Mandela died of same disease as dad - Tribune

• Written by  Blessing Ekum
• Saturday, 07 December 2013 

BLESSING EKUM looks into Nelson Mandela’s health challenges and how he finally lost the battle to the disease that also claimed his father.

Nelson Mandela, the iconic African leader, was not only a dogged freedom fighter, but also his tenacity spilled over to his health life where he struggled with lung infection for over two decades. Though he suffered prostate cancer, a long-standing abdominal complaint, gallstones and problems with his eyes, his most persistent medical problem was respiratory.
Interestingly, Mandela’s father, Galda Henry Mphakanyiswa, died from lung disease (tuberculosis) when he (Nelson) was just nine years old.

In his autobiography, “Long Walk to Freedom”, Mandela spoke of his father’s illness and the manner of his death. “One night, when I was nine years old, I was aware of a commotion in the household. My father, who took turns visiting his wives and usually came to us for perhaps one week a month, had arrived. But it was not at his accustomed time, for he was not scheduled to be with us for another few days. I found him in my mother’s hut, lying on his back on the floor, in the midst of what seemed like an endless fit of coughing. Even to my young eyes, it was clear that my father was not long for the world. He was ill with some type of lung disease, but it was not diagnosed, as my father had never visited a doctor. He remained in the hut for several days without moving or speaking, and then one night, he took a turn for the worse. My mother and my father’s youngest wife, Nodayimani, who had come to stay with us, were looking after him, and late that night, he called for Nodayimani.

“Bring me my tobacco,” he told her. My mother and Nodayimani conferred, and decided that it was unwise that he have tobacco in his current state. But he persisted in calling for it, and eventually Nodayimani filled his pipe, lit it, and handed it to him. My father smoked and became calm. He continued smoking for perhaps an hour, and then, his pipe still lit, he died.”

The former President of South Africa’s history of lung problems began in 1988 towards the end of his 27-year incarceration after he was moved from Robben Island to another jail to ease the apartheid government’s efforts to negotiate with him about a possible release. At first, doctors were uncertain why Mandela had a persistent cough that ultimately caused him to collapse during a meeting with his lawyer. After being taken to a Cape Town hospital, a doctor told him he had water in his lungs.

In his autobiography, he said he refused to believe the doctors but “with a hint of annoyance, (the doctor) said, ‘Mandela, take a look at your chest,’ and he pointed out that one side of my chest was actually larger than the other.”

Surgeons had cut into Mandela’s chest and removed two litres of liquid from his lungs, which tested positive for tuberculosis. Doctors at the time suggested Mandela contracted the disease from his damp prison cell.

In January 2011, the 1993 Nobel Peace Prize winner was admitted to a Johannesburg hospital for what officials initially described as tests but what turned out to be an acute respiratory infection.

By December 2012, he suffered another bout of lung infection and spent weeks in a hospital. After being discharged, there was a relapse which saw him visiting the hospital again on March 28, 2013. He was again admitted to an undisclosed Pretoria hospital on June 8 for treatment of the recurring infection. He was initially treated for a lung infection, but with three weeks his condition, it was announced, had turned ‘critical’. Reputable news sources revealed that his liver and kidneys were functioning at just 50 per cent and he was on ventilation while also undergoing regular renal dialysis.

The lung infections have been linked to his experiences during his years of incarceration. Sometime in June this year, Mandela’s long-time friend and fellow Robben Island inmate, Andrew Mlangeni, was admitted to two military hospitals in Cape Town, suffering from a lung infection. Mlangeni spent 26 years and Mandela 27 years as political prisoners on the island.

On the island, political prisoners were made to work long hours on a lime stone quarry as part of their punishment. According to the some media reports, Mlangeni said he believed working on the quarry had led to lung problems.

Medical experts have suggested that exposure to dust, and in this regard rock dust, can easily result in lung infection called pneumoconiosis (an occupational and restrictive lung disease caused by the inhalation of dust, often in mines). Mandela was exposed to this for over 20 years.

During his years as an up-and-coming lawyer who founded a firm with partner Oliver Tambo on Fox Street in downtown Johannesburg, Mandela was a smoker but later gave up smoking years after. Not only did he not smoke, he also did not eat red meat, and sipped wine publicly only when it was helpful for promoting South Africa’s vineyards.

Usually, especially for young adults, lung infections are easily treatable with antibiotics, although depending on the severity of the condition an oxygen mask or ventilator, may be used to aid breathing. However, in Mandela’s case, age played a role in his responsiveness to treatment of the disease.

Medical experts say respiratory illnesses like pneumonia striking a man his age are serious and require intense care and monitoring. It is generally called ‘the old man’s friend’ because when it strikes people in their old age, it, more often than not, ultimately takes them away.

In an interview with Scientific American, Steven E. Weinberger, an internist and pulmonologist with the American College of Physicians with 25 years on the faculty of Harvard Medical School, said age indeed plays a role in the treatment of this disease.

“Certainly the body’s defence mechanisms change with age. There’s something called immunosenescence; with age, some of the immune system cells are less capable of making antibodies. What I’ve read about Nelson Mandela tells me his infection is recurrent. One wonders if there are any structural changes in his lungs. For example, if he has any form of underlying lung disease, that will affect the lung’s defences and may make him more susceptible to infections. These kinds of structural changes are more common in older people,” he said.

Symptoms of the disease include cough, sputa production and fever. In cases where the infection becomes chronic, it can lead to the patient being debilitated, suffering weight loss, fatigue and malaise. In some infections, they may be spitting up blood.