Mandla David Radebe has spent most of his life institutionalised. At 16 years old, he killed his friend and was sent to juvenile prison and then sentenced to 29 years in jail. He was diagnosed with schizophrenia and after receiving medical parole was sent to a number of hospitals before he landed at Life Esidimeni, Randfontein.

Radebe was one of around 1,700 psychiatric patients moved out of Life Esidimeni when the Gauteng Department of Health terminated its long-established relationship with the healthcare provider. “Justice must be served to the health officials,” said his sister Elizabeth Nomsa Radebe, testifying at the Life Esidimeni arbitration on Monday in Johannesburg.

“If this can happen, these people must be arrested and put in jail,” she continued. “They’ve caused us, for those who lost their families, their kids, those who survived, [we] are still struggling to get right. Due to this, they’re playing games [with] our family lives.”

Radebe and the relatives of the 143 patients who died as a result of the department’s catastrophic plan will on Tuesday come face to face with another of the key decision-makers in the Life Esidimeni tragedy. On Monday, suspended Gauteng health head of department Dr Tiego Ephraim Selebano’s attempt to avoid appearing at the arbitration was thrown out of court and he is required to testify on Tuesday.

Elizabeth Radebe had not been told where her brother was being moved last year but eventually tracked him down to an NGO in Hammanskraal. “When they brought him, I screamed and cried.” The staff told her to be quiet. “Nomsa, how did you find me?” he asked.

He was smelly, skinny and dirty. His hair had grown and no one had shaved his beard. She offered some food and cold drinks she had brought to other patients. The patients fought each other to eat. An NGO staff member said they hadn’t been paid by the department – the department didn’t pay the NGOs for months – and there was no food. The staff member planned to buy a braai pack that afternoon from her own pocket, not enough for all of the patients.

Mandla David Radebe survived his ordeal and is recovering at another facility, but patients’ relatives, those who were scared their loved ones would die and those who lost their loved ones, want answers.

Selebano, who tried to overturn the subpoena to have him appear, will face tough questions. In his report on the Life Esidimeni deaths, Health Ombudsman Professor Malegapuru Makgoba said the fingerprints of Selebano, suspended Gauteng director of mental health Makgabo Manamela and former Health MEC Qedani Mahlangu were all over the disastrous plan.

Manamela testified at the arbitration last week after a last-minute postponement request was denied and she took days to recover from a sudden illness. Her appearance was littered with contradictions and attempts to deflect responsibility, frustrating the arbitrator, former Deputy Chief Justice Dikgang Moseneke. While she was reluctant to be honest, her testimony highlighted the department’s incompetence and she could not refute claims she had violated protocol and did not speak out when she should have.

Selebano will have to shed light on his own role in the deadly project and could be pushed on what his principal, Mahlangu, instructed him to do and why they pushed ahead despite repeated warnings. Mahlangu is in the UK studying and is only set to appear at the arbitration in late January.

Selebano told the ombudsman that the pressure on the department’s staff was intense but he wouldn’t reveal where the pressure came from. He said he would “take the sword” for his staff’s mistakes because he didn’t offer enough support. “Dr Selebano’s evidence was both evasive and contradictory,” wrote the ombudsman.

The almost 2,000 chronic psychiatric patients were moved out of Life Esidimeni with what appears to be only the barest of plans. Selebano said there was another plan. He wanted the department to buy a facility to develop and move patients into, or at least to phase the move of patients to NGOs and home care in a staggered approach.

The plan to buy a property or renovate a facility was rejected, he didn’t say by whom, and Selebano was later side-lined during the project. In a cryptic reference to leaders getting too involved in the move and not letting civil servants do their work, he said “the eagle must listen to an ant”.

Selebano cannot, however, claim innocence. None of the 27 NGOs that patients were moved to had valid licences. Manamela had signed their licences, even though she was not authorised to, and often did so without following protocol. When the ombudsman questioned Selebano, he, as the official authorised to approve licences, signed new forms that were backdated to make it appear as though he had done so before patients were sent from Life Esidimeni.

Many of the 143 victims died in those NGOs. They had not been paid by the department, had no medical professionals to care for the patients, and couldn’t read medical files, if they even received them. They did not have enough food or heating to ensure basic survival. Indicative of Selebano’s incompetence is that he had no idea of the number of people who had died when he was interviewed by Malegapuru.

While Selebano did not have a grip on the crisis, patients’ relatives were scared their loved ones would be the next to die. Lesego Baloyi’s sister, Julia Kgatle, was moved to Takalani House, where typhoid broke out while Kgatle was there. Baloyi prayed her sister wouldn’t die. She survived but the experience has traumatised her and her family.

Legal Aid SA represents the families of patients who survived and Moseneke will have to consider whether they also deserve compensation from the government. The arbitration is mandated to advise on compensation for the relatives of those who died, but it’s unclear whether it will recommend relatives of survivors are also compensated.

Elizabeth Nomsa Radebe was asked what she wanted from the arbitration. “Justice”, she said, before turning to “dignity”. She said the government must pay for the tombstones of the dead. “With dignity they must rest in peace.”

The arbitration continues on Tuesday with Selebano’s testimony, unless he sends a sick note. DM

Photo: Former Deputy Chief Justice, Dikgang Moseneke (Greg Nicolson)