When she stepped into the packed white tent pitched in the parking lot of an old Parktown mansion turned conference centre, the room erupted into a chorus of Senzeni Na ("What have we done").
Qedani Mahlangu, the woman at the centre of what is arguably the greatest miscarriage of the right to health in South Africa since Aids denialism, finally appeared this week at the Life Esidimeni arbitration hearings.
As the former Gauteng Health MEC walked to her seat, the singing gave way to the distraught sobs of a single woman, crying into her hands, in the audience. She’s one of the family members of the 1 700 long-term mental health patients who were removed from state-funded care at private Life Esidimeni facilities in 2016 who are here for answers.
The move, which spread people between 122 community NGOs and to a lesser extent state hospitals, was supposed to save the Gauteng health department money.
Instead, it cost 143 people their lives.
The country has waited for four months for Mahlangu, who was the MEC in charge during the tragedy, to testify.
On the stand, Mahlangu maintained that she had no reason to suspect the move would turn deadly.
Listen: 'It wasn't my responsibility
supports HTML5 video
The former Gauteng health MEC says it wasn't her job to visit organisations prior to transferring state patients into their care.
She says senior Gauteng health officials misled and lied to her, particularly former head of department Barney Selebano and mental health director Makgabo Manamela.
The duo has joined a chorus of health officials who have testified that although a departmental “collective” decided to relocate patients, Mahlangu pushed heavily for the move.
Mahlangu says Manamela concealed, for instance, complaints of food shortages at NGOs that had been allocated just R112 per person per day to care for the severely-ill patients.
She claims the pair also led her to believe that many Life Esidimeni patients could initially be placed in hundreds of allegedly empty state hospitals beds — an assertion Premier David Makhura has said was used to sell him on the project in his state of the province address.
“With the information at my disposal at the time, I had a sense the (project) team knew what they were doing. I had no reason to worry,” Mahlangu said.
“If I had been given accurate information at the time… we probably would not be sitting here.
Those beds never existed, arbitration revealed this week.
Mahlangu said she only learned of the project’s fatal failings in August 2016 when she received a report describing “low lights” in project implementation including shortages of food, medicine, medical equipment and staff at NGOs. One organisation had a typhoid outbreak because of a lack of clean water and food.
She admits she never presented this information — nor the fact that experts had complained about several NGOs —to legislature. Not even when she revealed that 36 patients had died in September 2016. The fact that she concealed this type of information may bolster Makhura’s assertion at the February 2017 release of the ombud’s report that Mahlangu had kept him in the dark about the project.
She also could not recall whether NGOs had been, for instance, asked to tender for contracts, how much money her department had saved or what had been the outcome of moves to litigate against her and others to halt patient transfers. Facts like these, she says, would have been left to Selebano in what has become a main tenet of her defence.
Since news of deaths broke in 2016, Mahlangu has maintained that the Public Finance Management and the Public Service Acts preclude MECs from becoming involved in the day-to-day management of the department
Mahlangu’s interpretation of the Public Finance Management Act is correct, says the Rural Health Advocacy Project's Russel Rensburg.
Under the legislation, departmental heads such as Selebano are tasked with, for instance, ensuring departments follow procurement procedures and projects are fully vetted. But Rensburg emphasises that in practice MECs have been known to take over a range of administrative functions such as signing off on key appointments and approving budget expenditure.
Mahlangu has been quick to join the blame game, pointing fingers at both Selebano and Manamela as well as members of the Gauteng Mental Health Review Board — a body that should have safeguarded patient interest.
She has also publicly contradicted statements made by Health Minister Aaron Motsoaledi in which he took credit for instituting the ombud’s investigation and that members of his ministerial team shuttered dodgy NGOs, 27 of which were operating without licenses.
Motsoaledi and Makhura are expected to testify before the end of January.
Mahlangu says she did not watch arbitration proceedings while studying in London and only received evidence, including testimony transcripts when she returned to the country earlier this month. She says she was met by police at the airport. (Oupa Nkosi)
Making her way down the stairs of the arbitration venue this week, Mahlangu must remember when she commanded a rather different presence in its halls. More than a year ago, she sat in one of its white, thick-walled rooms threatening to sue anyone who used her name “inappropriately”.
“I mean you do so much in trying to do what is right. No one said it is going to be easy to lead and I fully understand that but I am working with lots of people who work extremely hard; sometimes they will make mistakes… the question is how do you learn from them,” she told Bhekisisa then.
Arbitration has revealed just how ready she was to lawyer up as civil society organisations challenged what became known as the Gauteng Mental Health Marathon Project.
When the South African Depression and Anxiety Group wrote to her about the death of Virginia Machpelah at the Precious Angels NGO and related mounting bodies in a local mortuary, Mahlangu accidentally responded by hitting “reply all” on an email intended for her subordinates.
It read: "Get our legal team involved in this process. These NGOs are dishonest. Please treat this as urgent."
She revealed this week that the department hired a private law firm to respond to SADAG’s letter. Through its lawyers, the Gauteng health department accused the organisation of being disingenuous and self-serving.
This arrogance that opposition parties say is characteristic of the former MEC remains visible at the hearing, if somewhat subdued.
But cracks in Mahlangu’s armor could be showing.
In the months that followed her resignation, the WhatsApp status attached to the cell phone number Mahlangu widely circulated during her time in the office read like the morning affirmation. It bore a quote attributed to the American agony aunty Ann Landers, (her real name is Eppie Lederer) who dolled out socially liberally but morally conservative advice via a syndicated column for more than 40 years. Her work was by her own admission more the stuff of cuttings hung on refrigerator doors than of Pulitzer Prizes.
It read: “Maintaining self-respect in the face of a devastating experience is of prime importance”.
Have something to say? Tweet or Facebook us on @Bhekisisa_MG
SPECIAL REPORT: #LifeEsidimeni - How did more than 90 mental health patients lose their lives at the hands of the state?
#LifeEsidimeni: What Qedani Mahlangu’s testimony may mean for David Makhura
#LifeEsidimeni: Did Qedani Mahlangu send patients to their deaths for political gain?
As deaths mount, take an inside look at the detectives working around the clock to solve the country’s medical mystery.
Partners and families allegedly drugged women and in some cases even physically restrained them as doctors performed the procedure.
Until now, the national and provincial health departments have not been able to say where services are provided. Here's how we found them.
Bhekisisa means "to scrutinise" in Zulu
In South Africa, Zulu patients who would like to be thoroughly assessed by a doctor, would ask the physician to "bhekisisa" them.