Glue-sniffing street children in Cape Town are ending up in wheelchairs and on crutches, paralysed by a substance in the glue that is toxic to their nerves.
The condition, which has alarmed welfare workers and doctors, affects children who have sniffed glue for long periods or in large quantities, slowly disabling them.
Conradie Hospital medical officer Nicolette Bester, who has treated four affected children in the past few months, said the condition was called "peripheral neuropathy". First it affects children's toes and feet, travelling up their legs, and then starts in their fingers, hands and arms.
In the early stages, and depending on the health of the child, the condition is reversible - provided they immediately stop sniffing glue for ever - but the worst scenario is that it will paralyse the respiratory tract and result in death.
One of the children, 16-year-old Thembela of Brown's Farm, spoke from his wheelchair at the hospital, saying he had sniffed glue daily for the past year.
He experienced paralysis in his legs about three months ago and said he had no idea the glue was causing the problem.
"It feels good, you sleep nicely," he said of glue-sniffing.
Greg Berry, manager of Cape Town City Mission's street workers, said Thembela had been a good soccer player.
"First I noticed he was walking a little bit funny and then two months ago he couldn't walk at all. His muscles were like jelly and now he can't even hold on to the soccer ball," Berry said.
Bester said Thembela had improved dramatically since he stopped sniffing glue when he was admitted to Conradie. He can now walk on crutches for short periods and once they fitted braces to his legs to help him to stand upright he would be discharged.
Social workers have traced Thembela's parents and he will return home.
Three other children, one showing little sign of recovery, are also at Conradie and another is at Groote Schuur. Another child, discharged from Conradie, is being cared for by City Mission.
Lorenzo Davids, City Mission's executive director, said they were extremely alarmed at the emergence of the problem, which they started noticing at the beginning of the year.
"But now it is becoming widespread. We think it may be that we are at the end of winter, the period children are cold and hungry and sniff a lot more glue," he said.
A comprehensive approach, including a drastic education programme for the children themselves, was essential to nip the problem in the bud.
"What we need is for research to be done and we intend calling on everyone, including the glue manufacturers, to come to the table to address this one," Davids said.
Berry said street workers who had worked with street children here for as long as 15 years said they had not seen the condition before. But he knew there had been a campaign around glue in Johannesburg where some children had ended up in wheelchairs.
"I am trying to find out more now but all this is very new to us. We need everyone to get on board and help us try to address this problem," he said.
When Thembela was first admitted to hospital a group of about 20 street children stopped sniffing glue for three weeks, according to Berry, but "as the days go by and they are fending for themselves they forget".
"They are not really scared. It is their nature to accept whatever comes their way, and deal with it," he said.
Bester said it was the "hexane" in the glue that caused the problem because it was toxic to the nerves.
She was concerned too that it could have an effect on brain tissue in severe cases.
"Depending on how healthy you are, you can recover, but it will take months and months, sometimes even years - and of course you would have to not ever sniff glue otherwise you would quickly relapse," she said.
Peripheral neuropathy is a known phenomenon and Dr Bester says there are many substances toxic to the nerves that can cause it.
Although she realised that glue could have this effect in street children, this was the first time she had seen hard evidence.
The hospital is also concerned from a cost point of view if they have to make bed space available for these children, who are not actually ill. They also experience discipline problems.
"But then of course there is also the moral crisis of sending them back to homes from which they ran away in the first place, now in need of a great deal of care. We are fixing them short-term but that isn't really sorting out the real problem," Bester said.
Donald Perry, managing director of Qualichem which bought the Genkem division from Bostik two months ago, pointed out that although most of the children referred to the glue as Genkem, it was unlikely that it was only their product being used.
They were, however, prepared to get involved in any discussions around this issue in an effort to resolve it.
"Our products are completely safe, unless you really sniff them every day as opposed to just working with them."