Ballito’s snake bite victim’s first day at ‘big school’

After a three-week recovery period, the six-year-old girl who was bitten by a Mozambique spitting cobra while sleeping in her Ballito family home, finally had her first day of school at Umhlali Preparatory School.

Mikayla’s dad, Ludwitg Grove, said they will always be grateful to the Netcare Alberlito Hospital doctors for their quick reaction to the crisis.

“We were extremely fortunate as there was a highly experienced medical team ready to initiate treatment immediately. Anaesthetist, Dr Ian Lander, was outstanding, and he had already contacted Dr Bianca Visser, who has vast expertise in the treatment of snake bites.” said Ludwig.

Principal clinical manager of Netcare uMhlanga Hospital’s emergency department and a locum doctor for Netcare Alberlito Hospital’s emergency department, Dr Bianca Visser rushed to Alberlito despite being off duty.

“Treating a venomous snakebite is highly complex. On my way, I phoned ahead to instruct the treating doctor to start preparing everything we would need as a Mozambique spitting cobra bite to the face is almost always critical,” said Dr Visser, who has lots of experience administering antivenom.

“I previously worked at Ngwelezane Hospital near Empangeni, where we sometimes treated up to 10 snakebites a day in peak season. In contrast, here we generally see only five to 10 snakebites over the whole season.”

When she got to Mikayla, she was in a critical condition.

“Mikayla was agitated, vomiting, her face was swollen and there was imminent risk of her airway becoming obstructed.”

Dr Visser said they intubated Mikayla and secured her airway.

“The emergency department team started premedication with steroids and adrenaline to prepare her body to receive the antivenom. Mikayla received five vials of antivenom with no anaphylactic reaction, and then we administered another five vials.”

The swelling stopped and Mikayla remained stable although she had to be monitored continuously. She was admitted to the intensive care unit [ICU], where she received seven more vials of antivenom overnight.

According to Dr Visser, the effects of Mozambique spitting cobra venom are mostly cytotoxic – meaning that it causes damage to soft tissue including swelling and necrosis (causing cell death), however it can also result in some autonomic neurotoxic symptoms including vomiting, agitation, blurred vision and salivation.

“If someone is bitten by a snake it is imperative that they receive appropriate treatment as soon as possible.  We do not need to identify the snake to be able to manage a patient appropriately therefore people do not need to chase the snake, trying to catch or kill it before seeking emergency care,” said Dr Visser.

After spending four days in the ICU, Mikayla was transferred to the paediatric ward of the hospital. Plastic and reconstructive surgeon, Dr Trishan Pillay, was consulted and found there were still indications of infection in the soft tissue of her face and neck.

“We found that in addition to the loss of skin on her cheek where she was bitten, the venom had caused infection beneath the skin, extending under her chin, around her neck and onto one of her shoulders,” said Dr Pillay.

“We had to take Mikayla to theatre four times in six days to clean out the infection, and by the sixth day the infection was under control. There had been significant loss of fatty tissue, however, and a hole remained in her cheek.

“We created a small tissue flap from under her chin to close the skin, and removed the surgical drain that had been put in place to help clear the affected area. A few days after Mikayla’s discharge from hospital I saw her for a follow-up appointment and she is doing extremely well and greeted me with a big smile. In a few months’ time we will need to transfer some fat to replace the lost fatty tissue, which gives structure and volume to the face.”

Mikayla’s dad said they have spoken to her about the experience and think that she understands what has happened to her.

“Mikayla was glad to hear that the snake that bit her was not killed but was released back into the wild. She even decided to name the snake, and called it ‘Pearl’,” said Ludwig.