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Monday, June 24, 2013
Mandela and The Ambulance That Broke Down
» Ambulance engine failed on the road
» His wife, Graça Machel, was ‘frantic’
» Doctors say Madiba could have died
Former president Nelson Mandela was fighting for his life in a military ambulance in the early hours of a bitterly cold Saturday morning two weeks ago when the vehicle broke down on the highway between Johannesburg and Pretoria.
Madiba, who receives 24-hour medical care at his Houghton house, had suffered a serious medical setback and an emergency ambulance was summoned from 1 Military Hospital in Pretoria.
He was rushed to the Medi-Clinic Heart Hospital in Pretoria after being resuscitated.
Then the ambulance broke down.
For about 40 minutes, medical staff and nurses had to keep Mandela alive while the vehicle was stuck next to the road in icy 6°C weather.
Graça Machel, Mandela’s wife, travelled with him in the ambulance. Three separate sources have confirmed that she was “frantic”.
After the long wait a second ambulance, also from 1 Military Hospital, arrived. A frail Mandela was carried on a stretcher on the side of the road to the new vehicle.
As Madiba prepared to spend his 15th night in hospital, shocking details of what happened in the early hours of June 8 began to emerge yesterday.
President Jacob Zuma’s spokesperson, Mac Maharaj, yesterday confirmed that Mandela’s ambulance had broken down due to “engine failure”.
Several sources with direct knowledge of the incident confirmed Madiba had to be resuscitated, but were unable to describe exactly what prompted the dire situation.
CBS News reported yesterday that Mandela went into cardiac arrest, but that couldn’t be independently confirmed.
Cardiologists said yesterday that the elderly statesman and Nobel laureate could have died next to the road.
It is an indication of how serious his condition was – that in the early hours of the morning an emergency military ambulance was summoned from 1 Military Hospital in Pretoria to rush Mandela to hospital.
Mandela’s ambulance waited on the side of the road for between 40 and 45 minutes until a replacement ambulance arrived.
The second ambulance had to travel all the way from 1 Military Hospital in Pretoria to the scene of the breakdown.
When the allegations were first put to Maharaj, he was angry, saying that he had no comment.
But a couple of hours later, he issued a startling admission: it was true, Madiba’s ambulance had broken down due to “engine failure”.
Maharaj would not be drawn on why it took so long for a second ambulance to arrive and whether the fact that it wasn’t already on stand-by as backup was a violation of protocol.
Instead, he issued a formal statement saying “the fully equipped military ICU ambulance transporting former president Nelson Mandela . . . had a full complement of specialist medical staff, including intensive care specialists and ICU nurses.
“The convoy included two quick-response vehicles.”
Maharaj said that “when the ambulance experienced engine problems, it was decided that it would be best to transfer to another military ambulance, which itself was accompanied for the rest of the journey by a civilian ambulance”.
He is insistent that “all care was taken to ensure that former president Mandela’s medical condition was not compromised by the unforeseen incident”.
“The doctors attending are satisfied that the former president suffered no harm during this period.”
But cardiologist Dr David Janekelow disagrees that the delay did not impact on Mandela’s health.
“You want to get to emergency care as quickly as possible. If somebody had to be resuscitated and there is a delay in getting to hospital, that could have significant consequences.
“It is difficult to assess without a proper medical examination, but any delay is a cause for serious concern.”
Another cardiologist, Dr Richard Nethononda, agreed with Janekelow saying: “Mandela could have died on the roadside while waiting for another ambulance to arrive.”
He explained that health professionals know that the moments after a person has had a cardiac arrest (if that is indeed what Mandela suffered) are “golden minutes”.
“This means that anything can happen, because the person’s blood circulation and oxygen supply are very low and this could affect his liver, kidneys and the brain, leading to organ failure.”
Nethononda also criticised those who took the decision to drive Mandela all the way from Houghton to Pretoria, saying it was “very irresponsible” of them.
“Mandela is old and frail and that means his kidneys could be functioning at 50%. They should have done a risk assessment and rushed to the nearest hospital where he would have been stabilised and then transferred to the Pretoria hospital,” he explained.
Dr Jeff King, also a cardiologist, said: “If Mandela was still being manually resuscitated when the ambulance broke down, it would have had an impact on his health.
“But if he was stable, it wouldn’t have made a difference, because the ambulance and the staff would have been fully equipped to offer medical assistance while waiting for another ambulance to arrive.”
Pikkie Greeff, the secretary of the SA National Defence Union, yesterday said “the breakdown (of the ambulance) comes as no surprise as it is well-known that the SA National Defence Force does not have the technical staff to maintain its vehicles properly and many of the ambulances are over a decade old”.
He said that 1 Military Hospital does not even trust its own military ambulances, preferring to “outsource civilian vehicles to transport its patients to the military hospital”.
Greeff added: “We are paying the price for the arms deal, where billions of rands were spent on unnecessary weapons and vessels instead of spending it on support infrastructure.”
The former president had been battling a lung infection for a few days prior to his hospitalisation.
Mandela contracted TB while in jail in 1988 and back then had to be rushed to hospital where he went into surgery and had more than 2 litres of fluid removed from his lungs.
He wrote in his autobiography A Long Walk to Freedom that doctors said his condition was exacerbated by “his damp (prison) cell”.
Since then, his condition has dogged him – particularly in winter when temperatures plummet and germs are abundant.
Two weeks ago, his lung infection took a turn for the worse and affected Mandela’s breathing, to the extent that sources say he had to be resuscitated.
The South African presidency will not officially confirm or deny this, except to say that he is being treated for a lung infection.
Jankelow said that if a person goes into respiratory failure, this results in a “deprivation of oxygen, which could lead to a dangerous heart rhythm abnormality, resulting in the need for resuscitation.
“Cardiorespiratory failure leads to hypoxia – where tissues are deprived of oxygen and this affects the functioning of organs such as kidneys, liver and heart.”
Jankelow explained that this is different to a heart attack, where the cause is cardiac arrest, but both affect the ability of the heart to function and could result in a patient having to be resuscitated.
Maharaj has maintained for the past two weeks that Mandela is in a “serious but stable” condition.
President Jacob Zuma said, at one point, there were signs of improvement – a sentiment echoed by former president Thabo Mbeki in an interview with Power FM on Thursday.
Mandela’s children and grandchildren continued to visit him in hospital yesterday, with Machel leaving earlier in the morning.
The president’s wife has slept near her husband’s side every night since he’s been hospitalised.
Machel returned to the hospital after midday, followed by Madiba’s grandchildren in two cars, just before 1pm.
David Manaway, the husband of Madiba’s granddaughter Zaziwe Dlamini-Manaway, was seen driving in with a black Jeep Cherokee. Another car was filled with other grandchildren.
Just after 3pm, Mandela’s ex-wife, Winnie Madikizela-Mandela, arrived with her daughter Zindzi.