‘Winnie held his hand’: Doctor remembers Madiba’s last breath

16 July 2017 - 00:00 By SUTHENTIRA GOVENDER and YASANTHA NAIDOO

His official date of death is December 5 2013, but on a wintry night six months earlier Nelson Mandela stopped breathing.
Shortly after midnight on June 8 that year, Madiba, 94 and in frail health, was gently turned onto his left side in his bed in his Houghton home. He stopped breathing and had a "terminal event".
His nursing team went into overdrive and alerted his doctors, who feared he "might have died".
But after urgent medical intervention he was revived and put onto a ventilator. Within minutes, he resumed breathing by himself.
Shortly after he had been resuscitated, his wife, Graça Machel, walked into the room. She was unaware of what had just happened until being notified by doctors.
Standing beside him, Machel said: "Papa, you are going to be OK. Hang in there, Papa! You are going to be fine."
These and other previously undisclosed details - including that it was his former wife, Winnie Madikizela-Mandela, who was holding his hand when he died, and not Machel - have been revealed in a new book about Madiba.
Mandela's Last Years - written by the former surgeon general of the South African National Defence Force, Lieutenant-General Vejay Ramlakan, and published by Penguin Random House - goes on sale tomorrow.
Ambulance caught fire
While Good Morning, Mr Mandela, written by his former personal assistant Zelda la Grange, laid bare the squabbling and power struggles in the Mandela family before and after his death, Ramlakan's 238-page book is described as "the true story of Nelson Mandela's final journey by the head of his medical team".Ramlakan divulges in extensive detail the shocking events of June 8.
Not only did Mandela - who was "literally fighting for his life", Ramlakan said this week - need to be resuscitated, but the military ambulance in which he was rushed to the Pretoria Mediclinic Heart Hospital from Houghton caught alight en route.
It was previously reported that the ambulance broke down, but the book details how, barely 20km into the journey, the vehicle stalled in the fast lane and was engulfed in black smoke.
"This was awful. Madiba in an ambulance on fire," Ramlakan writes.
Miraculously, the situation was quickly brought under control and, 30 minutes later, a back-up ambulance was on its way.
Ramlakan also speaks candidly and in depth about the clandestine operations and military protocols that were implemented to counter media scrutiny.
'Strange, gripping and powerful'
The book - to be released on the eve of Mandela Day - also reveals details of spy cameras found in the former president's Houghton bedroom, his hospital room, on the fence of his Qunu property and even in the morgue he was taken to in Qunu.
Ramlakan does not identify those thought to be responsible for planting the cameras.
He outlines how hoax bomb threats and decoys were used to fool the media and the public when Madiba was in hospital."We wanted people to know the facts about Mandela's activities and his health, because in the years immediately prior to his death, media reports on his health were filled with intense speculation and rumour.
"What was hidden from them was a truth that was strange, gripping and powerful," Ramlakan writes.
The former three-star general retired from the defence force in 2015 shortly after coming under fire for his role in signing off on upgrades costing more than R22-million at President Jacob Zuma's Nkandla home.
In the first two sections of the book, he describes Madiba's health issues during his early political life, his incarceration, and his years as president and afterwards.
Alzheimer's fears
In the final section of the book, documenting the last six months of Mandela's life, Ramlakan highlights the toll that internal family politics had on the failing health of the Nobel peace laureate.
"We were privileged to have his family ask us to tell this story and have thus been able to satisfy all ethical concerns," Ramlakan said.
At many points during Mandela's final years, Ramlakan and the medical team assigned to look after the former president - called the Charlie Team - were deeply concerned about his health.
On one occasion in 2008, Ramlakan recalls, he noticed that Mandela - who had just turned 90 - was unusually listless.
"There were no obvious signs of ill-heath but I was concerned that his lack of interest in daily affairs masked something else, such as Alzheimer's, dementia and/or depression," he writes.
Ramlakan asked his defence force colleague Dr Zola Dabula, who was operational commander of the presidential medical unit, to assess Madiba's mental state.
Plagued by doubts
Ramlakan recalls that Madiba referred to Dabula as his "homeboy", because both had roots in the Eastern Cape.
"Soon Mandela confessed [to Dabula] that he was sad and somewhat depressed," Ramlakan writes.
"The sadness derived from his incarceration, which had deprived him of time with his family. He felt guilty for past neglect due to his role in the liberation struggle and also believed that this still affected relationships within his family."
But despite these feelings of guilt, Mandela told Dabula that he did not regret the path he had taken.
The end of 2008 saw the military medical team taking over all aspects of Mandela's healthcare, a move that Ramlakan says was not unanimously welcomed.
He writes that Mandela was "sub-clinically unwell" by 2010 - the year of the Soccer World Cup - and describes clashes between the medical team and Mandela's staff.
When bedsores were detected in 2010, while Mandela was at home at Qunu, his medical team "instituted certain measures - fewer visits, for example - that Mandela's staff were used to arranging without considering his wellbeing", Ramlakan writes.
"Not for the first time there was a clash between the medical team and the household staff. The medical records showed that Mandela was often exhausted by the round of daily activities - and had been even when he was president - but his staff seldom took account of this."
When important visitors were turned away, the staff voiced their disapproval.
Clashes with La Grange
As Mandela's health deteriorated, clashes with La Grange increased, Ramlakan writes. He says La Grange was "unhappy with the turn of events regarding the healthcare of her boss, and began challenging aspects of the system".
He writes: "She was voluble and assertive and went into direct conflict with the medical team. Mostly she seemed not to understand that the healthcare system is the most regulated of professions and correctly so: issues of life and death are always present.
"Her officiousness created an unfortunate sideshow. And as all doctors know, a sideshow can take the focus off the patient with disastrous results."
Honouring Mandela's legacy
La Grange said she would "not respond directly to any queries other than to wish Dr Ramlakan well with his book".
She added: "He has captured his experiences and opinions, just as I have captured mine.
"We all choose how we wish to remember Madiba and best honour his legacy."..

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