Beating the odds

In early 2009 Discovery Health member Kowie Loots suffered a severe head trauma. During the months that followed, he went on the medical scheme’s Care Coordination Programme, an initiative that not only offered him the post-acute care required to aid his recovery, but also the emotional support his family needed.

Kowie Loots is an engaging man. He has an easy smile and soft blue eyes. He is tall, confident and open, and has an unmistakably pragmatic view of life. This is perhaps what makes his story all the more incredible, miraculous even. On the morning of 9 January 2009, while out with his crew in a plantation near Wolesly in the Western Cape, Kowie was struck on the back of his head by a falling pine tree, the roots of which had become rotten. He suffered a 5x5cm gash in his skull, causing a part of his brain to spill out, many other fractures to his skull and three broken vertebra in his neck.

“It was a complete freak accident,’ Kowie says. “It had been raining. I dropped my cellphone and bent down to pick it up. It slipped out of my hand, so I bent down again… That is the last thing I remember about that day.”

Kowie’s business, Ocean Cut Timbers, was at the time exporting 40 crates of gumtree timber to Vietnam every week, and it was not unusual for him to be out in the field with his team.

Kowie’s foreman Marius Brandt and his driver Dawid carried Kowie to the company truck, and drove the 20km gravel road to the closest hospital in Ceres. Once he was stabilised, the doctor on duty arranged for an ambulance from Worcester to transport him to Mediclinic Panorama in Cape Town.

Kowie arrived at Panorama at 3pm and was placed in ICU. His fiancé Martien had already been informed and was waiting at the hospital. She had called Kowie’s parents, Anchen and Murto, who made arrangements immediately to travel from their home in Jeffreys Bay.

“We dropped everything,” says Anchen. “My eldest son, Joshua, flew from Johannesburg, and the rest of the family drove from Jeffreys Bay later that afternoon, so we could all be with him.”

Kowie was operated on at 6pm that evening, nine hours after his accident, by neurosurgeon Dr Grant du Plessis and the attending physician, Dr Theo Hattingh.

“Kowie suffered an open compound fracture to the skull, and neural tissue was leaking out,” explains Dr Du Plessis. “We had to stem the leakage, restore the brain membrane and close up the fracture to prevent infection.”

The surgery was lengthy, he recalls, around three and a half hours.

It was a long and emotional weekend for the Loots family, not knowing if Kowie would make it, and not knowing if he would suffer permanent brain damage if he did.

Anchen arranged to see Dr Du Plessis first thing on Monday morning, and she remembers his kindness and encouragement. “He said he believed Kowie would wake up, and that it would be as if he had suffered a stroke. There would be damage to his left arm and leg.  He also said that it would take a long time for Kowie to recover. But he said that no doctor could make a prediction, especially when it came to brain injury, before 18 months to two years after the injury occurred,” she says.

Dr Du Plessis had stayed on call for the weekend expecting that he might have to perform further surgery. Kowie’s brain had swelled to a pressure count of 20mm.  A normal brain pressure count is between 8 and 12mm. Had there been even 100^th of a millimetre of further swelling, a second operation would have been necessary. “Thankfully,” Anchen says, “it didn’t happen. His brain pressure count dropped to 15mm the next day, and continued to drop in the following days.”

Dr Du Plessis arranged for the whole family to visit with Kowie on the Monday morning. “It was just for five minutes,” explains Anchen, “but it was so special to be there, and to be able to pray for Kowie as a family.”

Anchen and Murto were offered a place to stay in Gordon’s Bay, roughly 50km from the hospital. Anchen made the trip to the hospital daily, sitting beside Kowie’s bed from 9am to 7pm. At the time, she remembers, her only solaces were prayer and sitting looking out over the ocean in the evening.

“It was a difficult road. Kowie was very sick and still unconscious. But I was allowed to sit with him. As soon as he heard my voice, he’d put his hand out for me...”

On 25 January, Kowie briefly opened his eyes. Anchen remembers that when she was with him he remained quite peaceful, but when she got up to leave the room, he would become agitated and try to pull his tubes out.

“This type of agitation occurs quite typically with patients who have suffered a brain injury,” says Dr Du Plessis. The increase in movement, however, meant he had to undergo surgery to fuse the three broken vertebra in his neck. Two days after the surgery, he was fitted with booties to aid in strengthening his leg muscles. “They bothered him so much,” recalls Anchen. “He kept trying to kick them off, and out of sheer frustrating shouted ‘Cherize, help me!’” (Cherize, Kowie’s daughter, was 11 at the time.)

For Anchen it was wonderful to hear him speak. “I was so grateful for every millimetre of improvement,” she smiles. “He also recognized Cherize in a photo one of the sisters showed him, which meant he could see.”

But Kowie’s frustration was increasing. He continued to try to remove the tubes, and at one stage he even managed to pull his neck brace off.

He was scheduled to be moved from the ICU into a private ward. This brought a new set of worries for Anchen who knew that Kowie needed 24-hour care due to his agitation and restlessness.

She was busy packing his belongings when two representatives from Discovery Health came to see her. They wanted to speak to her about Kowie joining the Care Coordination Programme (CCP) at Intercare Sub-Acute and Rehabilitation Hospital in Tyger Valley.

She agreed, and his transfer was scheduled for 25 February.

In the meantime, the matron-in-charge organised round-the-clock care for Kowie in the private ward. This meant that for the week before admission to Intercare, he would be taken care of when Anchen went home or left the room for any reason.

Discovery Health’s Care Coordination Programme was in its pilot phase at the time. The idea behind the programme is to offer integrated care for patients with complex medical cases. These would include complications after surgery and, as in Kowie’s case, rehabilitation after severe physical trauma. Discovery Health’s Integrated Care Manager and head of the programme, Dr Chantal Hadfield explains that the intervention aims to bring all the relevant parties together during the phases of a patient’s rehabilitative care so that quality of life is maintained. “A trained care coordinator is assigned to each case,” she explains. “It’s this person’s job to coach, educate and understand the needs of the patient and their family and loved ones, organise and attend multi-disciplinary meetings and give feedback to everyone. They need to navigate the healthcare system so that the patients and their families can concentrate on the road to recovery.

“It’s important to get everything in place as early as possible in the process, so that when a patient is discharged their families are equipped to support them and there is a minimized risk of them deteriorating when they get home,” Dr Hadfield adds.

Kowie was at Intercare for roughly six weeks. Here he made slow but steady progress. At the time Anchen managed to organise a flatlet three blocks away from Intercare. “In the beginning, Kowie was very difficult and refused to eat. I was worried they would have to use tubes again, but then it came right. About a week later he could stand and sit with the help of the nurses and the physiotherapist. His eyes were still closed, though, and he wasn’t ‘really there’,” she recalls.

On 7 March, Cherize’s birthday, Anchen called her granddaughter and handed the phone to Kowie. In a rare moment of lucidity, Kowie said, “Hallo, I love you,” and then handed the phone back to his mother, his eyes still tightly closed.

A day later Kowie was able to push himself on the wheelchair. On 11 March, he was able to take in solid foods, even though it was being pushed through a straw.

He was slowly beginning to recognize people and identify objects and colours during occupational therapy sessions. He also wrote his name for the first time.

A central part of CCP is that families are kept well- informed of every part of the patient’s progress, and to offer as much support to them as possible. This was of great benefit to the Loots family as regular meetings were held with them during Kowie’s time at Intercare.

Kowie’s family realised that he would not be able to stay at Intercare indefinitely and that arrangements would need to be made to take care of him once he had been discharged. The multidisciplinary care coordination team recommended a quiet environment, and it was arranged that Kowie would go to Martien’s home, a farm in Wellington.

Families who have gone through such a trauma need support to help with any fears they might have after discharge, and CCP was there for them, preparing them as much as possible when Kowie was discharged on 11 April. He had been hospitalised for a little over three months.

“Discovery was fantastic!” Anchen smiles.

Kowie settled down and with the help of a male nurse made good progress on the farm.

Since then, it has been a steady uphill climb for Kowie. His life changed irrevocably on that Friday. He was a scratch golfer, had played Eastern Province rugby, tennis and table tennis, and his business was growing. But the determination that led him to those successes continues to drive him today. He has since moved to Jeffrey’s Bay, where he has rebuilt his life step by step and continues to gain strength. His speech and functioning in daily life have improved in leaps and bounds.  He has found a new love in bowls and has taken part in the National Paraplegic Bowls Tournaments in 2012 and 2013, where he was placed second and fourth respectively. The only visible signs of his accident are a limp in his left leg, and there is limited movement in his left arm and shoulder, due to nerve damage he suffered because of the accident. So it’s not surprising that when he visits the caregivers who monitored his progress so diligently in the months after his accident, they still can’t believe the miracle of his recovery. 

More about Discovery Health’s Care Coordination Programme

Discovery Health’s Care Coordination Programme (CCP) provides high-quality, planned, family-centred post-acute-illness care. It involves the coordination of necessary additional care after an episode of illness or injury. This type of care focuses on recovery, support and rehabilitation for both the patient and their family, and is provided by recovery and rehabilitation experts, including nursing sisters, physiotherapists, speech therapists, occupational therapists, social workers, psychologists, dieticians and doctors. An individual care plan is developed for each patient, which is then monitored by a care coordinator. Typically the conditions where patients would see the most benefit from post-acute care include stroke, heart surgery, joint replacement, trauma injuries and poorly controlled diabetes. CCP was initiated in Cape Town and has since been rolled out in Johannesburg and Pretoria (2011), Bloemfontein (2012) and Durban (2013).