The Mandela info debacle

What could have become a significant crisis in the country developed last week, because of a series of really awful decisions made behind the scenes. These concerned giving updates to the nation about the health of our most valued citizen, Nelson Mandela.

We need to know who made these bad decisions, because they clearly had no relevant expertise in making such judgements, and to be assured that they will not be able to impose their lack of wisdom on us again.   

If, as has been reported, conflict between puny "communicators" in the Department of Defence and in the Mandela Foundation led to this debacle, such decisions should in future never be placed in their hands.  Clearly, they do not have the ability to handle such occasions.  We do not need a government misinformation and miscommunication system. It is hard to imagine how the story could have been more totally bungled than it was.   

It is not a matter of state security, of course. If anything, the situation was destabilised by their decisions.  And it was not a matter of attending to Madiba's personal dignity and privacy - in fact, the way it was handled attracted far more attention and curiosity than necessary. Of course there was no need, unless he had wished it so, for pictures of the great man in bed, or intimate details of his physical condition. But the state of health of any present of former head of state is of natural and appropriate interest to the nation and the world, and it is our business, as it can have an impact on our lives. 

What we now know

From what we now know, Nelson Mandela, who has had previous chest infections (without provoking international alarm or even attention) developed such an infection while on holiday in Cape Town. There are reports that there may have been "a collapsed lung", though these are not confirmed, and the term could have various meanings.  He was flown across country to Johannesburg on a military flight, and admitted to Milpark Hospital.

There were later reports that he was seen by Dr Plit, who is a distinguished lung specialist. And I was greatly re-assured at the belated press conference, to see the presence of Dr. Veejay Ramlakan, Surgeon-General of the SANDF, who I have known over years, to be a sound and wise physician. He was in excellent hands. They confirmed that he had a significant chest infection, which must always be taken seriously especially in a man of that age, and that it was responding well to treatment. 

We were misled

We were apparently deliberately misled, and some might say lied to, when we were told he was at the hospital merely for "routine tests".  At that age, no tests are truly routine, and they do not need hospital admission or consultation with senior physicians. And a diagnosis and treatment plan had apparently already been made. The more that this excuse became obviously untrue, the more people worried. And for far too long, there was silence, with no official statement of the basic and true facts. In any such situation, a lack of news very readily leads to the assumption that the truth is so awful that people are not daring to tell us. Many people concluded, quite reasonably, that the Grandfather of the Nation was moribund and that we would soon be bereft. 

In Pretoria, when I visited my favourite bookstore, there was a large display of Mandela books, draped with a South African Flag, and provision seemed to have been made for adding black ribbon and a commemorative card. There was unusual activity in the air, with military aircraft flying in formation, and many assumed this was a rehearsal for a state funeral, rather than for the forthcoming Air Show. These were entirely reasonable actions and assumptions, while we were being misled. 

The analogy of doctors who lie to patients

Over many years of working with dying patients and their families, I have taught and written extensively about the issue of truth-telling in such situations. Inevitably, no news is taken as bad news, and lying backfires. As one woman said to me, scornfully, "The doctor tells me I'm doing fine. But I feel worse every day, and wake in the early morning to find my family from distant cities at my bedside, weeping. And I'm doing fine? " 

Nature abhors a vacuum, and so does society. In the absence of credible facts, rumours automatically and inevitably start. It was absurd for some of the authorities to scold us and patronisingly tell us not to panic, and not to speculate. In turn, they blamed the media.  But they themselves were causing the panic and speculation. It was like lighting a fire, and then scolding the wood for burning. 

When it's obvious that something important is going on, and information is being withheld, the conclusion is drawn that something dreadful is happening, so frightful that the authorities fear to tell us, and that they have decided we are too weak, foolish and incompetent to deal with the truth.  This is insulting, and rarely true. In fact, as we saw, South Africa handled the artificial crisis with restraint and dignity; and far more sensibly than the decision-makers who felt they could not trust us. When a loved one is ill, we are naturally concerned. And for almost everyone in South Africa, Madiba is a loved family member. 

Who will believe them next time? 

And the authorities must remember the other inevitable consequence of lying to us when we are so concerned - they have severely damaged their own credibility. When there is further illness, or just rumours, whatever they say will be justifiably disbelieved. The aloof and non-transparent Nelson Mandela Foundation, a faceless bunch at the best of times, has severely damaged its reputation and plausibility. It is not a democratic institution and has no special authority to make decisions affecting us all. Madiba belongs to the nation and to the world, not to the Foundation. 

It appears that Acting President Motlanthe eventually handled the situation admirably and sensibly. When a Foundation spokesman was quoted as saying, "we cannot be held accountable for anything", he unwittingly confirmed the core problem. The unaccountable must never be allowed to make such important decisions. 

Pneumonia

In the old days (when I did my medical training, they still kept some leeches in the hospital pharmacy) pneumonia was known as the Old Man's Friend. Although antibiotics were readily available and in use, it was also recognised, as is too easily forgotten these days, that not everything that can be treated, must be treated.

It was understood that eventually, we all die of something, and some causes are much more unpleasant than others. It was more common to face the fact that eventually, with advanced age, some of us really wear out ; that the burden of living can eventually become unwelcome; that death is not necessarily the enemy.

As the American writer Stewart Alsop wrote during his own final illness: "There comes a time when a dying man needs death, like a sleepy man needs sleep". And it was considered that pneumonia could be a comfortable way to die, and that zealous treatment could at times be more unpleasant and undesirable, so long as the individual was enabled to make the decision about whether to accept and welcome aggressive treatment.

I hope, as, surely, do we all, that Madiba will be with us for a good time to come.  But just because we ourselves hate the idea of carrying on without this great, compassionate and wise man, we should hope that he is allowed to make his own decisions, so far as possible, about his own health and also eventually to be allowed to embrace great peace when he is ready to do so, with decisions made for his own benefit, and not ours.  

(Professor M.A. Simpson, Health24, January 2011)