Manto Tshabalala-MsimangBMJ 2010; 340 doi: https://doi.org/10.1136/bmj.c127 (Published 14 January 2010) Cite this as: BMJ 2010;340:c127
- Pat Sidley
South Africa’s controversial former health minister between 1999 and 2008, Dr Manto Tshabalala-Msimang, known with derision as Dr Beetroot, has died. She obstructed AIDS treatment that might have prevented at least 330 000 unnecessary deaths, according to researchers from Harvard School of Public Health (J Acquir Immune Defic Syndr 2008;49:410-5).
Having gone into exile with her close friend and mentor the former South African president Thabo Mbeki in 1962, she studied medicine, qualifying in 1969 in what was then Leningrad in the former Soviet Union. She was caught stealing from patients while working as medical superintendent at a hospital in Botswana; was fired, tried, and convicted; and was struck off the register and kicked out of the country. It was kept secret, but Mbeki conceded later when it became public that as president he had appointed her as health minister in 1999 knowing her background.
Her nickname, Dr Beetroot, arose from her suggestion that beetroot, garlic, olive oil and lemon, and African potato were more use than antiretroviral drugs. This was seized on by her critics and used remorselessly, and caused her and President Mbeki much damage internationally. Outrageously, the South African stall at the 2006 international AIDS conference in Toronto was decorated with vegetables. It drew the minister scathing criticism, for example, from Stephen Lewis, the United Nations special envoy on AIDS, who described her as “obtuse, dilatory, and negligent” and the government’s views as belonging to a lunatic fringe.
She ran information campaigns on AIDS that research conducted by South Africa’s Human Sciences Research Council showed had little effect, leaving many with confusing messages.
By 1999 when Mbeki became president the number of HIV positive people in the country had reached five million—an explosion of the disease in one of the few developing countries that could have afforded treatment.
Early in his presidency, Mbeki did not accept that HIV caused AIDS. Although this was not government policy few in the cabinet contested him. Tshabalala-Msimang had not initially shared these doubts, but as Mbeki’s health minister she enacted his views.
She initially enthused about the antiretroviral drug nevirapine to prevent vertical transmission of the virus and was offered the drug for free by Boehringer Ingelheim, but she refused it to women who needed it, even after an order from the Constitutional Court. While policy was to offer antiretrovirals to victims of rape, she also saw to it that doctors who tried to give the prophylaxis were dismissed. At the Rob Ferreira Hospital in Nelspruit in Mphumalanga province, Thys von Mollendorff, the medical superintendent who made arrangements for people who had been raped to get antiretrovirals, was fired. One of his staff, Malcolm Naude, was also dismissed but fought and won a case against the health department for interfering with his professional judgment. Von Mollendorff eventually settled his dispute out of court.
Instead of antiretrovirals Tshabalala-Msimang advocated virodene, a lethal industrial solvent discredited scientifically for treating AIDS, with which the African National Congress hoped to make money. She was surprised that she was criticised for cooperation with trials of virodene on soldiers in Tanzania, after the South African drug regulator refused to allow clinical trials. And she pushed Matthias Rath’s vitamin supplements, until a court stopped their sale (BMJ 2008;336:1458, doi:10.1136/bmj.a512).
She got rid of the head of the Medicines Control Council, Helen Rees, who did not support the government’s attempt to “get rid of AZT.” Zidovudine (azidothymidine, AZT) was the blockbuster antiretroviral made by Glaxo, which the government touted as being more dangerous than AIDS. The drug stayed on the market, however.
She did other damage during her nine year tenure. Public hospitals, clinics, and equipment fell into disrepair. Combined with large inefficiencies, incompetence, and corruption (all described in parliament by the current health minister, Aaron Motsoaledi) many hospitals and clinics failed to provide necessary services and were often without water, electricity, and telephones. Drugs often ran out. Nursing staff, underskilled and unwilling to work, went undisciplined, as did doctors who failed to turn up to work. No new legislation was drafted and passed while she held office, and some draft legislation inherited from her predecessor was never completed.
This showed in the markers of the health of a country: maternal, infant, and child health became worse than during apartheid. South Africa was one of only 12 countries that went backwards, according to the 2008 Unicef report on progress towards the 2015 millennium goals.
Official reports were suppressed for a time while a process of whitewashing took place. But when her deputy minister confirmed the catastrophe, Tshabalala-Msimang was dismissed by Mbeki, in 2008.
1500 clinics built
At her funeral, President Jacob Zuma paid tribute to the 1500 clinics built during her tenure. Despite her shortcomings she was popular in the African National Congress, and she polled high enough in the party to continue to hold power and credibility there after being sacked.
She placed her loyalty to the party and to Mbeki above all else, according to Patrick Masobe, former chief executive of the statutory regulator of private health insurance. “She was ill served by her senior staff. When well thought through advice was given to her, she would respond positively. She could be very warm, but there were days when she was very difficult to work with.
“Her main weakness, was seeing everything through political lenses,” he said, explaining why she backed policy with which she had not previously agreed. Steven Friedman, director of the Centre for the Study of Democracy at the University of Johannesburg, offered a similar explanation.
Two years ago confidential medical records fell into the hands of the Sunday Times, South Africa’s largest national Sunday paper, leading to the headline “Manto: a drunk and a thief” (16 August 2007). They showed nightly partying and staff ordered to get her alcohol.
Tshabalala-Msimang died while waiting for a second liver transplant. Her doctor, Jeff Wing of the University of Witwatersrand, said that her death was caused by problems related to her transplanted liver. Her first transplant was in 2007, and led to accusations that she had jumped organ donor queues, was too old, and had damaged her own health by drinking heavily.
Her harshest critics were among AIDS activists. Mark Heywood of the AIDS Law Project, said that anything she may have achieved was overshadowed by the millions who suffered and died needlessly because of her AIDS policies.
She leaves a second husband, Mendi Msimang, who was the African National Congress’s treasurer general, and two daughters from her first marriage.
Cite this as: BMJ 2010;340:c127
Mantombazana “Manto” Edmie Tshabalala-Msimang (née Mali), former health minister of South Africa (b 1940; q 1969, First Leningrad Graduate Institute of Medicine) died 16 December 2009 from complications with her transplanted liver.