||01 July 2012 07:00
Chantal Rutter Dros
|Show: ||Carte Blanche|
Erwin Kruger (Pippie's father): "Sometimes I have nightmares; I wake up in the night, there are some times that I couldn't even sleep. And all I could see was her face in front of me, like with the fizzling and the burning. But you get past that with God's help and love of my wife and my family. You get through that."
The nightmares Erwin Kruger is describing started after a terrible accident, involving him and his three-year-old, left her with devastating burns and him with considerable guilt. When we met Pippie she'd been healing at Garden City Clinic for six months and was waiting for a medical miracle to change her story. This story began last New Year's Eve when Isabella, fondly known as Pippie, was outside with her father. A fire lighter gel he was using to start a braai exploded in his hands at their Limpopo home.
Erwin: "Pippie was three metres to my right and the blast went in her direction. I immediately grabbed her and held her to my chest and ran to the house and called my wife."
Erwin and his wife Anice faced any parent's worst nightmare as it quickly became apparent that little Pippie's body had borne the brunt of the explosion.
Dr Ridwan Mia (Plastic surgeon): "She had 80% full thickness burns. She was at least three or four times her body size because of all the swelling."
Reconstructive and plastic surgeon Dr Ridwan Mia knew keeping her alive was unlikely. But he couldn't at that stage have anticipated the journey on which fate would take him and his young patient.
Dr Mia: "We weren't sure that she was even going to survive to the next day."
Anice Kruger (Pippie's mother): "When he came out he said there is a 10% chance of survival and I actually laughed at him. I think it was maybe trauma, or something, and I told him there and then, 'We will prove you wrong.'"
Initially the challenges facing this young family from Ellisras in Limpopo seemed insurmountable.
Anice: "Cardiac arrests, her lungs collapsed, she had kidney failure, sepsis... severe sepsis."
Doctors also had to make a bite plate for Pippie as the little girl ground down several of her baby teeth in response to the itching burns. She also stopped speaking after the accident.
Anice: "The first time she went under anaesthetic was when I really prayed and told God if he wants to take her please do. But if you give her back to me, I please want her back perfectly and I don't want any worries."
Chantal Rutter Dros (Carte Blanche presenter): "Determined, Anice went home, set up her computer and began trawling the Internet for radical solutions to her little girl's extensive burns."
Anice: "With a lot of praying and by the grace of God I got onto Professor Green from Harvard and he sent me in the right direction."
Anice stumbled on what must be the epitome of personalised medicine. Called Epicel, it was invented by former Harvard cell biologist Prof Howard Green and allows for one's own skin cells to be cloned. Today this is done at the Genzyme laboratory in Boston.
Dr Mia: "And the skin is then cultured to grow. They grow it on a scaffolding made of mouse cells, which are attenuated so the DNA is removed from those mouse cells. It grows into sheets. It's extremely thin and almost like putting cling wrap onto the patient."
Though Epicel dates back to 1975, it's the first time an African burns patient is being treated this way. About R750 000 had to be raised for Pippie to have this treatment option. Roughly three weeks after her biopsies were sent over, 41 new pieces of skin began a 21-hour flight to Johannesburg.
Chantal: "The countdown has begun at Garden City hospital - the skin has arrived from Boston, Massachusetts, and is on its way and should be here within the hour."
It's 6pm, 16th of June and Netcare 911 paramedics and Genzyme/Sanofi's Dr Alan Barrett have just picked up the skin. Leaving OR Tambo International [Airport] with a police escort they begin the journey back in haste. Once it leaves the lab, the skin is only viable for 30 hours. Back at the hospital Pippie has been taken into theatre to prepare her for the procedure so that doctors don't lose a single precious moment once the grafts arrive.
Chantal: "How are you feeling now - today is the day, tonight is the operation?"
Anice: "I am about to explode. I feel like I am three years old, the Christmas tree is up. Tomorrow morning when I wake up I can have my present."
Eight minutes after leaving the airport, paramedics fight through peak hour Johannesburg traffic - they are already halfway back and on track to make what's usually a 45 minute journey, in 16 minutes.
Dr Alan Barrett (Genzyme/Sanofi): "The amount of work it's taken and the amount of people involved to get it to this stage... it's just amazing that this is actually here."
At the hospital Dr Mia prepares to carry out the procedure for which he has trained extensively over past months.
Chantal: "Doctor, it's been a long time coming. How do you feel now that it's happening?"
Dr Mia: "Quite excited... lots of nerves in the air."
Police clear the way and, with media in tow, Dr Barrett rushes the precious box to theatre, cutting our interview short.
Dr Mia: "Here we go, excellent! And the skin has arrived."
Outside, Anice's parents comfort her as her composure finally gives way. The limited period in which the skin remains viable - and the media frenzy around the procedure - adds to the medical team's pressure. Sanofi Medical Director, Dr Sven Kili, pulls the clear plastic boxes from the carrier to reveal pink cell medium gently supporting the translucent skin grafts.
Dr Sven Kili (Medical Director: Sanofi): "Typically, Epicel is grafted onto patients very soon after they have massive burns. She has done phenomenally well; she is past that! So it's not life-saving any more for her, it's hopefully life changing."
Dr Mia delicately flattens the grafts against the open wounds to ensure blood vessels make contact with, and begin to nourish, the new skin cells. Waiting outside, Anice finds solace by spending time with her one-year-old, Arno.
Anice: "I don't think I am scared at all. This is God's perfect timing... he did it exactly the way His will was. I trust Dr Mia with my life, so he will bring her back out."
Doctors work systematically to cover her with the grafts, starting with her thighs and working their way up to the chest, hands and arms and, later, face and neck. When the accident happened the burns were so severe the scars contracted her arms, hands and other areas. They had to be cut and stretched to allow for the new skin to bring flexibility.
Dr Mia: "So far so good, the skin is going on quite nicely."
Chantal: "Two hours have passed and doctors say they are thrilled with the way it went. Now it's a matter of waiting for Pippie to recover."
Anice: "It's like still praying, but it's not like, 'Please be with her'. It's like, 'Thank you God, thank you'."
In the week after the operation Pippie's story spread around the world, so much so that an international sigh of relief seemed to follow the first bandage change when Dr Mia declared the procedure a resounding success.
Dr Mia: "We are happy to say that about 90% of our skin graft has taken. We are very pleased to say it's been a long operation, but it's looking really good."
Her progress continued to gain momentum as, with each passing day, Pippie took a few more baby steps along the road to recovery.
Chantal: "It is almost two weeks since Pippie's groundbreaking surgery that captured the hearts and minds of South Africans and around the world. We're here today to see how she's progressing."
Chantal: "Anice, have you noticed any changes?"
Anice: "This morning we took out the ventilator and there's already a big difference - she is moving so much more and everything. So I can't wait to see her in a few weeks' time."
A team of specialists and nurses take to the little survivor's isolation room in Paediatric ICU, where every bandage change means another crucial milestone reached.
Dr Mia: "I've removed the dressing and, if you look, you can see these are areas that we grafted and you can see the grafts are doing very well. I would say 10/10... that looks very good. We are cleaning the area very gently. We have to be very careful how we do it. We can't rub - it's more like a dabbing manoeuvre because we could still in theory pull all the skin off."
On her chest the large wounds show fantastic progress as blood vessels are clearly evident beneath the transparent new skin. Even the little hands, previously distorted by burn contractures, are looking much better. The new skin is most obvious over her thighs. And, probably most important of all, her face is healing well. It will take time for the grafts - for now as thin and transparent as a sheet of cling film - to thicken and pigment.
Dr Mia: "This is the best she has ever been. All her wounds are nicely covered and she has got skin covering those open burns, so this is a very different baby from the beginning."
Anice: "Yes, don't know how to say thank you any more... wish there [were] a better word and I just wish I could give everyone a hug. This journey has been tough and it's been traumatising and everything, but in the end you realise how much you can change for the good and keep going... how strong a mom really can be. And if you keep praying and hoping, something good will come. Never stop trying, that's the thing I learnt."
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