Pretoria – Three-year-old Nhlelo Chauke was travelling home from a family visit in Limpopo in January last year when her mother’s vehicle was involved in a an accident that left Nhlelo unresponsive, with paramedics having to resuscitate her at the scene.
After spending three weeks fighting for her life at Netcare Montana Hospital, Nhlelo was transferred to Netcare Rehabilitation Hospital in Johannesburg.
According to Professor Andre Mochan, a neurologist practising at the paediatric unit of the rehabilitation facility, it was clear that Nhlelo had a long way to go in regaining brain functionality.
“She had suffered a diffuse brain injury, where due to the impact of the accident the nerves and cells had been badly shaken, resulting in bleeding in multiple parts of the brain,” said Mochan.
“On arrival, she was completely non-communicative, had difficulty responding to visual stimuli and her movements were totally unco-ordinated. She was not able to sit up or hold up her head.”
Mochan, along with the other members of the multidisciplinary paediatric team in the unit, spent the first three days assessing Nhlelo using internationally recognised scoring systems.
“Nhlelo’s scores were very low but there were some hopeful signs, such as her ability to move her limbs and open her eyes,” said Mochan.
Charne Cox, Nhlelo’s physiotherapist at the rehabilitation hospital, explained that although she was 3, Nhlelo’s brain injury was so severe that the team needed to go right back to the basics of baby movements – doing tummy time, learning to roll, learning to sit and so on.
Nhlelo’s father, Mzamani Steven Chauke, recalls the relief that he and his family felt as Nhlelo began to improve.
“At the time of the accident I was still in Limpopo as I was going to drive back home a couple of days after my wife, who needed to return to work. I am a paramedic and when I received the call I did not even know if my little girl would make it through resuscitation.
“Upon arriving at Netcare Montana Hospital’s emergency department, I was informed that Nhlelo had a very slim chance of survival. There was nothing we could do but pray, and our prayers were truly answered. Nhlelo survived and by her second week at Netcare Rehabilitation Hospital she started to recognise me again. That’s when I knew something positive was happening.”
Chauke says that the team at the hospital included him and his wife in Nhlelo’s rehabilitation, providing encouragement and sharing information as to how she was improving at regular family meetings with the treatment team.
Initially, Nhlelo had been booked into Netcare Rehabilitation Hospital for 3 months, but her progress was so exceptional that she was able to go home after 8 weeks.
“By the end of her stay, when I would walk into the ward in the morning, she would smile and run to hug me. It was truly heart-warming to see her recover so well,” Cox remarked.
“While Nhlelo’s progress was far beyond our expectations, we find that all children have amazing mental strength and can adapt more quickly and easily than an adult, provided they have the appropriate support.”
Looking back, Chauke recalls that before the accident he had not realised the significance of Nhlelo’s second name, Confidence.
“At the time it was just a name that I chose, but it came to have great meaning as our little Nhlelo has all the confidence she needs to take on and overcome life’s challenges,” he says.
Nhlelo was discharged in April 2021 and now, one year later, her father says he sees her recovery as a miracle.
“She attends crèche every day and while she still has some difficulties with her balance due to an ongoing issue with her ear, she is improving all the time. She’s very smart and loves counting, reciting the days of the week and the months of the year, and is fascinated by colour,” said Chauke.
“Nhlelo has become very attached to the photographs we have of her at Netcare Rehabilitation Hospital. She keeps them on the dressing table and gets quite upset if anyone moves them. The people at the hospital really do things with all their hearts. The way they support the family and look after the kids goes above and beyond the call of duty.”
Mochan explained that each brain injury patient was different and it was almost impossible to predict the outcome of the rehabilitation process.
“We cannot force the brain to do things that it is not capable of doing but it shows us what it can do during the treatment process. As that is revealed we can adjust our strategy and work with the brain. It is from this that we can start to see a trajectory of improvements,” he said.
“When a human brain has been damaged by injury or a tumour, for example, the rehabilitation process is a bit like rebooting a computer after crashing, opening program after program with the team closely observing to assess where problems may lie.”
Mochan said the process was so delicate “and you do not want to overstimulate the brain as that will risk ‘crashing the computer’ again”.
“This is important for both health-care professionals and family members to understand. We have to go step by step, at the pace at which the brain is able to recover,” he said.
Mochan pointed out that when it comes to children’s brains, the rehabilitation process is particularly complex compared to that of the adult brain, which is already fully developed. In a child, injury disturbs normal development, which needs to be addressed in addition to the recovery from the injury itself.
“Sometimes a child may seem to recover quickly following a brain trauma and it is understandable that the parents want to take their little one home as soon as possible, however skipping the rehabilitation process would be doing the child a great disservice. This is because it is hard to know what damage has been done to longer-term development processes,” he said.
“It is therefore imperative that kids with brain complications, no matter how small, are referred to a rehabilitation facility so that an in-depth evaluation can be conducted, and a rehabilitation plan can be developed accordingly.”
IOL