Londeka is a bright little girl aged ten. She turns 11 on May 8th 2003. She is in Grade 6 at a rural school called Forest Hills Primary (teacher Miss Tomlinson; best friend Thobeka) near Pietermaritzburg in KwaZulu Natal, and her home is in Imbali township. Her father Sibusiso died some years ago; her stepfather died in February 2003 and her mother Ntombezuti (39) is not expected to be around when Londeka grows up.
But none of this has dimmed Londeka's ambitions - to look as normal as possible and to become a doctor. Londeka was badly burned as a toddler, tipping hot water over herself accidentally. She lost half of her hair and burned one arm quite badly.
She was patched up at the time and has good movement with her damaged arm, though contractures had to be released when she was eight years old. Her damaged arm cannot move as far as her undamaged arm, but the difference is minimal. Londeka was also lucky that her face is largely unscathed. But little girls don't like to be bald.
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| Pre-surgery, right side | Pre-surgery, left side |
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| Pre-surgery back | Post-surgery with tissue expander |
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| Extent of arm extension | Extent of arm extension |
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| Extent of arm extension | Extent of arm extension |
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| Londeka with her surgeon, Martin Kelly | Post-surgery, in hospital |
Children of Fire learned about Londeka when the charity arranged for a British maxillofacial prosthetist Colin Haylock to visit South Africa in February and emailed around the country to charity and medical contacts, to find severe paediatric burns cases in need of his particular skills.
Londeka's name was put forward from the Howick area but when charity director Bronwen Jones met her off the bus at dawn one Johannesburg morning, she said: "I immediately saw that her burns were not bad enough for prosthetics, but I also saw that look of hope in her eyes. I knew we could not send her back without doing something." Jones arranged for Londeka to be seen at Johannesburg General Hospital. She said: "I was sad because the reconstructive surgeon there said that there was not enough hair; that Londeka should learn to live with a wig. "I pleaded that good Afro wigs are hard to find; that they are hot and uncomfortable; and that children can be teased as much wearing a wig as they are teased if they are bald.
"When it seemed that the state sector would not help, I turned to Netcare's Dr Martin Kelly as I knew that he had helped another badly burned child of a similar age and used a tissue expander very successfully to restore his hairline."
Dr Kelly not only agreed to help, but recognising the seven-day-a-week overload of the charity's schedule, he came and carried out the required scalp measurements on a Sunday morning in an Auckland Park garden. Londeka's treatment costs were all born pro Deo by Sunninghill Hospital. The surgeon and anaesthetist both gave their time for free. The nursing care and general attitude of hospital staff were exemplary.
The little girl was been prepared for her operation by Children of Fire, so that she understood how a tissue expander works. She was also given lessons on the structure of the skin, the brain, even on teeth and the circulatory system.
A tissue expander is like a balloon that is placed between the skull bone and the good hair-bearing skin, stretching it "like a pregnancy on your head" until the hair can cover a larger area. It does not make more hair, but it make the hair go further. The expander is installed and then there are injections of saline (salt water) over many months - 100ml at first with a 23 gauge needles or less, and then about 50ml each week. If too big a needle is used, it can damage the valve. About one litre or a little more can be put into 700ml tissue expander until it is stretched to capacity can be taken out and the hair moved.
Londeka returned to her block-built several-bedroom family home of cousins Siphumelelo (3) and Thembelilihle (7), aunts Smangele (19), Bongani (50) and Betty (40) and her mother in late March while the expansion takes place - assisted by reconstructive surgeon Dr Jan Kleynhans in Pietermaritzburg - and will return to Johannesburg for the hair to be moved into position, maybe in August or September 2003.
Children of Fire bought her a big straw hat that will allow space for the expander to "grow" for quite some time.
While Londeka was in Johannesburg, Children of Fire also introduced another innovation. Trust Director Jones says: "Most badly burned children fall behind dramatically with their schooling, because of their time in hospital and often because of their insecurity about their appearance. We have set up a school in Auckland Park that is primarily for blind and low vision children, but it will also allow burned children to continue learning even when they are away from home for surgery."
Londeka was given Grade 6 mathematics - sourced with the kind assistance of Melpark Primary School. In learning about her mother's condition, she was also given information about the immune system and how people with immune deficiency can prolong their lifespan and improve their quality of life. This was worked through to ensure that the complex vocabulary was understood and she was given counselling about what the future holds.
For further details on tissue expansion refer to our website sections: Mfundo Ntamehlo and also that on Tissue Expanders.
Londeka was accompanied home by Thomas Ranamane, National Head of Children of Fire Trust's UMashesha ("quick mover") volunteers, because she was too young to travel alone.
His task was to make contact with the fire brigades, hospitals, SAPS, communities at risk and any burned children in need of advice.
He explained that Children of Fire was set up as a charity several years ago after its founder took on the care of a six month old baby who lost her entire face and hands in a shack fire.
The objectives of the Trust are to assist badly burned children to get the best surgery, therapy and education that is possible and the Trust also seeks to prevent such injuries with a wide-ranging education and prevention campaign.
Ranamane said: "Initially the prevention campaign focused on teaching squatter camp residents basic first aid, fire fighting and fire prevention skills.
As time went on, it became clear that there were other wider aspects of community safety that led directly or indirectly to children being injured – from alcohol and intimidation to illegal electricity connections."
The UMashesha members are bright, committed, well-trained and most of them live in communities at risk. They speak from direct experience of unsafe living conditions.
They write their own safety plays, dealing with topics as diverse as the drunken father who kicks over a candle while his children are asleep, locked inside the shack; the epileptic girl whose fit is triggered by flickering flames and her subsequent injuries as she falls in the fire (and the superstition of onlookers who will not pull her out); the explosion of a home-made paraffin stove and its consequences for a community.
These plays are put on in whatever language is appropriate to the community, in schools and churches across Gauteng. Mr Ranamane hopes that the idea can take off in KZN as well. He said: "Our ideas have no copyright if they can help a community."
The UMashesha also accompany burned children to and from hospital, where their relatives either can't or won't do so. Burns are forever, so a child injured as a toddler may still need reconstructive surgery ten years later.
The UMashesha help people after they have lost all their possessions after shack fires, with donated clothes, South Africa made safe candle holders, sugarcane gel stoves, and anything else that helps the families to get back on their feet again.
Children of Fire Trust and the UMashesha receive no money from government at all. Everything is funded from donations - from R5000 for a firefighting water tank to place inside a squatter camp to R1000 to provide occupational therapy sessions to a burned child in a remote area.
Ranamane said: "We act as a friend to the emergency services but, when there is corruption or indolence, we act in a watchdog capacity as well."
Mr Ranamane will ensure that little Londeka is left in good medical care. He was hosted during part of his visit by KZN charity CINDI run by Yvonne Spain.
Children of Fire has to help children who lose their bottoms in fires to acquire nappies (about R150 for a pack of 15 for small adult size); Ms Spain has to help people in the final stages of Aids with nappies as well. This unusual link has kept us in contact, even with the UMashesha now using CINDI’s posters about plants that assist people with HIV and growing the plants themselves.
Dr Siya Mjamekwana at Edendale Hospital near Pietermaritzburg has offered to assist with Londeka's needs as well. He was unaware of tissue expanders and the process. A Dr McKerrow at Greys Hospital might also assist.