All he wants is a head of hair, a broad smile and a chance to study for a better future.
See also "Tissue Expanders"
November 2001
Mfundo has been undergoing tissue expansion of his scalp for months, staying with a trustee each time he received an injection of saline. On November 27th 2001 he had the strangest-looking head in Johannesburg; on November 28th the tissue expander was removed and his head morphology was almost back to normal.
Mfundo is usually very stoic but he did not cope well with the anaesthetic this time round; it led him to vomit a great deal and the morphine drip did not ease his discomfort as much as he would have liked. The drain from his freshly bandaged head seemed quite alarming with its continual flow of blood. He barely ate anything until the evening of December 1st, when a trustee took him home for a celebratory braai (South African barbeque). Maybe it was just too much for a 15 year old boy, being in a ward of sick old men, even though his fellow patients were very kind to him.
The treatment at Netcare's Milpark Hospital was in marked contrast to many state hospitals visited recently, from the friendly welcome to the quality of food. It is a pity that Mfundo had no appetite.
Mfundo's tissue expander has been removed and the stretched hair-bearing skin moved over to the side of his scalp where he lost all his hair when he was burned. We have no idea how well it has worked yet as his head remains tightly bandaged. His eyes still don't seem to close fully when they are relaxed in sleep, and it is not clear if more work can or should be done on his hand. He will remain in the home of one trustee for some time, until the skin has taken very firmly to its new position.
The surgeon and his anaesthetist worked pro Deo; Netcare took the same approach for nursing and accommodation. The charity will meet the cost of the theatre consumables, ward dressings, etc. For the insertion of the tissue expander many months ago, the consumables cost some R10,000. This is considerably higher than in the state system which gets most medication at one third of the cost that is charged to the private sector, but Mfundo would not have got this operation at all in the state sector in Gauteng province.
We look forward to bringing you pictures of surgeon Gavin de Aguiar's skilled and successful solution. Mfundo has been a remarkably good patient throughout this time (except for losing pressure garments twice!) and coped very well with a space-age appearance, even when it seemed the long rasta hat we bought him was too short to conceal his "bubble-head".
The Family
Mfundo Ntamehlo (pronounced oomfoondoh un-tah-maich-lo) was born on April 29th 1986. His father abandoned the family early on, but Mfundo remains in his mother Lina Boniwe Nthamehlo's care. He now also has a supportive stepfather called Wellington Bonakele Madokweni and they all share a small two-room shack at in 7th Avenue, Alexandra Township, near Johannesburg. Also living in the same shack are Mfundo's brother Thembelani Ntamehlo age 18; his stepsister Ntombozuko Ntamehlo (and her child Jomo Sinovolo Ntamehlo age 6); his half-sister Luthando age 2; his uncle Andisiwe Ntamehlo who is only two years older than Mfundo, a distant cousin Vathiswa Qumashe, mother of Sibongile (3), studying for Std. 9; and a young woman known as Nomhle (20) who is not a relative.
Ntombozuko stays home to look after Vathiswa's child, Sibongile. Jomo attends the Thabiso creche. Andisiwe goes to Minerva High School - in Std 9; Thembelani is in Std 6 at Minerva School and Mfundo is starting Std 5 (Grade 7) at Ithuthe Primary School in January 2002. Mfundo has no living grandparents on his mother's side and there are no details of relatives on his father's side. The home is very poor and crowded, but clean. At night Mfundo usually has to share a single bed with his mother and little Luthando.
The Injury
On August 5th 1997 two people living close to Mfundo's home, lit a brazier (known locally as an imbawula) to try to get warm. Mr Dlamini and Mrs MaNgubo poured thinners on the fire and claimed that they did not notice as Mfundo opened a gate to the yard and walk towards them with little Jomo. The flames soared into Mfundo's face, burning much of his hair away and as he raised his hands in panic, burning the skin away there too.
Jomo escaped unscathed but Mfundo was rushed off to the local clinic and from there, to Johannesburg General Hospital. He received some skin grafts and remained in hospital for many months. When he finally went home, he had fallen far behind in his education and his self-esteem was at an all-time low.
Further surgery involved literally "burying" his hand in his groin (for a live skin graft), resulting in a rather puffy patch on the back of the hand and having the unintended effect of introducing raised lumpy veins in the groin area. Much of this only became apparent when the charity offered to help Mfundo.
On first assessment in 2000, it became clear that some of Mfundo's problems would never be tackled in the state hospitals and that some of his problems had been caused by treatment in the state system. Mfundo was already 14 years old and on the brink of manhood, yet was four years behind where he should be educationally. We established that, in common with many other paediatric burns cases in South Africa, education seems to be the last thing on anyone's mind when the child is hurt. And yet, if the whole social and emotional circumstances are not taken into consideration, the burned child in addition to likely disfigurement and disability, also has the burden of being far behind his peers in the school system.
Make or Break Time
We recognised that it was make or break time for Mfundo. If he didn't get back on track educationally and if he didn't have certain operations to improve his appearance, and to improve function, he could lose hope and just be a burden on his family. We took him to see several surgeons and Dr Gavin De Aguiar agreed to take on his case, assisted by anaesthetist Dr Jacques van Westing.
In early 2001 Mfundo was operated on at Milpark Hospital in Johannesburg. In order to be sure that it was safe to use skins for grafting from the groin area, we had to first take Mfundo to a urologist Dr David Smart. The "lumpy veins" are unfixable but fortunately the blood flow in them is in a direction that is not dangerous, so the area could be used again for "donor skin".
Mfundo has received a tissue expander that will help him regain a more normal hairline. This is no longer available at all in the state system in Gauteng Province, South Africa. Mfundo has also received a skin graft below the lip to help him smile more easily; the puffiness of the hand graft has been reduced and a new pressure glove (made of stretchy elasticised material) fitted to the hand by an occupational therapist.
While undergoing his first operation, the surgeon realised that Mfundo could not close either eye fully. The right eye was particularly bad and over the next few days it became noticeably red. The surgeon decided to take Mfundo to theatre again and to put a substantial overlapping skin graft into the right eyelid. If this were not done, he would have been at risk of a desiccated cornea.
In at least June and July 2001 Mfundo will have to return to the hospital once a week or more, to have saline injected into the tissue expander. His scalp - currently with a neat line of metal staples across it, will become a more and more peculiar shape until the expansion is complete and the tissue expander can be removed.
It needs to be kept very clean and as one puts on a cream, the surface feels a little like a waterbed in one's head. Mfundo has had to abandon his favourite game of soccer until expansion is complete, as he must not knock his head in any way. The incision on the scalp and the graft beneath his mouth are treated with a topical antibiotic called Bactroban and the graft on the eyelid is treated with another cream called Chloromycetin.
Silenced by Scars
Mfundo's mother says that her son was "silenced by his scars" but now she says he has hope again. He stayed with us over many weeks in Auckland Park and enjoyed having his own bed and own space. He will continue to overnight here around each tissue expansion time. He even celebrated his 15th birthday here and is now the proud owner of a remote-control car, a top quality soccer ball and some soccer boots, as well as a collection of little animal toys for each night spent in hospital, new books and new clothes. A local school assisted with some worksheets to ensure that he didn't fall further behind in his schooling while recovering from his operations and Marius, a first year medical student from Wits University, came and gave Mfundo a little personal tuition.
Mfundo has also been taught some skills that all the women in the shack at home might never have let him learn - he can now sew on a button and iron his own shirt, as well as make pancakes and cook a chocolate cake.
Normally Mfundo attends Ithute Primary School at Alexandra Location. He would prefer to go to a less crowded school with better facilities. He would like to study to be a doctor but for now just must get more confident with his long division! Mfundo is a kind-hearted boy who seems young for his years but each day he is more confident and more mature. He likes little children and was happy to help and to play with fellow burn survivor Dorah, as well as playing Scrabble and Monopoly with older children too.
Along The Way
While we were visiting one surgeon, we met Mr Rautenbach, aged 33 and still dealing with problems related to burns injuries three decades previously. At the age of 3 he had plugged in a bar heater, with its bars covered in wire, and held the bar to see if it would warm up. He got stuck on it as the electricity came through.
Doctors wanted to amputate his hand but a visiting surgeon from the UK persuaded them to keep the hand. They took a skin graft from his bottom and Rautenbach says: "Bum fluff still grows through on my palm sometimes."
Now he cannot move one finger properly, the palm is slightly contracted, and he gets blisters on the palm. Mr Rautenbach is immensely grateful that he kept his hand but warns that people should never under-estimate the fact that Burns Are Forever.
January 2002
Left: Gavin de Aguiar, a leading reconstructive surgeon, and Mfundo, following seven months work on him.