Item 780 - Statement by the Office of the President on the health care and status of President Nelson Mandela

TRANSCRIPT

Because of recent rumours and inaccurate statements made to the media on the health of President Nelson Mandela, the President has agreed to the suggestion that a description of his past and current medical problems be issued to the media by representatives of the panel of doctors who have been managing his medical problems since his release from detention. The President has expressed the wish that this be done in some detail.

In 1984, while in detention, a large hydatid liver cyst was detected in Mr Mandela's liver. A prostatectomy was performed in the same year for benign prostatic hypertrophy. Pulmonary tuberculosis, presenting principally with a left pleural effusion, was detected in 1989 and anti-tuberculosis thereapy was administered. He was also found to have high blood pressure (systemic hypertension) and there were abnormal T wave changes on the electrocardiogram.

Shortly after his release from detention, Mr Mandela was referred by his lifelong friend and, at the time, general practitioner, Dr N Motlana, to the Department of Medicine, University of the Witwatersrand, for examination, investigation and treatment. In March 1990, he was therefore examined by the Head of the Division of Cardiology and a diagnosis of hypertensive hypertrophic cardiomyopathy was made. This is a well reconised and fairly prevalent condition, especially in elderly subjects. The condition entails a somewhat inappropriate response of the cardiac muscle to the increase workload caused by the hypertension with resultant thickening (hypertrophy) of the left ventricular myocardium. In the case of President Mandela, the condition was completely asymptomatic and importantly had not yet caused abnormal breathlessness.

Clinical features included a blood pressure of 200\100mmHg, cardiac enlargement on both clinical examination and chest X-ray, thickening of the left ventricular wall on echocardiography (+18mm when the upper limits of normal is +12.5mm), abnormal atrial sound on auscultation and an abnormal electrocardiogram with large QRS voltages and deeply inverted T waves reflecting the cardiac hypertrophy. Exercise stress testing showed no evidence to suggest associated occlusive coronary artery disease. The President has received various tablets to treat the hypertension and cardiac hypertrophy and is currently taking an ACE inhibitor, Verapamil (a calcium antagonist) and a small dose of thiazide diuretic. The hypertension has been well controlled and is usually now about 140\85mmHg.

Echocardiographic measurements of left ventricular wall thickness have revealed regression of the hypertrophy and a recent measurement was 13.5mm. The electrocardiogram remains abnormal but shows improvement in that the QRS voltages have diminished and the T waves are only shallowly inverted. His cardiovascular status is regarded as entirely satisfactory at this time.

In 1994, the President was examined by an ophthalmic surgeon in the private sector and surgery performed for a cataract in his right eye. He has also been examined in the private sector by an ear, nose and throat specialist for some hearing loss and he currently uses a hearing aid. In June 1990, he had a further minor operation on his prostate performed in the private sector and neither then, nor on re-examination very recently, is there any evidence of malignancy.

Previous and current X-rays of the chest confirm some pleural thickening due to the previous tuberculosis. In 1993, he was also seen by a specialist in pulmonology in the private sector and it was favoured that he has some bronchiectasis and fibrosis of his left lung due to the previous tuberculosis. In 1993, and again recently, he had mild bronchiectasis which sometimes has mild secondary infection. Investigation for underlying malignancy or reactivation of the tuberculosis has been negative. Recent such investigation included examination of the bone marrow but again no evidence of tuberculosis or malignancy was detected.

A recent CAT scan of the liver confirms the large hydatid cyst (10 x 10cm) and this is similar to the finding in 1984. A relatively new drug, Albendazole, which has been shown to be effective in treating hydatid cysts is currently being administered. A second, far smaller hydatid cyst is present behind the original cyst. Surgical management of this hepatic hydatid cyst is not favoured at this time.

The President has gained 3 or 4 kilograms in weight over the last 3 or 4 months and is feeling very well. He will continue to be managed and carefully observed by senior academic staff in the Departments of Cardiology and Medicine, University of the Witwatersrand and Johannesburg Hospital. At this time, he is assessed as being physically fit for a man of his age and remarkably active as well as, of course, mentally astute.

Whenever the President is abroad or outside the borders of South Africa, he is accompanied by a full-time medical officer of the South African Medical Service (SANDF) in order to manage any acute or inter-current illness and to ensure the maintenance of his medical care as prescribed by his current specialist medical advisors.