ATTACKED BY A COBRA
Struck twice by a Mozambique spitting cobra, five-year-old Mikayla Robbertse was set to lose her arm – or her life
Charmaine Robbertse was tired but content. It was a week before Christmas, and the 46-year-old former insurance broker had finally settled her large family in the home they had always dreamt about – a rambling farmstead on 60 hectares of rugged bushveld near Lephalale (Ellisras), far north of Pretoria, in South Africa.
Charmaine was devoted to her family. Her husband, Bertus, was a supervisor at a nearby chemical company, and together the couple had seven children from previous marriages, three grandchildren, and a changing array of foster children – children the pair tried to put back together with patience and love.
But one foster child was particularly special. Mikayla, an elfin five year old with lively brown eyes, was the daughter of Bertus’s 25-year-old son, Lampie. The little girl’s mother separated from Lampie before she gave birth, but when Mikayla was born with foetal alcohol syndrome, the young mother struggled to cope. Lampie was often away for work, so Charmaine and Bertus became Mikayla’s full-time carers and officially fostered her soon after.
By nine o’clock that Monday night in 2011, Mikayla’s excited chatter about their new home “with the wild animals” had stopped, and she dozed happily on a sofa near Lampie and her pet Pekingese, Jimmy. Bertus scooped Mikayla into his arms, and Charmaine led the way to her bedroom. She lifted the cheerful, stripy cerise and lime duvet in a routine bush check for creepy crawlies, then Bertus slid Mikayla in. The couple smiled down at the child for a moment, then crept out.
WAKE-UP CALL
It was 11.30pm when the bushveld stillness was broken by Mikayla’s piercing screams. “Snake! Kayla’s been bitten by a snake!” exclaimed Lampie, shocked into being fully awake when he discovered a puncture wound on his daughter’s left middle finger and another on her elbow.
Bertus left his son to find and identify the snake, and quickly bundled Mikayla into the cab of his Nissan van. Charmaine cradled the child on her lap while Bertus drove as fast as he dared down the dirt road to the Ellisras Hospital, about 40 minutes away.
As they pulled in, the call came from Lampie: he had found a metrelong Mozambique spitting cobra behind a bedroom cupboard. The snake – one of the most dangerous in
Africa – is capable of spitting venom and blinding victims with deadly accuracy. Lampie would have returned most snakes to the wild, but he fiercely dispatched this one with a spade, his thoughts on his daughter.
At Ellisras, doctors placed a mask over Mikayla’s pale face and gave her oxygen before injecting two vials of polyvalent antivenom into her slender arm. “Is that enough?” asked Charmaine anxiously. She was assured it was for a child so small and that Mikayla should be fine by morning.
But by dawn Mikayla was struggling to breathe. Charmaine was told that the child needed to be transferred to nearby Marapong Private Hospital. After an examination at Marapong, the doctors advised that Mikayla needed more specialist care at the Steve Biko Academic Hospital in Pretoria. But that was 300 km away and there was no ambulance available.
NIGHTMARE RIDE
With Bertus called away for work, Lampie arranged to have a friend drive his stepmother and daughter. In readiness for the journey, the Marapong doctors taught Charmaine how to perform CPR and urged her, “Stay calm, the child’s life depends on it.” This became her mantra as she nursed Mikayla in the back seat of Lampie’s friend’s car.
Three times the child stopped breathing; three times a terrified Charmaine managed to revive her. But by the time they reached Warmbaths, Mikayla was unconscious, and they were still 100 km from Pretoria.
A rapid response vehicle had been alerted and raced to meet their car. Soon its flashing red lights were in view, bringing Charmaine unspeakable relief. The paramedics managed to stabilise Mikayla, but she was so weak they sped her not to the Steve Biko
Academic Hospital but to the closer private Netcare Montana Hospital.
Although the Robbertses could not afford the fees, Mikayla spent three days in the clinic’s ICU. Her kidneys and lungs were failing, doctors informed them gravely. Mozambique spitting cobra venom is cytotoxic, with digestive enzymes that eat flesh as they spread, and as these reached her liver, they were affecting it, too.
At the same time, Mikayla’s small hand was swelling obscenely and slowly turning black. The doctors were terribly sorry, especially as she was left-handed, but her finger and probably her arm would need to be amputated to save her. THE SNAKE MAN
With mounting private hospital expenses, it was decided to transfer Mikayla to the Steve Biko Academic Hospital, a government hospital, for the operation. On the way, a desperate Charmaine called a mobile number slipped to her by a paramedic at Montana. It was for Arno Naudé, an expert in snake identification and bite treatment, who lectures to medical students at the University of Pretoria.
When she told Arno that Mikayla would likely have her arm amputated, he had one word: “Whoa!” Doctors can be too quick to amputate, he said, and advised that they wait for the venom to run its course. In the end, however, the decision was made for them – Mikayla’s liver, underdeveloped from the foetal alcohol syndrome, was too seriously affected by the venom for her to undergo surgery.
Two days before Christmas, Mikayla’s little face and body had become distended and her skin had turned yellow. Doctors told Charmaine and Bertus she was unlikely to survive the night and advised them to summon the rest of the family.
Arno joined the family during their tearful bedside vigil. He told Charmaine that Mikayla should have been given at least eight vials of antivenom – four times the dose she received. He explained that smaller patients need just as much antivenom as adults. Now, he said, there was nothing to do but wait and pray. CHRISTMAS GIFT
Charmaine and Bertus did both, fervently, and by morning Mikayla had stabilised. By Christmas Day she was conscious, smiling through nausea at the gifts her family brought, and asking after Jimmy, her little Pekingese dog.
Doctors told Charmaine and Bertus she was unlikely to survive the night and advised them to summon the rest of the family
Mikayla continued to rally, and on December 28 was wheeled into theatre – not for an amputation but for doctors to open the massive blister that covered her hand and inspect the damage below. This was more extensive than imagined – the venom had tunnelled under the skin, eating away tissue to halfway up her forearm.
A plastic surgeon, Dr Anton Brewis, assessed the damage. He explained that the wound would need to be cleaned of every bit of infected tissue. Following that, he was confident that he could save Mikayla’s arm with a surgical procedure that temporarily attached her hand to a flap of skin on her groin.
On January 13 the wound was cleaned a final time, and exposed to the bone. Mikayla’s hand was stitched into place and remained there for the next two weeks while the flesh attached itself, slowly rebuilding her hand.
There was surprisingly little pain from the wound itself, but cleaning it was an ordeal, and Mikayla’s liver struggled to cope with the powerful medications she required. However, the feisty child never complained and on January 27 Mikayla’s hand was separated from her groin and the remaining wounds on her forearm were patched with skin harvested from her thigh. On January 31, six weeks after she was bitten, Mikayla returned to Lephalale. Residents turned out to welcome her with banners and balloons tied to the trees, but all Mikayla wanted was to play with Jimmy and her toys, which included a large candy-striped knitted snake.
“Some snakes are naughty,” Mikayla observed simply, “but some snakes are nice.”