HOPE AND JOY: LOOK AT PIPPIE NOW!
Back in 2011, a family braai turned into a nightmare for the Kruger family when fire starter gel exploded near two-year-old Pippie, leaving 80% of her body badly burnt. Fast forward 11 years, and the toddler who wasn’t expected to survive is a vivacious, joyful teen.
Anicè Kruger likes to tell the story about a journalist who once commented that “if Pippie doesn’t touch your heart, you clearly don’t have a heart”. “It’s hard to describe what makes this child so special, but she changes people. She wakes up every day with a smile,” says the mom of this brave 13-year-old.
That’s remarkable for anyone, but even more so for a child who has undergone 62 surgeries in her short life: following her traumatic accident, Pippie underwent extensive skin grafts, and since then has had several Z-plasty procedures to release scarred skin that could have uncomfortable contractures. She also receives injections of botulinum toxin to give her greater control over her limbs, as the shock of the burns she received as a toddler brought on five heart attacks, which in turn led to strokes and lung collapse, cutting off oxygen to her brain and leading to the development of cerebral palsy.
Delicate skin graft
Not that Pippie has let this condition stand in her way. “I recently saw a picture of Pippie playing the piano. Because she doesn’t have the coordination to strike the keys with her fingers, she was playing with her chin,” says Dr Ridwan Mia, the plastic surgeon at Mediclinic Sandton who conducted Pippie’s extremely delicate skin graft – a first in South Africa at the time.
Dr Mia recalls that he met Pippie for the first time on the night of her admission. “It was touch and go,” he admits. “Because her injuries were so severe, we had few goals beyond minimising damage and trying to assess the depth of the burns.”
His job was made more difficult by her body’s reaction every time he tried to lift a dressing to view the burns – her temperature would plummet, her airway would swell and a full resuscitation would follow. At the same time, Dr Mia knew he needed to move fast to remove the burnt tissue: “Because it’s now dead, the body no longer recognises the tissue and treats it as if it were an infection,” he explains. Eventually, the team decided to operate on Pippie in her ICU bed, rather than risk transporting her to the operating theatre.
Dr Mia recalls that Pippie’s body was so small that handling her was a challenge. “At first, we weren’t sure how to go about reconstruction. It took several weeks for her to become sufficiently stable for us to develop a proper plan.”
With only 20% of her skin’s surface unburnt, the team had limited options – and with Anicè reluctant to let the doctors harvest skin from the only areas that remained unscarred, they weren’t quite sure how to proceed.
Touching hearts
They hadn’t reckoned on Anicè’s research and fundraising skills, though. After Dr Mia mentioned that an American company had developed a procedure to culture skin from epidermal cells, Anicè went online to find out more – and, in the meantime, collected enough money from concerned South Africans to fund the costly surgery.
“I realised just how much Pippie’s story had touched the heart of this nation when, one day, a domestic worker came looking for me in the hospital. She told me the family she’d worked for had baked goods to raise funds for Pippie, and because she also wanted to contribute, she gave me a R20 note,” Dr Mia remembers.
Dr Mia was concerned that there weren’t enough viable cells for the procedure, which typically requires a 2cm2 sample to clone the skin. Luckily, the team successfully harvested enough skin – but their new concern was that the procedure had never been conducted outside the United States. What followed was a carefully planned, intricate arrangement to transport the cloned skin. Meanwhile, the operating team held rehearsals using one of Pippie’s dolls, so it would be all systems go as soon as the skin landed in South Africa.
The cultured skin was just five to eight layers thick, making it incredibly fragile – by way of comparison, the skin on your hand comprises 500 cell layers. Pippie was sedated after the surgery so the skin wouldn’t move and could grow. “We were told the grafted skin would take on the properties of the area it covered, but even so, it has been incredible to see how skin grafted to her scalp has grown hair,” Dr Mia says.
It’s perhaps not surprising that, after their 11-year journey, Pippie is “smitten” with Dr Mia, according to Anicè. The feeling is mutual, it would appear: “She brings so much joy,” her doctor confirms.
Indomitable spirit
Pippie’s mother describes her teenager as “cheeky, always laughing”. Although her mom and her medical team see her as a fighter, she doesn’t consider herself remarkable – she refuses to use a wheelchair, for example, preferring to do everything herself.
When you listen to Anicè, it’s apparent that she too has an indomitable spirit. “When the accident first happened, I didn’t realise how serious her situation was. I thought that she might just need a plaster, and when I was told she had a 3% chance of surviving, I refused to listen. I suppose that was my own survival instinct kicking in.”
“When the accident first happened, I didn’t realise how serious her situation was. I thought that she might just need a plaster. Then I was told she had a 3% chance of survival.”
Anicè Kruger
Nowadays, Anicè takes her cue from Pippie. Although this makes it difficult to plan things in advance, she’s developed a knack for turning obstacles into occasions for fun. This applies to everything, from the occupational and physiotherapy that Anicè carries out herself, to scheduling surgeries. “It’s not always easy to accept that my little girl has to endure these operations, but once I consider how they will help her, they become something positive. Besides, we always turn our trips to Johannesburg for surgery into an adventure.”
Images Franzoa Wolmarans
