From Our 2013 Archives

Nelson Mandela Dies

By Nicky Broyd
WebMD Health News

Reviewed by Michael W. Smith, MD

Dec. 5, 2013 -- Nelson Mandela, the man who presided over the birth of a democratic South Africa and who is often referred to as a "secular saint," has died at age 95 after a lengthy illness.

In a life that represented the triumph of the human spirit, Mandela spent 27 years behind bars and came to symbolize the fight against apartheid, a system of racial segregation introduced in South Africa by the ruling white National Party in 1948. It meant people of color were treated as third-class citizens, shut off from good housing, education, and jobs, and denied access to many beaches, parks, hotels, and restaurants.

Originally fought using a policy of passive resistance, the fight against apartheid eventually became an armed struggle. Mandela, leader of the revolutionary wing of the African National Congress (ANC), was arrested and charged with sabotage and attempting to violently overthrow the government. At the end of his trial he was sentenced to life in prison, where he remained until 1990.

The era of apartheid formally came to an end on April 27, 1994, when Nelson Mandela voted for the first time in his life. At midnight on the evening before voting, a ceremony in Johannesburg marked the end of decades of minority rule.

From dawn to dusk the next day, the lines at the polling stations were long as blacks were allowed to vote for the first time. The ANC went on to win, Nelson Mandela became South Africa's president, and the new "rainbow" nation was born.

Health

While a prisoner on Robben Island, Mandela was forced to undergo hard labor in a lime quarry. There was no running water in the prison cells, and prisoners were segregated by race, with black prisoners receiving the fewest rations. Mandela wrote in his autobiography, Long Walk to Freedom, "The authorities liked to say that we received a balanced diet; it was indeed balanced -- between the unpalatable and the inedible."

He wrote that in the early evening, "We again received mealie pap porridge, sometimes with the odd carrot or piece of cabbage or beetroot thrown in but one usually had to search for it. If we did get a vegetable, we would usually have the same one for weeks on end, until the carrots or cabbage were old and mouldy and we were thoroughly sick of them. Every other day, we received a small piece of meat with our porridge. The meat was usually mostly gristle."

Considering this diet and the fact Mandela spent so much of his adult life in prison, he enjoyed remarkably good health.

Tuberculosis

Mandela talked in his autobiography of having a "history of high blood pressure." In 1988, less than a month after his 70th birthday while held at Pollsmoor Prison in Cape Town, he described a bad cough that he couldn't shake off. He was transferred to a nearby hospital where he had 2 liters of fluid removed from his chest and was diagnosed with the early stages of tuberculosis. The doctor agreed with Mandela that his damp cell probably contributed to the illness.

Six weeks after being admitted to the hospital, he was transferred to a clinic that had never before had a black patient. He said, "The clinic was extremely comfortable and for the first time I actually enjoyed a hospital convalescence."

Cataracts

In 1994, the year he became president, Mandela underwent an operation to remove a cataract. Cataracts are the clouding of the normally clear lens portion of the eye.

Mandela and other political prisoners on Robben Island were forced to break limestone rocks in a quarry without protective eyewear. On their release, an ophthalmologist examined the prisoners and found that many had cataracts due to damage caused by light and lime dust.

Mandela's tear glands were burned by the alkaline nature of the limestone, which left his eyes dry and prone to irritation. This made the removal of his cataract more difficult.

Prostate Problems

In 1985, while in prison, Mandela underwent surgery for an enlarged prostate gland. He also had some tumors removed, which proved benign.

But in 2001 routine checks of his health led to a decision to biopsy the prostate gland, which revealed the presence of a microscopic cancer within the prostate.

He didn't undergo surgery or require chemotherapy, but he did successfully undergo a 7-week course of radiation.

More Recent Health Scares

In January 2011, aged 92, he spent two nights in a hospital in Johannesburg being treated for what was later revealed to be an acute respiratory infection. Before this information became known, the gap was filled with claims that he was in a coma or had a collapsed lung.

Just over a year later, at the end of February 2012, Mandela was again admitted to the hospital. This was a planned admission for an exploratory laparoscopy (in which a tiny camera is inserted into the abdomen) to try to determine the cause of a "longstanding abdominal complaint."

This time there were frequent news updates about Mandela during his overnight stay. He was sent home after the doctors concluded "the diagnostic procedure he underwent did not indicate anything seriously wrong with him."

In December 2012 he again spent time in the hospital. Tests revealed a recurrence of a previous lung infection and the presence of gallstones. These are small stones, usually made of cholesterol, that form in the gallbladder. Mandela underwent a successful operation to have the gallstones removed. After more than 2 weeks he returned to his home in Johannesburg.

In late March/early April this year, the increasingly frail Mandela was back in the hospital for 10 days. He was diagnosed with pneumonia, an infection in the lungs, which can make it difficult for oxygen to reach the blood.

He was again admitted to the hospital in the early hours of June 8 when his condition was initially described, for the first time, as serious but stable. He was treated for a lung infection and left the hospital after 3 months.

From September until his death, he received medical treatment at home.

Legacy

Mandela retired from public life in June 2004 ahead of his 86th birthday, telling the world: "Don't call me. I'll call you." But he still campaigned for health and educational issues through the Nelson Mandela Foundation and the Nelson Mandela Children's Fund.

Although slow during his presidency to recognize the enormity of HIV on the people of South Africa, he made up for it afterward.

A number of AIDS charity concerts have been hosted in his honor, and he repeatedly urged people to seek testing and treatment. In 2005, in an attempt to destigmatize HIV and AIDS, he announced that his son, Makgatho, from his first wife, had died of AIDS.

Latest government figures show HIV prevalence among young South Africans increased slightly between 2009 and 2010 but is generally levelling off. Other age groups show a similar trend.

His last public appearance was at the closing ceremony of the soccer World Cup in July 2010.

It was the dream finale to the biggest sporting event Africa had ever seen. Guests ranged from politicians to major sports personalities and actors. They included Morgan Freeman, who played Mandela in the film Invictus, about South Africa's triumph in the 1995 Rugby World Cup.

Just 20 years earlier, South Africa had been a nation where society was divided by race, entrenched by law, when black and white people never sat together in stadiums, didn't go to the same schools or restaurants, and didn't play on the same sports teams. Mandela helped change all that.

Although he received nearly 700 awards, including the Nobel Peace Prize, his lasting legacy is that he ended apartheid and inspired not just a nation, but people across the world.

SOURCES: Mandela, N. Long Walk to Freedom, Back Bay Books, 1995. South African History Online. SouthAfrica.info. South African government web site. Health 24 -- South Africa's premier health and wellness site. The South African Presidency web site. Mail & Guardian: "Nelson Mandela: A Tribute to a Nation's Leader." Nelson Mandela Children's Fund (UK). Nelson Mandela Centre of Memory. The Sunday Times. BBC News. The Guardian. The Telegraph. NHS Choices. Los Angeles Times.

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