Phantom doctors

At uSpiked, we do not like being the subjects of the stories we present to our audience. We agonised a great deal on how to handle our newest Intern, Nokwanda Dlamini’s experience in Mpumalanga province two years ago. To safeguard against subjectivity, we tapped on a veteran investigative journalist of the province, Prince Mbeki Mashile who has been a friend and Roving contributor of uSpiked since our inception in 2014.

Relying on aggregated publicly available data from various sources, including, but not limited to South African Society of Psychiatrists’ (SASOP) data on treatment gaps and psychiatrists/psychologist staffing ratios vs WHO benchmarks, the 2025 State of Mind Report on national well-being trends and shortage of public-sector psychiatrists relative to population size, Mental health disorders and disability in South Africa, we arrived at a dire conclusion:

The country faces a substantial and largely unmet mental health burden: at least 16% of the population, and likely more, have a mental health condition, with mental disorders accounting for the highest burden of disease of any health condition (13.8%, compared with 11.8% for HIV), at an estimated annual economic cost of around ZAR161 billion, roughly 4% of GDP. Despite this grim scenario, care access remains severely limited.  A 2019 national survey found that over 90% of South Africans with a mental health condition did not receive formal care. According to research by Sapien Labs, the country currently ranks among the lowest globally for mental well-being, with structural drivers including stark public-private healthcare disparities, since over 80% of the population rely on an under-resourced public system reflecting inequities entrenched since apartheid, alongside a link between poverty and psychological distress, with adults in the bottom income quintile facing roughly twice the prevalence of psychological distress as those in the top quintile.

["Burden of disease" is a measure of the overall impact of a health problem on a population; combining how many people it affects, how severe or disabling it is, and how much it shortens life, usually expressed in a single metric like DALYs (disability-adjusted life years) that lets very different conditions be compared on the same scale.]

This summation is however more academic. When we heard of our Ms Dlamini’s case, it became quite clear that her experience cannot be blamed on any predispositions. As a student at Rhode’s she had access to what would pass as good healthcare, but that good healthcare was responsible for the earlier misdiagnosis of Bipolar Disorder (which is clearly a mental illness). However, as soon as the attending doctors in Grahamstown realised their error, the reassessment brought forth a fresh diagnosis, Attention deficit hyperactivity disorder (ADHD), which is technically not a mental illness.

According to experts we consulted while evaluating her narrative, ADHD is a neurodevelopmental condition that affects a person’s attention, impulse control, organisation, and activity levels. So for this Mpumalanga doctor (whose identity we know but have decided to withhold for now), to rash to her with a syringe loaded with Clopixol Depot (Zuclopenthixol Decanoate), a drug manufactured by the Danish Lundbeck, would mean she must have relied on an earlier misdiagnosis of Bipolar that must remained within her clinical history on the records without reading and considering the updated diagnosis. Hence the earlier misdiagnosis appears to have shadowed her years later back to Mpumalanga.

Communicating with us, Dr Heidi Sinclair, a British-trained psychiatrist now based and with a practice in Cape Town, such misdiagnoses are quite common as the symptoms for both conditions often overlap. But the blunter indictment came to us from Millicent Achieng, a California-based expert who works with neurodivergence kids; “the solution is simple, a General Physician, though vital,  have no business diagnosing mental illness or neurodivergence conditions, they should remain in their lane.

“The problem is mainly pride, some of them are just too proud to make referrals to experts. They want to justify the years they spent in Medicine schools.”

On the drug Clopixol Depot 200 mg/ml 

In a contract signed by the Department of Health on 01/11/2024, Lundbeck was awarded a contract to supply 2,328,758 units of Clopixol Depot 200 mg/ml valued at R138,933,702.30. While we have no reason to imagine that the National Department of Health made a mistake by ordering these many units, we also doubt Lundbeck’s sales representatives could have recommended the administration of this Depot drug for management of ADHD. 

That could be a good expenditure for a drug that is marketed for maintenance and treatment of acute psychoses, mania and exacerbation of chronic psychoses, and may be an advantage in treating noncompliant patients, but increasing the number clients by simply adding more subsets is questionable in our books. More broadly, it is prescribed for schizophrenia and related psychotic disorders, and is particularly useful for psychotic patients who are agitated, restless, hostile, or aggressive.

The two immediate things policy makers should consider:

1. Consider creation of Neurodivernce Health wards rather than heap this subset together  with mental health persons
2. Consider providing resources  to parents of neurodivergence persons to avoid situations like that faced by Ms Dlamini's mum who like many in the population  defaulted to the earlier diagnosis of Bipolar Disorder

The question uSpiked has been trying to get answered by the Mpumalanga doctor is what symptoms did Ms Dlamini exhibit to warrant forced-administration of this powerful drug. She may not provide us with any answers since the name under which she features at the two Mpumalanga Hospitals does not appear within the database of the Health Professions Council of South Africa.

Had these two been in place in 2024, first her mum would not have gone for the Calvary and two, the 72hr hold would not have been evoked.

This could only mean two things. Either she is an imposter and not doctor at all or she is clandestinely undertaking unapproved clinical trials among the rural forks in the Province.

We can confirm that since it became known that uSpiked was considering publishing Ms Dlamini’s experience, several individuals have attempted to derail this work; through persuasion and intimidation and other unorthodox means. 

But they have been wrong, we picked our name uSpiked for a reason. That’s why the entire team has contributed to this editorial.

A spike is not decorative. It is something that pierces.

And sometimes journalism must do precisely that: pierce the comfortable surface of institutions, expose what lies beneath it, and ask questions that those in positions of authority would rather leave unasked.

This editorial is therefore not a declaration or apportionment of guilt. It is a declaration of scrutiny.

If the doctor acted properly, the evidence should demonstrate it.

If the medication was clinically justified, the records should establish why.

If the procedures followed the law and professional standards, those responsible should have nothing to fear from examination.

But if a vulnerable person was deprived of autonomy, subjected to inappropriate treatment, or otherwise failed by the very institutions entrusted with her care, then the public deserves to know. Whether that person is our Intern or not.

That is not persecution.

That is accountability.

uSpiked's personal note

Since we are still on associations mode (declaration of interest space), with just six weeks and five days to the Local Government Elections-2026, uSpiked wishes to place on record its total and complete endorsement of Bheki Mashile, editor of the Umjindi Guardian, in his campaign for Mbombela’s Ward 41.

Mashile has been professionally known to our Executive Editor for 19 years and has been a friend of uSpiked since the publication was founded in 2014. More importantly, he has established a starling record in community journalism and public engagement in Barberton.

Should he succeed, Mashile will hardly be the first journalist to cross the often-blurred boundary between journalism and politics.

South Africa has a long tradition of journalists entering political life.

Helen Zille, once a political correspondent at the Rand Daily Mail, went on to serve in the Western Cape Legislature, Parliament, as Mayor of Cape Town and as Premier of the Western Cape.

Nigel Bruce, who edited Financial Mail for 11 years, subsequently served in the National Assembly.

Liezl van der Merwe, a journalist, became a Member of Parliament; Zelda Jongbloed, another veteran journalist, served in the National Assembly; and investigative journalist Aishah Cassiem entered the Western Cape Provincial Parliament.

Garreth Bloor, whose journalism career included BSkyB and Avusa/Times Media Group, went on to serve as a Cape Town councillor and Mayoral Committee member.

The examples extend beyond these names.

Our readers are already familiar with Byron Price, the father of All politics is local.

And perhaps the most instructive contemporary example is that of United States Senator Jon Ossoff, whose background in investigative journalism remains evident in the forensic manner in which he approaches public hearings. Mashile's presence within Mbomela Municipality would not just be beneficial to voters of Ward 41, but all voters of Mbombela.

Journalism, at its best, trains people to ask inconvenient questions, interrogate official explanations and demand evidence from those who exercise power.

Those are not bad qualities in a politician.

Indeed, they may be precisely the qualities citizens should expect.

For the residents of Mbombela Ward 41, the question is therefore not whether Bheki Mashile is a journalist entering politics.

The question is whether he can carry the same determination to scrutinise power into public office from within the system.

His record suggests that he understands the community he is seeking to represent. Nothing against other candidates, but for us, he is the guy. 

And if elected, the people of Ward 41 will have every right to expect him to remember the fundamental principle that journalism teaches at its best:

Power must never be allowed to become an answer in itself.

 

---