29th Jun 2017 9:13:29 AM

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Thando













On Saturday 5th November 2011, Thando to see us. He turns three years old on 20th November 2011.
Thando and his young mother (21) live in Pietermaritzburg, KwaZulu Natal. She still attends school.
He was in a spaza shop where a paraffin stove caught fire.
The shop owner tried to throw the stove out of the door but it hit the wall and bounced back onto Thando.
He was injured on 25th September 2011 and kept in hospital for a month. He was then discharged because in hospital "there could be a risk of secondary infection."
He was brought to the home of his grandma (47) in Emmarentia, Johannesburg, where she is employed as a domestic worker and helps with twins of a similar age to Thando.
She took him to Hillbrow Hospital for his dressings to be changed as Parkhurst Clinic said he was too complicated for them.
They changed the dressings on a Thursday and said that he should come back the following Monday.
On the Saturday we removed his dressings by soaking in a mild saline bath because the nurses had not used Jelonet or other paraffin-impregnated gauze, so the ordinary gauze was stuck to the wounds.
Many of the wounds, even from the donor sites, were weeping and infected. Many were malodorous.
We noted infection on both upper thighs, the left of his trunk and much of his left arm.
It took one and a half hours to soak the dressings away and to redress the wounds without causing the toddler pain.
It is very hard to keep a child clean and safe near the nappy area at this age. We told his grandma to ideally put him on the potty first thing in the morning so that he is not defecating in nappies and the chance of cross-contamination is reduced. She will know how often he poos, so can try to put him on the potty at these times.

Thando should have some sort of sedative before dressing changes; a GP can advise (and not just related to his age but also to his weight - he is a little overweight so too little and it won't work).
We noted that he is happier if people talk to him throughout dressing changes and explain to him what they are doing.

He can (and will) help by pulling off some of the dressings himself, as he is partly aware of what might cause pain and what might not.
He needs to be shown everything before it is used, to lessen the anxiety - e.g. a tube of topical antibiotic cream so that he can see that the shiny metallic nozzle is not a syringe.
Thando says: "Ngyaxolisa" - "I'm sorry" about the pain and the tears, which is remarkably mature for such a little chap. It is good to have a Zulu-speaker on hand for dressing changes, but he also responds to the calming tone of a voice even where he is not proficient in English.

We suggested the way ahead:
He needs his dressings changed on Monday, Wednesday, Friday and ideally again on Sunday. With Opcite the time to change them may be lengthened once the infection has gone.
Meldene Medicross (in Melville) is open on a Sunday morning without appointment. Good doctors there for advice are Dr Asheeka Mahomet, Dr Nazeera Khan and Dr Johan Le Roux and Dr Jean du Plessis. The nurses are kind and all staff there know burns cases well.
He must keep his antibiotic in the fridge and complete the course (asked the kind employer to ensure this happens if the granny does not have a fridge in her accommodation). He may need another course, or even to have the type of infection checked at Lancet Laboratories. The charity can arrange that if need be.
Non-adherent dressings like Jelonet dry out in this hot South African summer weather after two days and will stick anyway. Opcite is good, Primapore is ok, topical antibiotic cream such as Bactroban or Chloromycetin need to be placed on the infected areas. (We used two tubes on 5th November). Ideally the same person should accompany him to all dressing changes - it is better for his reassurance.

Charlotte Maxeke (Jo'burg Gen) Hospital will avoid helping him now that he has been seen at Hillbrow Hospital.
However, the Charlotte Maxeke plastic surgery department sees outpatients on a Monday at 12 noon and on a Wednesday at 12 noon in outpatient's clinic (OPD) 256. It can take three hours to be seen .

Once his grafts have taken on the arm, he may benefit from a pressure garment (a stretchy brown Lycra-like sleeve that will appear to be inside-out) - these can be sewn by occupational therapists at Charlotte Maxeke.

Thando is a lovely-natured child and we hope that this traumatic time can soon be over for him. Fortunately he is not burned over the joint areas so physiotherapy needs will be minimal.





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