Communicative Injustice at the Heart of Life Esidimeni
This is again another form of communicative injustice, as proper healthcare dictates that experts in the situation should have been part of the planning and moving of the patients.
Communication in healthcare is an essential justice as the lack thereof can be the differentiator between wellbeing and suffering, life and death.
Communicative injustice combined with healthcare injustice in the Life Esidimeni tragedy was the subject of health sociologist Dr Qawekazi Maqabuka’s doctoral dissertation.
During Nelson Mandela University’s recent autumn graduation season, a visibly emotional Maqabuka crossed the stage to receive her doctoral degree from the Department of Sociology in the institution’s Faculty of Humanities.
The timing was perfect as in April, the National Prosecuting Authority confirmed its decision to institute criminal prosecution against the individuals responsible for the Life Esidimeni tragedy, following years of investigations and an inquest.
“It’s been ten long years since the Gauteng Department of Health (GDoH)
terminated its contract with the psychiatric care facility, Life Esidimeni, relocating some 1 700 mental healthcare patients from specialised facilities to unlicensed, illegal NGOs to save costs,” says Dr Maqabuka. This decision resulted in the deaths of over 140 patients, collective trauma and 44 patients still missing.
“In my dissertation I explore the concept of communicative justice by analysing how those responsible for the Esidimeni relocation ‘project’, as well as the service providers overseeing the NGOs, failed to communicate with or consult the families of the patients.
The families had no idea how to find out what was happening to their loved ones, nor were their rights to be involved in the care and well-being of their loved ones respected. Many families had to try and get information from security guards and staff at Life Esidimeni. This is communicative injustice to the extreme.”
Family member after family member testified about this during the arbitration that started in 2017, led by former Deputy Chief Justice Dikgang Moseneke. Mrs Betha Molefe was one of them.
An excerpt from her testimony reads as follows: ‘There is nothing that I can say to the Government because I am traumatised as I speak…I’m against the way in which they operate …They turn their backs on us, they have nothing to do with us.
That shows that they were not taking care of our children. If they did care about our children, they could have come to us and shown that there was no deliberate intent on their part. They could have come and said ‘Please forgive us, it was not deliberate on our part’.”
Dr Maqabuka’s dissertation shows how even doctors and psychiatrists, who should have been part of the allocation and moving of patients, were not permitted to participate in the decision-making process.
This is again another form of communicative injustice, as proper healthcare dictates that experts in the situation should have been part of the planning and moving of the patients.
She further explains that the GDoH failed to conduct adequate assessments, ignored warnings from the experts, and placed cost-saving above the constitutional obligation to protect vulnerable individuals.
The Ombud Report highlights how the relocation decisions were made without due diligence or adherence to healthcare standards. This conduct by the GDoH is not only a case of systemic failure in healthcare, governance and accountability, it is a case study in communicative injustice.
Justice Moseneke described the NGOs as “death chambers” where patients deteriorated at a rapid rate, with many of them dying within weeks and months of the move. The deaths of the over 140 patients were caused by a combination of starvation, neglect and lack of medical care.
“I take the harm caused a step further,” says Dr Maqabuka. “The scope of communicative justice is not exhausted by what we owe to the living, but also requires us to focus on the relevance of the concept of ukulandwa komzimba, where African spiritual practices ensure the safe passage of dead souls to the afterlife.
This was severely breached to the extent that some of the bodies were buried in the backyards of the NGOs instead of being entrusted to their families who could be with the deceased, communicate with them, as is the practice, and reassure them that they were being taken home.”
Another act of communicative injustice she raises is that South Africa has 12 official languages but patients who cannot communicate in English often do not get the care they need. In addition, many of the Life Esidimeni patients were mental healthcare patients who needed their loved ones to communicate for them.
“People cannot always speak for themselves and we need to make sure that someone who cares for them can speak for them. Communication is at the heart of what makes us human, it is how we share and receive information. Communicative justice is therefore an essential justice,” Dr Maqabuka explains.
One of her PhD supervisors, Professor Nomalanga Mkhize, Director of the School of Governmental and Social Sciences at Nelson Mandela University, says: “Dr Maqabuka’s study gives a very nuanced and sensitive account of the key role communication plays in the recognition of our personhood and dignity, and raises how much more important communication is in the rights and humanity of those who are not able to speak for themselves.”
“The Life Esidimeni case made news headlines globally and it should have set a precedent for state accountability, ethical behaviour, care for people, human dignity and communicative justice,” Dr Maqabuka continues.
“And yet it is far from the only case where the most vulnerable in society are being treated badly by government departments in South Africa. The injustice continues.”
Another case she cites was first reported by Msindisi Fengu in the City Press on 24 March 2018, where Legal Aid SA, represented by senior Advocate Lila Crouse, had managed to avert a case similar to Life Esidimeni. In the legal case Frail care crisis collective vs MEC for social development, the
Eastern Cape MEC wanted to move 236 frail care and disabled patients from Lorraine Frail Care and Algoa Frail Care in the province to NGOs to reduce costs.
In June 2016, the department gave notice to the two frail care facilities of its intention to terminate the contract with the Life Healthcare Group which managed them, effective 31 December 2016. The families were only informed of the intended closure of the two centres on 19 November 2016.
“In 2026, state mental health facilities remain mismanaged, under-resourced and have yet again been investigated and censured by the current health ombud,” Dr Maqabuka continues. “The past has a way of repeating itself.”
The families of the Life Esidimeni patients have since called for transparency from the NPA, to be included in the process and to be communicated with about what is happening.
“We hope this is honoured. We need to witness proactive change from the government at frail care and mental healthcare facilities; we need to see care in action for the most vulnerable,” says Dr Maqabuka.
“What is the point of democracy if the most vulnerable in our society do not feel the true material reality of democracy and justice in action?”
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