Every year countless numbers of South African children end up in hospitals with serious burn injuries. Whatever the cause of their burns, they face a life of emotional trauma that comes from severe physical disfigurement. But the reality, as Khadija Magardie found, is that they can be helped if the injuries are attended to in time
The smell of burning human flesh is arguably one of the most unpleasant on Earth. Care-givers and emergency workers alike have been known to say that a very first whiff, mystifyingly, brings on palpitations. And the faintly musty, sourish odour is not easily forgotten it tends to linger in the nostrils, even days afterwards.
Imagine having to live with that smell every day, because looking in the mirror somehow encourages your senses to produce the smell in your nostrils.
Imagine searing pain all over your body, especially your face and hands a fierce burning that makes you want to dive into water to make it go away, but you are being restrained, so you cannot run. Imagine a room full of strange people in green gowns and big masks bending over you shouting instructions. You wake up later, groggy, in a bed with white sheets. You cannot feel your face because there are just swollen, blistered lumps where your hands used to be.
You scream for your mother, but nobody is there, only people who look like they have plastic over their faces, who walk by your cot occasionally. You fall asleep and when you wake up again two nurses are lowering you on to a plastic bed where they start unwrapping the bandages around your head and those limbs you can still recognise as legs and arms. With each touch, you scream wildly, as the burning returns again. The little pieces falling off the bandage are your own skin.
After what seems like a lifetime of the same routine sleeping, waking up, sleeping, waking up a strange person comes to collect you from your cot. They say you are leaving the place where you have been feeling all this pain and going somewhere with this person. Nobody tells you where your mother is; in fact, the nurses appear too frightened to look you in the eye every time you ask for her. But you are just happy to leave that place where they have been “hurting” you for so many months.
After all, this can all be pretty scary if you are only five years old.
When you arrive at the place the stranger takes you to, you are given a little room with its own little bed. Next to the bed is a dressing table, with a stool and a mirror. Even though it’s difficult to walk and you still feel tender, you walk over to the mirror and look at yourself. And instantly, you wish with all your heart you were back in the hospital …
There are places in South Africa that the rest of the country would prefer not to know about. These are the paediatric burn units that care for the countless numbers of infants, toddlers and children who are burned, some beyond recognition, by items that other members of the population may consider harmless.
Hot water is one.
In the suburbs, where there are well-protected bathtubs, taps that normally run tepid water from modern geysers and always someone on hand in case of an accident, it is unlikely that a child could lose a limb, or a life, from hot water burns. But in a one-bedroom shack in an informal settlement, with no electricity or running water, an adult preparing to bathe a child may first pour stove-boiled water into the tin bathtub on the floor and momentarily turn her back to refill the bucket with cold water. In that split second, the unknowing child steps into that tin bathtub, changing his or her life forever if not losing it.
Burns, say the brightly coloured educational posters of the Burn Treatment Centre at Chris Hani Baragwanath hospital, are forever. Not only do they have severe physical consequences for a victim, especially a child whose body is still small, leaving little space for skin grafts, but they also leave a lasting psychological trauma that comes with not looking “acceptable” anymore.
Experts say the emotional trauma suffered by a person, let alone a child, who has visible scarring and deformities from a burn injury remains with them for life. In a society that is unforgiving and harsh on physically disfigured people, some choose to hide away something that influences the knowledge medical experts may have of the severity of the problem of children being burned.
In many instances, parents hide children from society not uncommon in rural, often deeply superstitious communities. This even happens in urban areas. One badly disfigured little girl sent a Gauteng delivery man fleeing in terror over the garden gate, screaming “tokoloshe”.
Up to 58% of burn-injured patients also display typical symptoms of mild to severe depression. Others even take their own lives.
What is also spoken of in hushed tones, and whispered in hospital corridors between social workers, are the deliberate injuries inflicted on children by those nearest and dearest to them.
Sizwe Ndlovu* was only six years old when he was dragged out of a raging fire in his mother’s home in a rural village about 40km outside Newcastle, KwaZulu-Natal, last year. Even the most optimistic reconstructive surgeons say the little boy’s face, which was literally melted off by the licking flames, will never look “normal” again.
Sizwe nearly died in a fire set by his father, who wanted to “show” his mother for daring to claim maintenance from him for his child.
There are children who are burned as forms of “punishment” from parents: placing chubby toddler hands on hot plates is a common method.
Other children, especially those who are handicapped, are victims of unintentional and deliberate neglect in children’s homes. Earlier this week a quadruplegic boy, in a Bloemfontein school mandated to care for him, burned to death in a shower when he was left unattended and could not turn off the hot taps.
The paediatric burn unit at Chris Hani Baragwanath hospital is reputedly one of the best of its kind in the country. It is in this unit that one sees the true face of poverty. The beds are nearly always filled to capacity with children who have been burned in ways that indicate that, had their parents had better life options, the injuries would never have occurred. The unit is particularly full during the winter months, when families burn fuel to keep themselves warm.
Paraffin stoves, open fires, candles and cups of boiling tea are the most common culprits when it comes to the unit’s patients, who are burned on their faces, hands and even whole bodies.
In one bed is a baby, scarcely 11 months old, who has severe burns on her abdomen she pulled on a table cloth, sending the boiling liquids on the table straight on to her.
A little boy, in the section for the older children, has a mangled piece of flesh, bandaged in a plastic-looking gauze, where his hand used to be. As a common form of recreation in areas around squatter camps, little boys make boomerangs out of pieces of wire, toss them into the overhead electricity pylons and wait below to catch them.
His friend, who smiles shyly from his cot, lived in a children’s home. Nearly his entire body was burned as a result of a hot water bath. Only his hands remain unhurt, and as a result, unscarred. The nurses say they were told that the child mistakenly sat in the water. But, they say, the lack of burns on his hands indicate that it was almost certain that someone was holding the boy’s hands, firmly, as he boiled in the bath.
Joe Slovo squatter camp, a sprawling settlement between the suburbs of Crosby and Mayfair in Johannesburg, is one of countless others like it countrywide that have felt the full effects of an unstoppable fire.
The sole fire hydrant its bright yellow gleaming in the early morning light is in front of a home in a Crosby street, several kilometres from the entrance to the camp.
Two weeks ago a fire nearly devastated the camp. Although it started in a small section of the settlement, it spread rapidly and when the flames had died down, the remains of some 160 shacks lay smouldering. Residents have started rebuilding their homes and some are still rummaging through the remains to salvage items to use in their new shacks. Luckily, due to the quick thinking of some community members who alerted the emergency services, there were no fatalities.
In a squatter camp, homes are in such close proximity to each other that it is nearly impossible to halt the spread of a fire. Coupled with this, many homes are constructed with highly flammable materials such as chip-board, and in the winter months insulated with cardboard to keep warm. Inside a typical one-room shack, where there is scant space to walk around, it is easy for a paraffin stove, even a candle, to be knocked over by mistake. And whereas an adult may run for the nearest exit, or roll into some blankets to extinguish the flames, a child’s first reaction would be panic.
“Too many lives are lost because people do not know what they should do in the case of a fire,” says Bronwen Jones, a British journalist who founded Children of Fire, a charity dedicated to helping children who have been burned in fires and securing their access to the best medical treatment and facilities.
Jones’s organisation, after months of repeated haggling with the informal “landlords” and other heavies of Joe Slovo camp, built the first firebreak in the camp. It’s not much to look at just a simple piece of land, with no grass, between two shacks in the camp. But in a shack fire like the near fatal one in the camp last year a space between the flames can be a matter of life and death for the residents.
The charity has been involved in educating members of the community about fire-prevention, as well as offering various other services to the residents of the camp. Among the projects of the charity was organising a fire-fighting course for several individuals training them in fire-prevention methods such as “bucket runs”, where communities are taught how to work together to douse flames quickly.
The consequences of poverty and lack of education do not only mean being unable to put out a fire effectively and with as little damage as possible. It also plays a major role in whether a child victim of a burn accident remains disfigured for life, or not.
Children like Sizwe Ndlovu, living in rural areas, with little access to the necessary medical facilities, are unfortunately more numerous than those who have a chance at a better life.
Many parents and care-givers are unaware that reconstructive surgery is available at the state’s expense. In some cases, even doctors in the private sector offer their services on a “pro bono” basis. And reconstructive surgery is an extremely complicated, costly procedure that is largely, if not wholly, dependant on racing against the clock. The longer they are unattended, the slimmer the chance of performing surgery that can, if not change, at least improve the appearance of the injuries.
One of the conditions hardest to fix is keloiding a condition to which burnt skin is particularly susceptible. It occurs when irregular, tough fibrous tissue forms at the site of a scar or injury. Unless operated on very early, it is nearly impossible to remedy.
Zipho Zwane was burned in a fire in his family’s homestead when he was only one-month-old. The 13-year-old from Madazane near Ladysmith, KwaZulu-Natal, is scarred on one half of his face. He has no hair on the burnt side of his face and there is only a hole where his ear used to be. His left hand is also nothing more than a swollen claw it is common for the fingers to “melt” into each other under extreme heat.
It is likely that the doctors who initially treated the boy did a mediocre job on Zwane because they either lacked better facilities or were simply aware that the family would not ask questions anyway.
Until he met Jones and came into contact with Children of Fire, Zwane was resigned to life with his disability. But now he will be having surgery at one of Gauteng’s state hospitals, under the knife of a highly skilled plastic surgeon.
Among other things, he will receive titanium implants to build him an ear and highly specialised “tissue expanders” will be inserted under his hairline surgeons will use these to spread out his remaining hair and recreate the appearance of “normality” for the youngster again.
But he is one of the lucky ones. Many children’s families, especially in rural areas, not only have no resources such as telephones and transport to hospitals, but are also not informed by medical authorities that more can be done to improve the patient’s life.
Jones attributes this to a “lack of pushiness” on the part of families, who think that rudimentary skin grafts, such as those performed on Sizwe Ndlovu, are “the best the doctor can do”. What many do not know, she says, is that there are state hospitals around the country that, though few, have access to highly specialised medical care and techniques, can “work wonders” on otherwise badly disfigured children.
The fact that these skills are in short supply there are fewer than five hospitals, all in the large cities, which offer such surgery and they have very long waiting lists is off-putting to families who may consider that, with the worst of the physical damage healed, anything more is “cosmetic”.
But for children who have to leave hospital to face their family, schoolmates and peers, all the while knowing they look different, the trauma of being deformed is even worse than having dead skin scraped off in a hospital ward.
And unless they are severely physically deformed, it is unlikely that they are classified as disabled a classification that may earn them financial assistance in the form of a grant to the family. Few hospitals offer post-burn counselling to the children and their families.
There are additional physical risks associated with being badly burned, such as increased susceptibility to skin cancer. Badly burned patients may also need physiotherapy, as skin tightening after burns affects the mobility of joints, especially in the arms and legs. This is not to mention the necessity of a high-protein, excellent diet, to help the injuries heal quicker.
But when you are poor and you do not have the will or inclination to press big-time doctors in the city’s academic hospitals to see your child, all these follow-ups are immense hurdles to be overcome. As one nurse at a paediatric burn unit says, shrugging her shoulders: “How can you tell someone who cannot even afford bread to buy tubs of aqueous cream?”
*Not his real name