers’ Union (Sadtu), has blamed teachers’ poor health on a shift away from physical education in schools and an increase in administrative work.

“We should be concerned [about the health of educators] because they are the nation builders and they impart knowledge and skills to the future of our country,” he explains.

South Africa’s 2012 nutritional survey found that almost 20% of children aged two to nine were also overweight and obese. UCT researchers argue that improving the health of teachers may improve the health of pupils.

UCT researchers suggest wellness campaigns and healthier food options at schools to help teachers get fit. Sadtu is trying to encourage teachers to get active with dedicated sports days and proposed wellness campaigns run with the Government Employees Medical Scheme and the sports department, Maluleke says.

This could be good news for pupils.

In the study, researchers say: “There is no doubt that educators play an important role in health promotion. Improving the health of educators also improves their effectiveness as role models. Students are more likely to eat healthier foods if their educators are of normal weight and are regularly seen to eat healthy foods.”