With a new prosthetic eye and nose on the way, and out of intensive care, Rodwell Nkomazana is a long way from the boy who arrived in South Africa for emergency treatment in June. However, the essence of who he is has not changed.
On 7 May, nine-year-old Rodwell Nkomazana’s life was changed forever. While asleep at an all-night church gathering in his village outside Harare, Zimbabwe, Rodwell was attacked and mauled by a hyena.
Now, three weeks after being discharged from hospital, Rodwell looks like a different person to the one who arrived in South Africa on 19 June, but the essence of who he is has remained the same.
While what happened to him will undoubtedly change his life, it hasn’t changed who he is — it doesn’t define or make a spectacle of him. Speaking to the medical professionals who’ve worked with him, it’s actually others who have changed upon meeting Rodwell.
Rodwell’s ICU nurse
ICU paediatric nurse William Motlhamme met Rodwell after his first diagnostic procedure on 21 June, and Motlhamme soon became the young patient’s favourite nurse.
“You know, with me for the first time, he just liked me,” said Motlhamme. “I don’t know why… maybe it’s because I talk too much, I make jokes, I’m with children a lot.
“He used to have two teddy bears that he loved very much,” explained Motlhamme. “He named one William and the other Thumelo, which is us… the people who were looking after him.
“I loved it because the teddy bear that is William has big, big eyes. I thought because I wear glasses, maybe in his mind, he wanted to portray the glasses with those big eyes.”
Rodwell’s mother, Shamiso Mabika, told Daily Maverick that after coming to SA for medical treatment, Rodwell said he wanted to become a doctor.
Despite working in the ICU, Motlhamme said Rodwell’s case was the most traumatic he’d seen. He said that even when he was not on shift and was at home, he’d call in to check how Rodwell was doing.
As Rodwell’s ICU paediatric nurse, Motlhamme’s job involved noting the child’s vital data, administering medications, cleaning and positioning his feeding tube, suctioning his tracheostomy and helping with day-to-day tasks.
Motlhamme said he wished nurses could get the recognition they deserved.
“The doctors are the brains… they come and tell us what to do, but the nurses are the heart of the hospital,” said Motlhamme, explaining that nurses are with patients more than anyone else.
Motlhamme said that when working with a child who has a tracheostomy and feeding tube, it’s important to involve the parent.
He made it a priority to include mother Shamiso in his treatment, teaching her how to clean and position his breathing and feeding tubes, so that by the time they left they were confident enough to do it alone.
Additionally, Motlhamme did play therapy with Rodwell.
“Rodwell is a very cheerful child… he used to love playing a lot. I mean, he’s a nine-year-old — they love playing.
“But then he had emotional switches,” said Motlhamme, explaining how the child’s mood would shift throughout the day — he’d go from being mischievous and competitive, to quiet and shy.
To help with his emotional wellbeing and restore his confidence, Motlhamme the play-therapy with Rodwell took the form of playing soccer on a foosball table as well as using donated board games.
Motlhamme said he learnt a lot from Rodwell’s competitive spirit.
“He taught me then that he’s a fighter. That’s why his recovery was so quick because he’s a fighter. He’s a very, very brave boy.
“I learnt from this whole thing that happened to him, that as a human being, no matter what happens to you, you can still pull up your socks, dust yourself off and continue with life.
“I gained confidence that, should anything happen to me, it is not the end of the world. I can find other ways to deal with the situation and go on with my life.”
Rodwell was discharged from Mediclinic Sandton on 15 August, but will remain in South Africa for several weeks with his mother to complete his rehabilitation treatment and therapy, and to receive his prosthetic eye and nose.
Rodwell’s nasal prosthodontist
Prosthodontist Dr Avi Jagathpal, with dental technician Henk Cronje, offered their services free to help plan and design a prosthetic nose for Rodwell.
“It’s not something that we expect any form of remuneration for,” said Jagathpal, “It’s part of what we do. I mean, it’s no use being able to help people if you can’t help the people who need it most.”
During Rodwell’s first visit on 24 August to Capital Prosthodontics in Pretoria, Jagathpal took an impression of Rodwell’s face which will be used to create a plaster model.
“For us to start building up the nose, essentially what we need is a copy of what his face looks like,” explained Jagathpal.
“So to do that, we’ll be taking an impression today. When he’s gone away, we will have this [impression of Rodwell’s face] poured in plaster, and then we’ll have a duplicate of what his face looks like. Then we can start to make him a nose based on that…”
Using the plaster model, Cronje will create a prosthetic nose out of wax. At his next visit, they will fit it and see if it looks natural, and then take a more accurate impression. The final prosthesis will be made from silicone.
The impression taken on the initial visit will also help Jagathpal to make a substructure that will be screwed on to Rodwell’s face (where the prosthetic nose will attach). The substructure will be made out of cobalt chrome, and magnets will be used to locate the nose on Rodwell’s face, “so he just needs to place it there, and the magnets will lock together,” says Jagathpal.
In terms of the functioning of the prosthetic, Jagathpal is confident that the nose they create for Rodwell will fulfil its function of allowing an air passageway for Rodwell to breathe through.
In terms of aesthetics, it’s not so simple. Along with his nose, Rodwell completely lost his upper lip after the attack. The plastic surgeons, led by Dr Ridwin Mia, used skin tissue from Rodwell’s thigh to reconstruct his upper lip.
Jagathpal explains that the tricky part of his job will be covering the scar tissue from the skin flaps, saying, “between those flaps there are areas where there’s no real colour… so that’s going to be the tricky part — trying to get those stains to blend in with the nasal prosthesis”.
They will stain the prosthetic nose to match Rodwell’s natural skin colour as closely as possible.
As Dr Mia explained to Dr Jagathpal, the flap on Rodwell’s upper lip will begin to contract over the next year — there will be shrinkage and loss of fat tissue as the flap starts to adapt to its new position.
This will change the structure of Rodwell’s face: “Once all that tissue starts to contract, we’re not going to have the same fit of the prosthesis. There will be a big gap beneath Rodwell’s nose,” explains Jagathpal.
This means they will have to revise the prosthetic nose; however, the positive thing is that they can keep the substructures.
“So all the cast framework that’s going to be screwed down after the implant… that stays behind. So the heavy lifting is still in position. The easy part, which is just the silicone that goes on top, the aesthetic part, will just have to be redone at a later stage.”
And as Rodwell grows, the prosthesis will need to be replaced.
Jagathpal emphasised the importance of prosthodontics: “Our faces are what everybody sees. I mean, even if someone loses a tooth, they feel self-conscious about themselves.
“And it sort of humbles you into you [realising] how small our problems really are, and that there are real problems out there.
“When you lose part of your face… if we are able to replace that and give him back that self-confidence, I don’t think there’s a better feeling in the world.”
Ocularist Gavin Downward knows what it’s like to lose an eye and wear a prosthesis.
“I also wear a prosthetic eye myself. And my wife as well,” Downward says, chuckling. “So we’ve actually got a better feel for this because we know what it’s like when someone puts this compound in your eye.”
Downward has had a prosthetic eye since he was 17 years old, and his wife Chantal Kritzinger, who is also an ocularist, has a prosthetic cover shell that fits over her eye.
Kritzinger read about Rodwell’s story in the news and, having worked with plastic surgeon Dr Mia before, decided to offer their services.
Rodwell went for his first fitting on 24 August and just over a week later went home with his prosthetic eye.
After the attack, Rodwell’s left eye was so badly damaged that it had to be removed. The reconstructive surgeons, led by maxillofacial and oral surgeon Dr Jameel Desai, reconstructed Rodwell’s left bony orbit so that a prosthetic eye could fit into place.
At the first visit, Downward took an impression of Rodwell’s eye socket so that the prosthesis would fit perfectly into his socket.
Afterwards, Downward made a mould out of the impression of the socket (the negative) in plaster, then packed plastic into the mould to create a model of the prosthesis (a positive impression).
The model will then be polished and fitted. The position of the iris is marked on the model, the iris diameter is measured and the iris colour is hand-painted while the patient is present, on an iris button.
Then Downward brings the model back to the workshop to make a mould of the model where the position of the pupil is marked.
The eye goes back into the mould with a clear coat of acrylic to cover the veins and is cured for the last time. Finally, the eye is then trimmed and polished for final fitment.
“We try to match it as close as possible to the other eye,” says Downward, “so that when you see the patient afterwards, you can’t tell which eye it is.”
As Rodwell still has a significant amount of swelling around his face and in his left eyelid, a new prosthesis will have to be fitted fairly soon.
Downward explains that for children, you have to make eye prosthetics often, “maybe on a yearly basis. It depends on how fast they grow… skeletal development depends on the eye being bigger.”
Getting an impression of your eye socket is not a comfortable process for anyone, let alone a nine-year-old child. But Downward was astounded at how brave and cooperative Rodwell was.
While Downward created an impression, Rodwell gripped his mother’s hand tightly but he never once complained.
“I’ve worked with kids for many years. And a lot of times… especially a kid that’s been through trauma like this as well… he really behaved so well. I’m so amazed, hey.”
Over the past three months, Rodwell has learnt much from the surgeons, nurses, rehab team and prosthodontists around him. But he’s also, albeit unintentionally, had an impact on every person who has had the privilege of meeting him.
Donations towards Rodwell’s ongoing medical expenses, which will continue for years, can be made here: Help Rodwell. DM/MC