Amid conjecture, speculation and a sea of assumptions about a book – <a href="http://www.sundayworld.co.za/news/2017/07/25/mandelas-last-years-now-a-collectors-item" target="_blank" rel="noopener noreferrer">“Mandela’s Last Years”</a> – that most people have not been at liberty to read, including myself – it’s only fair and reasonable to raise a number of questions we hope will be addressed in the near future.
The book was released at bookstores throughout South Africa in <a href="https://www.timeslive.co.za/news/south-africa/2017-07-24-controversial-mandela-book-hits-the-shelves/" target="_blank" rel="noopener noreferrer">late July</a>. The author, Dr Veejay Ramlakan, head of Mandela’s medical team, reportedly wrote the book to document the courage and strength of this global icon up to <a href="http://www.news24.com/Books/mandelas-last-years-in-the-bleak-midwinter-20170718" target="_blank" rel="noopener noreferrer">the very end of his life</a>.
But, some family members &#8211; notably his widow <a href="http://www.iol.co.za/news/special-features/mandela/new-book-on-mandelas-last-days-angers-graa-10407174" target="_blank" rel="noopener noreferrer">Graca Machel</a> &#8211; and executors of the Mandela estate, have publicly distanced themselves from the book. Machel also reportedly sought legal counsel. Objections have been raised about alleged breaches of confidentiality and disclosure of private information.
While the author claims that he wrote the book with the permission of a <a href="https://www.timeslive.co.za/news/south-africa/2017-07-21-family-members-gave-blessing-for-doctors-book-on-mandela-publisher/" target="_blank" rel="noopener noreferrer">family member</a>, the identity of this member remains unknown. The publishers, in acknowledgement of respect for family unhappiness and threats of legal action, subsequently <a href="https://mg.co.za/article/2017-07-25-mandela-book-withdrawn-after-outrage-from-widow" target="_blank" rel="noopener noreferrer">withdrew the book</a>.
Many questions remain about the content of this book. What was already in the public domain prior to publication? What new information was disclosed? Does the public have a legitimate interest in the alleged disclosures in the book?
Historically, many books have been written and published about public figures. Think of <a href="http://www.mkgandhi.org/bk123.htm" target="_blank" rel="noopener noreferrer">Mahatma Gandhi</a>, Diana, <a href="https://www.csmonitor.com/Books/2013/0701/5-books-about-Diana-the-people-s-princess/Diana-by-Sarah-Bradford" target="_blank" rel="noopener noreferrer">Princess of Wales</a>, and other prominent politicians, statesmen and leaders, including <a href="http://www.nytimes.com/2011/02/13/books/review/Ledgard-t.html?pagewanted=all" target="_blank" rel="noopener noreferrer">Nelson Mandela</a> himself. What is unique about this book is that it has been written by a medical doctor and anti-apartheid activist. And that it has been written about the last years of his patient and comrade who is also a global icon.
It’s not the first time that a medical professional has written about his life, work or patients. But most such works have been written with the subject being portrayed anonymously, or with consent – to adhere to the sacrosanct rules of professionalism that promote confidentiality around the doctor-patient relationship. In this case, however, it is clearly impossible to anonymise a story about someone as uniquely identifiable as Mandela.
One can only imagine that this dilemma must have created several competing conflicts of interest for the author based on competing loyalties. These include loyalty to a patient during his lifetime and posthumously (as enshrined in the <a href="https://www.wma.net/policies-post/wma-declaration-of-geneva/" target="_blank" rel="noopener noreferrer">World Medical Association’s Declaration of Geneva</a>), his loyalty to the state as an employee of the <a href="http://www.dod.mil.za/" target="_blank" rel="noopener noreferrer">South African Defence Force</a> and his personal right to freedom of expression. On the face of it, satisfying all these loyalties would have required a number of negotiations and engagements – with professional bodies, medical ethicists, the South African Defence Force as well as the next of kin and executors of Mandela’s estate. This is an assumption and so the extent to which this did or did not occur remains unclear at this point in time.
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<h2>Family dynamics</h2>
Family dynamics are complex and challenging at the best of times in almost all families. This has been illustrated globally with the British Royal family, the Kennedys, Obamas, European monarchy and many others.
In Africa, the personal and public lives of leaders, statesmen and politicians have been widely discussed in the public media. When such disclosures, debates and publications are in the public interest, it’s often easily sanctioned by civil society. The public figures and their families accept such transparency as an integral part of public life.
In South Africa the complexity of family dynamics is increased in traditional cultures where individuals are embedded tightly within communal structures such as families and communities. In the context of such a communitarian ethic, value systems of families need to be explored. This is so because such value systems are linked to respect for family, elders and even ancestors. Respect for those who may exist in the afterlife is a strongly held value.
Hence one can assume a heightened sensitivity to literary works that may be perceived to dishonour not only the deceased but the family as well.
<h2>What the law says</h2>
Legally, journalism and authorship fall within the limits of contractual relationships. It is not uncommon for claims of defamation and invasion of privacy to arise in the setting of disclosure in literary media. This must often be balanced with rights to freedom of thought and expression which is constitutionally protected in South Africa.
Is it possible for claims of defamation or invasion of privacy to be raised on behalf of those who are no longer living? This falls out of my area of expertise and more directly in the realm of legal experts and publishers. One can only assume that such matters were discussed and that the publishers involved secured written consent from next of kin/executors and that this was included in any contractual arrangements with the author.
Evidently, this contentious book has focused attention on potential ethical and legal issues related to both the medical and literary worlds. Many questions remain unanswered and in keeping with the ethical principle of justice, judgement must be suspended until a detailed account of factual, objective content of the book is in the public domain. &#8211; Written by <a href="https://theconversation.com/profiles/keymanthri-moodley-392813" target="_blank" rel="author noopener noreferrer">Keymanthri Moodley</a>, Director, The Centre for Medical Ethics &amp; Law, Stellenbosch University
Originally published in <a href="https://theconversation.com/africa" target="_blank" rel="noopener noreferrer">The Conversation</a>
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Mandela’s Last Years: a narrative shrouded in conflict and assumption

When starting a business that stems from a passion, like being a doctor and having a desire to make an impact in a community, the last thing you would worry about is an accountant stealing from you.
Dulcy Rakumakoe grew up in the dusty village streets of Temba, just outside South Africa’s capital, Pretoria. Growing up in the townships, she was often encouraged to become a doctor because she was one of those smart children.
“When I looked around in the township, there was one Dr Mosala, and he lived in a very nice house. But I also noticed that the community really loved him,” says Rakumakoe.
So in 1999, she completed her medicine degree at the University of the Witwatersrand in Johannesburg and started her internship in Klerksdorp, a small town in the North West province. She then went to do her community service at Ganyesa Hospital and this is where the entrepreneurial bug bit.
“I saw how people were struggling to access healthcare. People would travel plus-minus 100 kilometers just to see a doctor. I thought that is unfair and I must do something,” she says.
Rakumakoe went on to open up her first practice in Vryburg, a North West province town which had a shortage of doctors. There were also around 20 villages around Vryburg which had no medical facilities. In this small town, Rakumakoe also joined a female football team, doubling up as its goalkeeper and team doctor.
As a small practitioner, she had little knowledge of financial management and accounting. So she entrusted this to a small town bookkeeper, recommended by her dentist cousin who’d worked with the accountant before. It also came at an affordable fee of R2,500 ($235) every two months.
For five years, the accountant handled everything financial in the business, including payments to the South African Revenue Services (SARS) – the government’s tax collecting agency. The accountant, as Rakumakoe thought, paid around R15,000 ($1,400) to SARS every second month for value added tax (VAT) and around R40,000 ($3,770)for annual income tax. All seemed well and good.
“I didn’t pay much attention to the financial side of things, as long as I saw the money I made at the end of the month… the type of relationship I had with him was that he would tell me, ‘this is how much you owe to SARS’ and I’ll just give him a cheque and tell him to sort it out,” she says.
After reaching the ceiling of being a doctor and the community having been saturated with more medics, Rakumakoe left Vryburg for a mining town in Carletonville, just outside Johannesburg and the accountant decided to continue working for her.
Here, Rakumakoe opened a practise focusing on the health of the miners, especially with HIV being a big problem in the mining industry. According to the World Bank, migrant miners between the ages of 30 and 40 are 15 percentage points more likely to be HIV positive and a woman whose partner is a migrant miner is eight percentage points more likely to become infected.
While plying her trade around the mines, the South African Football Association called her up to be the team doctor for the women’s national football team Banyana Banyana. This led to the international governing body, FIFA, calling her up to be a field medical officer during the World Cup in 2010.
But back at the mines, something else was brewing. In March 2008, a year after moving to Carletonville, Rakumakoe received a phone call. She relayed the message to the accountant that SARS had just done an audit on her business and she needed to prove that she didn’t owe the taxman around $75,000.
“After that first call he switched off the phone and disappeared,” says Rakumakoe.
A few days later, a letter from SARS arrived warning Rakumakoe that  she needed to settle the debt in two weeks or her business would be shut down.
“That’s when I felt the world crashing down on me. That’s when I felt what’s the point of being in business when I owe close to R1 million. How was I going to pay back that money in two weeks?” she says.
“I even tried going to the police, we just couldn’t find [the accountant]. I felt like it was the end of my business. I didn’t feel strong enough to face SARS. At that point I thought let me just allow them to come and evaluate what I owe so that they can take it and I’ll go look for a job because this business thing is not working.”
In her devastation, a friend introduced her to Kamva Chartered Accountants, who came at a much higher fee than what she was used to. She paid the firm R20,000 ($1,884) to manage her case with the tax collector and also for their services every two months.
“They re-audited my books for the past five years and presented cases to SARS with explanations of what had happened. It turned out my accountant was a fraudster who was directing all the money that he told me was due to SARS to himself,”
says Rakumakoe.
Luckily for her, the amount she owed was reduced and the tax collector allowed her to make payments of what was due over a six-month period.
“That was the lowest six months for me in that basically all my income was going to SARS to pay the debt and get my things in order,” she says.
“I knew at that point that I had to understand the financial side of the business. It was a risk for me to have been running a business for so long without financial understanding and knowledge.”
This prompted her to register for an MBA with the Gordon Institute of Business Science to help her understand all the facets of her business. While studying, Rakumakoe managed to pay off the debt.
Since then, her business has grown.
After completing the degree, the 39-year-old was able to properly develop Accessible Quality Healthcare (AQH) into a recognizable brand in Mondeor, south of Johannesburg. AQH is a private medical center providing healthcare for low to middle income markets through building integrated health and wellness centers.
Besides running AQH, Rakumakoe still runs the practise in Carletonville’s mines and is now able to follow her passion and keep one eye on the books.

Doctor, you are IN the red

One person’s passion can change the fate of humanity for good. Add a dose of personal tragedy to the mix, and you get a fascinating case study in the drive to change healthcare in Africa’s second-largest and fastest-growing economy.
<div id="attachment_175" style="width: 484px" class="wp-caption alignleft"><img loading="lazy" decoding="async" aria-describedby="caption-attachment-175" class="size-large wp-image-175" src="/wp-content/uploads/2017/04/1-2-731x1024.jpg" alt="" width="474" height="664" />Ola OrekunrinWelcome to the world of Ola Orekunrin, medical doctor, helicopter pilot, author, medical research fellow, fan of Hannibal Lecter movies and one of Nigeria’s trailblazing entrepreneurs.</div>
Orekunrin, 25, is among the brightest of a new breed of young and visionary entrepreneurs in sub-Saharan Africa. Furthermore, she is an African who has made her name in Europe and is now bringing home that experience to the continent to create wealth and jobs. She saw an opportunity in helping everyone from oil companies to factories airlift injured workers to distant hospitals after accidents.
Nigerians have been talking about an air ambulance system for the country since the early 1960s. No-one had taken up the idea, until Orekunrin stepped in two years ago.
“I’m very passionate about healthcare in Nigeria and I really do believe I was born to practise medicine,” she says.
How has she achieved so much at such a young age? A healthy measure of humility may be one reason.
“I’m the most clumsy, disorganized, eccentric person ever…honestly,” she says defensively.
The trauma and emergency specialist is poised to change the face of medical practice on the continent with Flying Doctors Nigeria Limited—West Africa’s first medical emergency evacuation service. She studied air ambulance services in India and elsewhere in Africa, before founding Flying Doctors with £200,000 ($313,000). The money came from the liquidation of her assets, including her life savings, fast car and London apartment. Private investors matched the money.
Today, she employs 25 professionals and the firm is poised for speedy growth, considering the retinue of current and prospective clients in the financial services, petroleum and public sectors.
“Our main clients are from the oil and gas industry and manufacturing firms. I definitely think patronage from these sectors is set to grow,” she says.
The service that Flying Doctors provides fills a gaping hole in quality healthcare in the world’s sixth-largest crude oil producer. Often distances between factories, remote oil industry installations and hospitals can be more than 100 kilometers. For this reason alone, Orekunrin is optimistic about more business coming from Nigerian and international corporates. She also expects increased business from the public sector and state governments, as most do not have organised disaster management systems.
“Tragedy led me to entrepreneurship,” she says. “I believe that perhaps my sister, who died when she was just 12 years old, may have lived if this sort of service was available in Nigeria at the time. I feel the need to make a difference and prevent it happening to someone else. So my main childhood motivation for becoming a doctor was because my sister was ill when I was growing up and I had very positive experiences with doctors and nurses. My mother wasn’t keen on me taking up flying, my other interest, so I went to medical school. My inner-rebellious child started learning to fly as soon as I left medical school. I love flying now, nearly as much as medicine!”
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Born in London and raised in a working-class foster home in Lowestoft, a little fishing town in the East of England, she enrolled for a medical degree at the University of York and qualified at 21—one of the youngest ever to take the doctor’s Hippocratic Oath in Britain.
Barely out of medical school, she jetted off to Japan for medical research work and then China, where she had “one of the most invaluable experiences”, in addition to picking up Japanese and a liking for sushi.
“My proficiency in Japanese meant nothing to people in China,” she told FORBES AFRICA. “After growing up in England, Asia was an interesting shock to my system, but my experience there has greatly influenced my work ethic and attitude to life.”
Now Orekunrin lives in Lagos, West Africa’s commercial hub and Africa’s fastest growing city with a current population of 19 million.
“It’s hard enough practising medicine in Nigeria, and I’ve seen that people tend to wonder why I am doing what I am doing now. I am getting used to the positive prejudice,” she quips.
“Starting a business like this has been much harder than I thought. It was a lot of hard work, with a lot of discouragement. There were a number of points when I thought it would never happen. It took an enormous amount of dedication, focus and sacrifice. But the number of lives we save each year makes it all worth it. I would do it all again in a heartbeat.”
Flying Doctors received its initial technical support from the UK’s East Anglian Air Ambulance Service. A portion of operating profits is ploughed into the Flying Doctors Foundation, which funds public healthcare projects in Nigeria. She won’t disclose what the firm is currently worth, but the rapid response air ambulance service they provide has been hailed as one of the most important healthcare innovations in Nigeria this decade.
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Tag: Doctor

FORBES AFRICA SOCIAL MEDIA

Mandela’s Last Years: a narrative shrouded in conflict and assumption

Doctor, you are IN the red

Flying Doctor Shoots For The Stars