Attacked by a Cobra!

Struck twice by a Mozambique spitting cobra, the child could lose her arm—or her life

Photo: © Getty Images
The venom of a spitting cobra can blind victims

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 their dream home—a rambling farmstead on 60 hectares of rugged bushveld near Lephalale, far north of Pretoria, South Africa.

Charmaine and her husband, Bertus, a supervisor at a nearby chemical company, together had seven children from previous marriages, three grandchildren, and a changing array of foster children who the pair tried to put back together with patience and love.

But one foster child was particularly special. Mikayla, an elfin five-year-old girl with lively brown eyes, was the daughter of Bertus’s 25-year-old son, Lampie. The girl’s mother separated from Lampie before she gave birth, but when ­Mikayla was born with fetal 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 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 11.30 p.m. when the bushveld stillness was broken by Mikayla’s piercing screams. “Snake! Kayla’s been bitten by a snake!” exclaimed Lampie, shocked to discover 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 meter-long 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 fiercely dispatched it 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 kilometers away and there was no ambulance available.

Photo: Courtesy Charmaine Robbertse
Mikayla’s swollen left hand where the snake venom had damaged tissue; the hand was temporarily attached to her groin to promote blood flow and tissue regeneration

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 kilometers 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 stabilize 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, the decision was made for them—Mikayla’s liver, underdeveloped from the fetal 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 stabilized. By Christmas Day she was conscious, smiling through nausea at the gifts her family brought, and asking after Jimmy, her ­Pekingese dog.

Mikayla continued to rally, and on ­December 28 was wheeled into ­theater—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.

Photo: Courtesy Charmaine Robbertse
In hospital, Mikayla reverted to her usual bouncy self after the operations

A plastic surgeon, Dr Anton Brewis, assessed the damage. He explained that the wound would need to be cleaned 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. On January 27 Mikayla’s hand was separated from her groin, and the remaining wounds on her forearm were patched with skin taken from her thigh.

On January 31, Mikayla returned to Lephalale. Residents turned out to welcome her with banners and balloons, 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, “but some snakes are nice.”

WORK IN PROGRESS
In November 2012, Mikayla had the swelling on her hand reduced by liposuction to help her bitten finger grow straight. Her surgeon also transferred tendons from her left forearm to her hand to improve finger extension.

Focus shifted to helping Mikayla use her right hand for writing and drawing, overcoming her natural lefthandedness. She was moved to a special school, where she has surged ahead, coming top of her class last year.

Mikayla, now ten, proudly displays her ‘funny hand’ for educational talks about snakes with a local snake handler in primary schools, demonstrating that apart from writing, she can do most things with it, even holding a glass of juice. And instead of being afraid of the snakes the handler uses, “she loves them!” says Charmaine.

In fact, Jimmy has had a rival for Mikayla’s affections: Fudge, a ball python, a gift from the snake catcher that he offered to care for at his home.

“We don’t feel comfortable with snakes in the house,” Charmaine confides. But, says Mikayla, happily, “Fudge is sweet, he doesn’t bite. People must just know which snakes do. And take care!”

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