Arbitration reveals the skeletons in the Gauteng health department’s closet culture that gave rise to 141 deaths and continues to thrive.
Levy Mosenogi could be described like many men who throughout history who have ended up on its bad side: a religious man and active in his community by his own account during his recent testimony at a Life Esidimeni arbitration hearing.
And when he was tasked with leading the relocation of almost 2 000 mental health patients out of state-sponsored private care at Life Esidimeni facilities, he became even more like those cautionary tales of characters from our history lessons. Not the obvious ones that present themselves in the immediate aftermath of a grave injustice, when narratives are preoccupied with dichotomies of good and evil or victor and villain, but the ones that creep in their wakes in which we begin to understand the importance of what seemed innocuous cameos.
Mosenogi became a man with a mundane title, some power and a sense of what he would later describe as a foreboding.
At least 141 people died as a result of the relocations, arbitration hearings have revealed.
Billy didn’t survive it.
A father speaks out about the terrible conditions his son died in after being removed from state-funded hospital care at Life Esidimeni.
More than two years after the project was announced and a year after the initial deaths emerged, Mosenogi testified late last week at the ongoing arbitration. The process, which takes place in parallel with criminal investigations, is aimed at keeping families and the Gauteng health department out of court.
He described his initial misgivings about the project and how he voiced these to former health MEC Qedani Mahlangu.
“I had a foreboding. When things were discussed, I found the head of department [Barney Selebano] also had serious misgivings.”
Asked what else he did about these feelings of dread, he responded: “I did raise it in my prayer meetings and asked people to pray. I raised it in my organisation [the ANC] in my branch.”
Cullinan Care and Rehabilitation Centre social worker Daphne Ndhlovu was more explicit about why she did not speak out as the centre’s patients began dying after it was allegedly pressured by the Gauteng health department to accept Life Esidimeni patients: she was threatened with being accused of insubordination.
Ndhlovu explained she was essentially following orders: “We knew we were not giving justice to our patients, but it was instructions from above.”
Last week, Mosenogi became one of the first Gauteng health employees to apologise publicly to Life Esidimeni families.
“I apologise for myself. I apologise on behalf of the department of health. The lesson we learnt is to speak truth to power.”
In 1945 and in the wake of World War II, the phrase “I was just following orders” became synonymous with the Nuremberg Trials – the military tribunals designed to bring Nazi leaders to justice. So famous is the association that, today, the “an order is an order” plea is often referred to as the “Nuremberg Defence”. Although the defence did not absolve those prosecuted at Nuremberg, it has worked intermittently throughout history since the Roman Empire.
Only two Gauteng health officials – Selebano and director of the mental health directorate Makgabo Manamela – have been suspended and are facing disciplinary action, says Gauteng deputy director general of communication services Thabo Masebe.
The pair have garnered a collective R1.3-million in wages while on suspension, alleges the Democratic Alliance’s Gauteng shadow health MEC Jack Bloom.
The former Gauteng health MEC says it wasn’t her job to visit organisations prior to transferring state patients into their care.
In 1963, Yale University psychologist Stanley Milgram released the first results of a series of studies – in part inspired by the Nuremberg proceedings – designed to reveal why seemingly good people could be ordered to do bad things.
In his research, published in the Journal of Abnormal and Social Psychology, Milgram tested how many people could be successfully ordered to administer increasingly painful shocks to a fellow participant.
Although this fellow participant was an actor and the shocks were fake, Milgram found that almost two out of every three people among a group of 40 were willing to deliver the highest shock possible, 450 volts, when told to do so.
Although Milgram’s work fell prey to a bevy of allegations, including data tampering, the quest to understand “the banality of evil” continues to fascinate psychology. Until recently, much of this work focused on the kind of factors, for instance, environment in Milgram’s work or institutional culture in the infamous Stanford Prison Experiment. (In this experiment, a fake prison was created on a university campus with participants divided into prisoners or wardens. It became such a toxic environment that it was called off after six days.)
But in 2016, a study by scientists from the Brussels’ Université libre de Bruxelles and University College London became one of the first to look not at what made people do bad things on command but what it felt like when they did.
In research published in Current Biology, scientists found that, when subjects were coerced or ordered to do something, they perceived a lag in the time between their decision and its consequence (in this case actual shocks or taking away money).
When people did these things of their free will, cause and effect were experienced more simultaneously – suggesting that people following orders felt less agency and even responsibility for their actions.
Researchers were reportedly quick to say that the work didn’t support the Nuremberg Defence.
And if humans are hardwired to pass the buck when we’re doing what we’re told, there may be few fields as dangerous as medicine – with its rigid hierarchies – for this to play out in.
The Rural Health Advocacy Project works with medical students and health workers to teach them to speak out for themselves and their patients. The costs for calling out your superiors are steep, the project’s Samantha Khan-Gilmore told Bhekisisa in 2016. From the moment that final-year students begin clinical rotations to when they begin their internships, Khan-Gilmore says they “experience a range of negative experiences at the hands of senior staff, most of which they believe are beyond their control”.
“They face tough choices about whether to stay quiet and support the status quo, or to speak up and risk victimisation. At the start of their careers, these healthcare professionals have a lot to lose,” she explains.
And when these medical students become professionals, speaking out becomes no easier. In fact, whistleblowers are often convinced that not even moving provinces will save them from the wrath – sometimes including physical threats – of superiors and peers should they report anything from abuse of overtime to surgery backlogs.
Meanwhile, anecdotal evidence from health workers suggests that regular performance appraisals, which could help workers and administrators accountable may be irregular and or vastly varying quality.
The Gauteng health department says that 100% of its employees have undergone performance appraisals in the past year and that results are loaded into its payroll systems. In fact, anyone below senior management is evaluated four times a year.
South Africa Medical Association chairperson Mzukisi Grootboom says this is surprising since complaints about the frequency and quality of performance appraisals are common among its members.
Today, the high-profile names whose “fingerprints were peppered throughout the project”, to quote the ombudsman, may be suspended but many more employees who had a hand in the Life Esidimeni tragedy remain in its employ – left to carry out future projects in the same organisational culture that allowed the scandal to happen.
And, to quote novelist and chemist CP Snow: “When you think of the long and gloomy history of man, you will find more hideous crimes have been committed in the name of obedience than have ever been committed in the name of rebellion.”