Manto Tshabalala-Msimang: Of drink and livers

The Sunday Times has forced into the open persistent rumours about Health Minister Manto Tshabalala-Msimang and alcohol abuse that, if correct, raise new questions about her fitness for office.

On Sunday, the newspaper reported in great detail on Tshabalala-­Msimang’s 2005 stay in a Cape Town clinic for shoulder surgery, alleging that she had smuggled in alcohol and been drunk on several occasions.

It went on to cite medical experts as saying speculation is rife that the cirrhosis, which necessitated her liver transplant this year, was alcohol-induced and that other patients of her age in her condition would not have qualified for the operation.

The minister’s spokesperson, Sibani Mngadi, has dismissed the allegations as “garbage”. She has instructed her lawyers to sue for invasion of privacy, alleging the Sunday Times articles were partly based on medical records which, in terms of the Health Professions Act, are private.

Sunday Times editor Mondli Makhanya has stood by the reports, insisting they are “200% true”, and that the newspaper had not removed medical records.

The media has reported cases of Tshabalala-Msimang’s erratic behaviour and apparent disorientation, but there is no way of knowing whether these were caused by alcohol, illness or another factor.
Doctors point out that liver failure can affect cognitive function.

Incidents include:

  • Early this year, it was reported that she had to be supported at a meeting of social cluster meetings in Parliament and that she broke into Russian. Tshabalala-Msimang received her medical degree in Russia while in exile;

  • At a formal gala event during a 2004 visit to South Africa of the Global Fund for HIV/Aids, Tuberculosis and Malaria, she shouted at Treatment Action Campaign activist Mark Heywood, accusing him being the white mastermind behind civil disobedience on Aids, in front of dignitaries and diplomats.

  • In May 2003 the German press reported her “crude language and uncontrolled behaviour” on a Lufthansa flight from Frankfurt to Johannesburg, when she launched a tirade against a German businessman who had refused sit next to her because of her stance on HIV/Aids. The captain had to prevail on her to return to her seat.
A senior health department official, who asked not to be named, said the minister’s drinking habits were well known, adding that they were “a serious problem, given that she preaches a moderate lifestyle to people with HIV/Aids and tells pregnant women not to drink because of foetal alcohol syndrome”.

A specialist told the Mail & Guardian this week that patients could suffer from liver disease for a considerable period before showing cognitive problems. Acute liver damage, however, could quickly produce neurological symptoms, with sufferers becoming confused and irritable.

Before her transplant on March 14, Tshabalala-Msimang’s doctor, Jeff Wing, announced that she suffered from autoimmune hepatitis, where the body’s immune system attacks liver cells, resulting in cirrhosis, scar tissue and progressive liver failure.

The commonest causes of cirrhosis are alcohol and viral infections, notably hepatitis B and C.

Important factors in deciding on transplant candidates include whether the person can stop drinking and avoid damaging the new organ, and the gravity of other side-effects of excessive alcohol use, including damage to the heart, circulatory system and brain.

Specialists look at the Meld (model for end-stage liver disease) score, calculated using lab tests, which considers the cause of cirrhosis and how urgent the need is. The higher the score, the more urgent the transplant. The allocation of donor livers is a sensitive matter, as they are a scarce resource.

Before her transplant operation at Johannesburg’s Donald Gordan Medical Centre, Tshabalala-Msimang spent an extensive time under medical care in the private wing of the Johannesburg Hospital. Her ill health had earlier been denied.

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