Monday, February 8, 2010

For Haiti's Countless Amputees, a Hard Road Ahead

By Ianthe Jeanne Dugan
Aid Groups Seek to Build a System for the Thousands Who Lost Limbs in the Earthquake

Selita de Elois carries her 4-year-old daughter, Louise, whose lower left leg was amputated after a wall fell on her during Haiti's Jan. 12 quake.

PORT-AU-PRINCE, Haiti—The only place in Haiti that makes artificial limbs and teaches people how to use them was destroyed in the earthquake, a loss that symbolizes the hard road ahead for this impoverished nation's countless new amputees.

Healing Hands for Haiti, a nonprofit with a rambling headquarters in the capital's Delmas neighborhood, has treated more than 25,000 people over 10 years. Now, as experts estimate that as many as 40,000 people underwent amputations in the quake's aftermath, the group's facilities are in a shambles. "We have to start over," says executive director Eric Doubt.

Even before the quake, Haiti's underfunded health-care system lacked resources for people who lost limbs in car accidents or to infections. The situation was complicated by a government that offered little support for the disabled, and a culture in which some people regarded the disabled bad luck because of the economic burden they represented.

Healing Hands is among many organizations and private doctors that are attempting to create, virtually from scratch, a system to treat amputees, who need urgent care now and maintenance for decades. The immediate need is for crutches and exercise therapy that will keep remaining muscles functioning. Artificial limbs, once fitted, need to be changed every three to five years, and every six months for growing children.

"Prosthetics are not a one-time thing," says Rob Sheridan, a surgeon from Massachusetts General who performed amputations on many earthquake victims at a hospital in rural Cange, 35 miles from Port-au-Prince, run by Boston-based nonprofit Partners in Health.

Dr. Sheridan, who also is chief of burn surgery at the Shriners Hospital for Children in Boston, is one of many doctors who performed life-saving operations and now plan to help rehabilitate patients. "We are trying to put together a program that would last a generation," he said.

The United Nations has put together a "sub cluster" to help disabled in the wake of Haiti's earthquake. The group, headed by Handicap International, had its first meeting in late January in Port-au-Prince, with representatives from the Haitian government as well as Healing Hands, Doctors Without Borders, Christian Blind Mission International and others.

The group will start producing temporary "emergency" prostheses in mid-February with salvaged equipment from Healing Hands in a tent compound near the Port-au-Prince airport. Components are to be shipped this weekend from France to supply 50 temporary artificial legs to patients whose stumps will soon be healed enough to be fitted, which takes between 4 weeks to several months. Components for 250 more prostheses are to arrive in the next month. These temporary limbs allow patients to regain mobility and generally they receive a customized limb in four to six months.

The group is planning to build at least one more new prosthetic factory in addition to the one Healing Hands intends to rebuild. "We will need more than one plant to handle all of this," says Wendy Batson, Handicap International's executive director.

The goal, Ms. Batson says, is to train workers to use local material to produce limbs at a cost residents can sustain—about $35 to $75 each for materials and labor. By comparison, in the U.S., insurance companies are billed as much as $20,000 each.

The number of Haiti's new amputees remains unknown. Handicap International counted 1,500 at 14 hospitals and heard of another 500. Ms. Batson estimates there are perhaps 4,000 in all.

Joia S. Mukherjee, medical director for Partners in Health, estimates 20,000 to 40,000 people may have lost limbs. At the group's hub in Cange, doctors in two operating rooms performed dozens of amputations in a single week. "This is going to be like Cambodia," she says, which has more than 40,000 amputees whose limbs were blown off by land mines.

Haiti's wounded were in worse condition than those in other countries hit by quakes, such as Pakistan and China, says Handicap International's Ms. Batson, because Haiti's medical infrastructure was destroyed. Many people lacked access to quick treatment that would have forestalled gangrene.

Joseph Shello, a construction worker, spent four days seeking medical care after the earthquake. By then, it was too late to save his mangled right hand, doctors at the Partners in Health Cange hospital told him. "I don't know how I will work again," said Mr. Shello.

The problem is among many acute medical issues facing Haiti. Trauma cases are decreasing, doctors say, but more patients now require mental-health care. Also on the rise are cases of diarrhea, tetanus and chicken pox, according to the United Nations. To prevent the spread of disease, the government says it will begin emergency vaccinations this week. UNICEF intends to deliver 24,000 latrine slabs, but is puzzling over how to install them amid rocky ground, concrete surfaces and a lack of sewage.

Giving birth to handicapped children, Mr. Doubt says, is considered bad luck because it economically disadvantages a family. Orphanages have a disproportionate number of disabled children as a result. He and others hope that given the new wave of amputees that have come out of the earthquake, the nation, with the help of outside organizations, will build a better support system.

"We are talking to foundations, medical bodies and other non-government organizations," Mr. Doubt says. "We are trying to find the resources to get something going quickly to rebuild."

Write to Ianthe Jeanne Dugan at

Source: WSJ

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