Manto’s last wish

In a desperate attempt to polish her legacy, family members of former health minister Manto Tshabalala-Msimang were trying, shortly before her death, to set up a press interview in which she would have acknowledged mistakes made during her controversial tenure.

Tshabalala-Msimang died in a Johannesburg hospital on Wednesday afternoon from complications arising from her liver transplant in 2007.

In the last months of her life some close to Tshabalala-Msimang began to voice concerns that she would be remembered only for her controversial — some say ”murderous” — stance on HIV/Aids when she was health minister.

This included her refusal to acknowledge the benefits of antiretroviral medication — which she repeatedly branded ”poisonous” — and her vigorous promotion of certain foods, such as potatoes and garlic, as remedies for HIV/Aids.

Aids activists maintain that Tshabalala-Msimang’s views — which were supported by former president Thabo Mbeki — resulted in the deaths of tens of thousands of South Africans.

Friends and relatives of Tshabalala-Msimang had been trying recently to persuade her to admit publicly, via an interview with Media24, that she had been wrong in certain respects. But the severity of the complications from her transplant prohibited her from giving the interview and she died before it could take place.

In September this year Tshabalala-Msimang strolled over to reporters at an ANC meeting in Benoni. The press contingent’s focus was on an ANC bigwig’s criticism of the party, and the former health minister’s presence — as the ANC’s national executive committee member deployed in Gauteng — was scarcely noticed.

”I went to hospital again last week,” she blurted out to the journalists. ”I’m surprised you didn’t pick up on that!”

The reporters were stunned. Here was the Mbeki era’s most controversial minister, about whom the media had written reams of violent criticism — including that she was an alcoholic — seemingly craving further press attention.

”But I’m fine now,” Tshabalala-Msimang said smugly to the journalists, before asking them: ”Do I not look good?” The bemused reporters could only nod.

This incident illustrates the enigma that was Manto Tshabalala-Msimang: on the one hand, charming and amusingly sarcastic, on the other hot-tempered and dangerously dogmatic.

When she was appointed health minister in 1999, the health sector at first expressed its faith in her. She was respected for her diplomacy and strong relationships with pharmaceutical companies and she had worked for years, during the apartheid era, at the National Progressive Primary Health Care Network (NPPHCN), one of the most influential non-governmental health organisations.

As chairperson of a parliamentary committee in 1998 she was lauded for her investigation into dilapidated Eastern Cape hospitals, when she vowed to fire corrupt managers and transform the hospitals.

But severe and confusing contradictions in her performance soon emerged. Months into her ministerial tenure she bluntly denied that some of the very same hospitals she had exposed as wracked with mismanagement were lacking in quality.

In a similarly contradictory vein, before her appointment, Tshabalala-Msimang had been involved in an intense campaign to empower community health workers and to advocate higher salaries for them; yet as minister she ignored their rights.

”I never understood her ideological shift,” says Tshabalala-Msimang’s former health network colleague, Judi Nwokedi, now a vice-president of international energy company Areva. ”When I tried to engage with her on these issues and reminded her that these were the very things that she had advocated she refused to speak about them.”

Yet Tshabalala-Msimang was also such a loyal friend to Nwokedi that she did not once forget to phone her on her birthday and she cancelled ministerial meetings to fly from Cape Town to Johannesburg to attend Nwokedi’s stork party.

”She always told me, ‘You don’t understand how lonely things get when you’re a minister. People only phone you when they want something from you; they’re hardly ever just your friend,”’ Nwokedi said.

Fierce loyalty
As early as 1962, when she went into exile in Tanzania, Tshabalala-Msimang — known then as Manto Mali (her maiden name) — was a rising star in the ANC. It was in Tanzania that she first met Mbeki and the two became close friends.

She later moved to Moscow to study medicine at the First Leningrad Medical Institute. After obtaining her medical degree she practised in Tanzania and Botswana.

”She always seemed to be very sensitive, almost defensive, about her qualifications,” recalls an award-winning health journalist, who did several in-depth interviews with Tshabalala-Msimang for a number of local and international media outlets.

”I once interviewed her at her house in Waterkloof where, without any prompting, she just wouldn’t stop telling me, ‘You know, I really did get that degree; I was one of the best students; go and ask them, you’ll see,”’ the journalist says.

Tshabalala-Msimang was at times fond of displaying some knowledge of Russian — albeit in rather strange ways. At a media briefing shortly before her liver transplant in 2007, she suddenly began answering a reporter’s question in Russian, much to the surprised incomprehension of colleagues and the gathered media representatives.

The minister often demonstrated a penchant for using other languages, too, in novel ways. At the opening of a clinic in Soweto, a foreign correspondent had confrontationally asked her: ”Does HIV cause Aids?” Shaking with fury, Tshabalala-Msimang responded with an outburst in isiZulu.

By way of explanation later, she told journalists: ”Sometimes you people think I’m the minister of Aids. And I’m not! I’m the minister of health. There are so many other urgent health issues that also require my attention. And Aids often — and unfairly — gets all the attention.”

Throughout her tenure Tshabalala-Msimang’s fierce loyalty to Mbeki never faltered. She seemed to take pride in being the enforcer of the then-president’s much-maligned HIV/Aids policy; and she continued to carry the baton for Mbeki when, following ANC pressure, he removed himself from the public Aids debate.

Any qualms she might have had about publicly defending Mbeki’s views were invisible. At the International Aids Conference in Durban in 2000, Mbeki caused outrage by pronouncing that poverty and not HIV was responsible for Aids.

At the same conference, Tshabalala-Msimang publicly chastised renowned South African HIV scientists Hoosen Coovadia and Salim Abdool Karim. The international medical community routinely quotes the two professors in respected scientific journals and appoints them to lead groundbreaking research projects. Tshabalala-Msimang accused them of being ”disloyal” and ”irresponsible” for promoting ”poisonous” antiretroviral drugs.

Tshabalala-Msimang then demanded the scientists’ presence in her hotel room, where she severely reprimanded them. When Coovadia and Karim tried to defend themselves, she spat at them: ”Shut up and listen!” as her glaring bodyguards hovered nearby.

Karim recalls: ”We had to listen to her for about an hour and we weren’t allowed to respond in any way.”

Tshabalala-Msimang’s wrath was not reserved for scientists who opposed her views. She was notoriously hard on her staff, who tell of top officials being sent to do her shopping at Woolworths and being too afraid to refuse her demand that they pay for her personal purchases on overseas trips.

And her early diplomatic skills seem to have been lost later in her tenure when she angered donors and foreign diplomats by refusing to meet them; or on the rare occasions when she did, beginning conversations with a full-frontal assault.

This week several of her closest former health department colleagues refused to comment on her death.

”I don’t want to contribute to her legacy,” said one.

”If she was someone good and deserved honour, I would have commented. But honour is not applicable in this case.”