Nelson Mandela was always the subject of public interest. Once he retired from public life, that interest intensified, resulting in the proliferation of false claims and rumours in the media and elsewhere regarding his health, his medical treatment, and, in particular, about events during the months leading up to his death.
On July 18, 2017 (Madiba’s 99th birthday) Penguin Random House South Africa released Mandela’s Last Days, by retired military doctor Vejay Ramlakan. Just a week later, the publisher pulled the book from shelves “out of respect for the late Mr. Mandela’s family.” Mandela’s widow, Graça Machel, had expressed her displeasure with it.
Ramlakan told his publisher that he had permission from Mandela’s family for the medical tell-all, and said in an interview Sunday that in fact the family requested he write it. But Machel is far from happy with the book.
“I condemn Vejay Ramlakan’s book Mandela’s Last Years in the strongest terms,” Machel said in a statement to Times Live, adding, “It breaches the doctor–patient relationship of confidentiality.” Machel said she was consulting lawyers on whether to sue the author and publisher.
It’s unusual for a publisher to pull a book they’ve paid for, printed, and publicized, and even more so after the book has already been released. Notably, the publisher said the book was pulled out of respect for the family, and not because the editors think that Ramlakan was lying. The publisher declined to comment on whether the manuscript had been fact-checked.
This book sets the record straight about Mandela’s last years. Written by the head of his medical team, the military doctor who witnessed first-hand what the former president was experiencing, it documents the complex medical challenges, the interactions between family members and staff, the constant scrutiny from the press, and the actions and responses of Mandela himself.
The book – that was released 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.
Written with respect and with the support of family members, this book completes the story of Nelson Mandela. It reveals a man who showed immense courage, not only when he fought for the freedom of millions of people, but until the very end of his own life.
Book Extract: He Has Departed
Tuesday 3 December was a difficult day for everybody on the medical team. The previous night’s panel discussion had revealed differing views of how to treat this crisis. Some felt that nature should be allowed to take its course. The larger group were not prepared to accept this attitude and instead guidelines were set within which further escalation of treatment would not be encouraged.
Every treatment regime comes with its negative impact on other parts of the body, and the art of medicine is balancing these negative side effects while addressing the primary problem. Madiba had developed side effects to most of his treatments over the years.
That Tuesday also initiated a new phase. To that point, a fighting spirit and a steely resolve had characterised all Madiba’s health battles. Now it seemed to those of us who had been with him for years that he was no longer fighting back.
In my earlier conversations with Makaziwe Mandela, I had debated with her about her understanding of ‘transitioning’. This was supposedly when a human being enters the spirit world to prepare for the next existence.
In this period, the soul is said to be in two separate worlds and part of both. The limbo remains while it waits for something in this world before finally passing on. Makaziwe was a firm believer in such interim processes and had told me that she had seen this when her close relatives had passed away, including her brother Makgatho and her mother. Madiba had himself witnessed the slow death of his son.
During Makgatho’s last days, Madiba and Makaziwe had many moments of reflection on life and its meaning. She was a religious person of strong conviction and a lifelong believer in God. When she asked her father, faced with a dying son, whether he believed in God, he had not answered directly. Instead, he had said that he believed in infinity.
Was Madiba now transitioning? Makaziwe was firmly convinced that he was. What was he waiting for before he would pass on?
The medical team were now having to treat a recurrence of the heart problems. With the concomitant decrease in blood pressure, therapy had to be upscaled from the previous day’s levels. At the panel meeting that Tuesday evening, we accepted that the situation was pre-terminal. While mechanically addressing all the blood results and the machine reports, the overwhelming feeling among the team was that ‘we are in the hands of God’.
I had decided to convey the situation to President Zuma and spoke to him that night. He took the news sombrely and asked to be kept informed. I hung up wondering what message I would give the president the next time we spoke.
I also asked Dabula to let Steve Komati know what was happening. Komati’s response was to immediately arrange to fly back to South Africa. While he was in the air, Madiba was in severe refractory sepsis. His blood pressure support had been raised to maximum levels, which turned his skin grey and dusky. He was now ventilator-dependent. His therapy had reached the maximum.
Fifty-seven years earlier, on 5 December 1956, Madiba and 155 other political leaders had been arrested and charged with treason. It was the time of the popular Congress movement and the Freedom Charter. They were heady days, when even the government crackdown seemed dwarfed by a growing spirit of defiance and revolution.
On this Thursday, fifty-seven years later, Madiba was transitioning. He was still receiving dialysis and was moving slowly in response to being touched by his medical team. His average blood pressure was dropping and his respiratory laboratory results showed the gravity of the situation. The panel had agreed to continue his blood pressure support and anti-biotics.
By that morning, Steve Komati had returned. From the moment he left Melbourne, he had expected to hear the worst. On landing, he had SMSed Dabula for an update, and when the response took half an hour his anxiety mounted. As he reached his home, an SMS came in from Dabula: ‘We are ok.’ Komati quickly freshened up and, though jet-lagged, drove to Houghton. I updated him.
Mid-morning, we decided to inform the family that those who wanted to visit Madiba should do so.
I then phoned Winnie Madikizela-Mandela’s office and asked her staff to ensure that she came immediately to visit Madiba and not wait for her daughters to return from London, where they had gone to assist with the premiere of the film about Madiba’s life, Long Walk to Freedom.
As the news spread of the request to the family, media enquiries came thick and fast. The presidency wanted to issue an update, but I requested that this be put on hold.
Madiba’s close household staff and police bodyguards were all allowed to visit him, some for the first time since he had returned home. It was a time of tears and sorrow. Silently, in dignity and reverently, they trooped in and spent a few minutes at the foot of the bed before leaving so that
the next group could enter.
Close family and the tribal elders from the Eastern Cape also visited him. When Mandla Mandela was in the room, Madiba’s eyes opened and he recognised his grandson. Then his eyes closed and he drifted back to sleep.
It was now dark and a hushed sadness enveloped the house.
All family and non-medical staff had been up to the room and left filled with profound grief. Madiba had never looked so ill to them before.
The medical staff on duty were all sombre, their faces drawn and blank. There was nothing to do except follow the protocols that had kept Madiba alive over the past six months. Despite all the medical expertise available, nothing more could be done.
Dabula, Komati and I stayed for the whole day and attended to the family and official matters.
For Komati and me, this was unlike any other crisis Madiba had faced. This time, he seemed at peace with his deterioration, if such can be said. He appeared to have withdrawn from the situation. Although his breathing was shallow and his blood pressure dropping, his expression was one of transcendental peace.
Besides the medical team, at Madiba’s bedside there was now only Winnie Madikizela-Mandela. Dressed in a dark outfit, her eyes red and teary, she sat motionlessly at his side.
When the ventilator alarms went off, Komati adjusted the machine
so that there were no loud noises. Madiba started the long, deep sighing consistent with the last stages of respiratory failure.
In barely a whisper, I heard Winnie Madikizela-Mandela say, ‘Doctor, he is gasping.’ Neither Komati nor I could look at her directly and she lowered her gaze.
As the monitors indicated cardiac asystole, I glanced at my watch. It was 21:48. I then looked at Mrs Madikizela-Mandela and said, ‘Mama, he has departed.’
As a now-still Madiba lay, with his hand in hers, in the soft glow of the bedside lamp, all of us experienced a sorrow the depths of which we had not experienced before. The room was filled with a peacefulness that gave it a dream-like quality, and though every second ticked on the wall clock, every action gently floated into the next.
The silence was broken by quiet sobbing from Mrs Madikizela-Mandela as she nestled her head besides Madiba’s still body. Wave after wave of quiet sobs broke her bowed frame.
Soundlessly, the medical team performed some of their last rituals and tasks.
The family members in the house were called in. Graça Machel and some of the grandchildren entered in tears.
Earlier, it had been emphasised to us that the ‘closing of the eyes’ was not to be done by anybody other than a senior member of the Madiba clan
or a member of the abaThembu royalty. This was to be arranged by Zola Dabula.
Downstairs, I found almost all members of the Mandela family gathered in the different lounges. Dabula was outside the house.
‘It’s time for the elders to close his eyes,’ I said to Dabula, and although it was dark I could see the sadness in his expression.
Next I informed the president.
Vejay Ramlakan was born in Durban in 1957 and joined Umkhonto we Sizwe in 1977, undergoing military training in South Africa and in Swaziland. He studied medicine at the University of Natal and served as president of the Medical Students Representative Council from 1979 to 1980.
He was a founding member of the United Democratic Front, and was involved in MK’s Operation Butterfly in Natal. From 1987 to 1991 he was imprisoned on Robben Island, and after his release he served as medical commander at the 1991 ANC National Conference, at CODESA, and for the President Mandela Guard.
In 1993 and 1994 he served as deputy chief of the MK Health Service and led the MK military health team for integration into the National Peacekeeping Force and later the South African National Defence Force (SANDF).
From 2005 to 2013 he served as South Africa’s surgeon general, and in 2011 he was appointed as chief of corporate staff in the SANDF. He retired from the military in 2015.