Haiti's Amputee Surge: Rehab, Prosthesis, Attitude Challenges in the Earthquake Recovery

A Haitian friend of mine relayed how during last week's earthquake, falling debris landed on the foot of one of her relatives. A few days later, without access to medical care, he died. Others who, like this man, suffered a crushed limb or appendage during the earthquake but who are fortunate enough to receive medical care will likely have their limbs or appendages amputated.

Press reports from Haiti depict amputations that wouldn't be necessary in a well-equipped and fully-staffed hospital but are the only way to save lives in the makeshift field hospitals scattered throughout what's left of the Haitian capital. A surgeon from Medecin du Monde issued a statement reported in Australia's Herald-Sun Thursday that estimates the number of amputations his group will perform in the next few days at 400.

Can you imagine the horror of the earthquake survivor? To first suffer prolonged agony amid widespread destruction with withering hope, to experience relief at being pulled from rubble alive only to face the brutal shock of having a limb or appendage sawed off?

The Guardian reported on the ironic experience of 29 year old Melene Samedi whose last act before the Haiti earthquake was shopping for shoes; during her shopping trip, the earthquake hit, dislodging a chunk of concrete that slammed into her leg. Today she is an amputee, recovering in an impersonal, makeshift hospital ward. Dr. George Bouttin, a Ft. Lauderdale, Florida surgeon volunteering in Port-Au-Prince, estimated that 95% of Haitians who suffered crushing injuries in the earthquake will undergo amputation.

Surgeons from Doctors without Borders predict this will lead to a tremendous surge in amputees in Haiti, possibly as many as 200,000. Dr. Phillip Guillieu, a volunteer surgeon from New York, told the Guardian that he alone performed 30 amputations in the past few days. My heart aches for the Haiti earthquake survivors facing this second assault on their bodies, however necessary the amputation may be.

The number of amputations indicates that the need for post-earthquake physical rehabilitation and prosthetic devices for the amputees will be tremendous.

Amputation Shock

Seventeen years ago, I awoke early one workday to a ringing phone. I will never forget my mother's words.

"Dad's in the hospital," she said. "They have to take his leg off."

I screamed, "No! They can't!" even as it dawned on me that this emergency wasn't negotiable.

My dad had been a heavy smoker since his teens, and the peripheral arteries in his lower leg closed up, cutting off the blood supply to his lower leg and foot.

I choked on the day of his amputation, seeing him immediately before surgery and knowing that one leg would be gone the next time I saw him.

After the surgery, my father wanted to show me the stump; I didn't want to see it.

He joked about being 20 pounds lighter. I cringed, still finding the whole concept of amputation gruesome.

A day or two after the amputation, my father demanded that we take him home, proclaiming rehab was a waste of time. Then he tried to stand up and couldn't balance on one leg. He fell down and couldn't shift his weight in a way that would allow him to get up. In his mind, he still had two legs, not one.

Necessary Rehabilitation

My father spent weeks in rehab where he participated in physical therapy, learning to balance, to stand, to reach, to get up when he fell, and to care for the stump where his leg once was. It was weeks before the stump healed sufficiently that he could be fitted for a prosthesis. Then he waited while it was custom manufactured.

One of the interesting aspects of the prosthesis was choosing the right kind. Did he want one that would simply enable him to walk? Or did he hope to run marathons, climb mountains? At 62, my father was something of a couch potato with no athletic aspirations and was content with a simple prosthesis. Younger Haitians or those who depend on movement more so than my car-society father did will likely need prosthetic devices that offer greater opportunity for mobility.

Once my father's prosthesis arrived, he had to learn how to put it on and care for it. He had to learn how to balance all over again. He graduated from a wheelchair to a walker, then a four-footed cane, and finally an ordinary cane.

My father had to build muscle to live as an amputee. He learned in rehab that tasks like walking required 30% more energy for him to accomplish than for those with natural limbs intact.

The new amputees adjusting to life after the earthquake may well be simultaneously coming to terms with the loss of housing, loss of their capital, and loss of family members and friends at the same time as they are learning to live without a limb.

Housing Adjustments

My father's homecoming required preparation. No longer able to climb stairs without extraordinary effort and some risk, my father would be sleeping in the dining room, converted into a bedroom. His bathroom required hand rails on the tub, a raised toilet seat, and non stick appliques to keep him from falling in the shower.

We installed a wheelchair ramp, for throughout his post-amputation life, my father resorted to using a wheelchair for early morning bathroom visits and during occasional bouts of stump irritation.

We checked the flooring for uneveness or other hazards that could cause trip-and-fall injury. Carpet had to go.

As Haiti is being rebuilt in the aftermath of the 2010 earthquake, Haitians of all ages will be going through a similar process to what my father experienced, learning to live with an artificial limb. They and their loved ones will be learning how to deal with the many daily challenges presented in life after amputation.

Haitian Amputees Will Need Costly Prosthetics Every 3 Years

According to the Boston Globe, in 2005 below-the-knee prosthetics usually cost $6,000 to $8,000 while a prosthetic arm or a leg above the knee typically cost from $10,000 and $15,000, with some prosthetics costing as much as $35,000. And a prosthesis is not a one time purchase. It requires adjustment and it wears out over time and needs to be replaced. The average prosthesis lasts about 3 years, the Amputee Coalition says.

The costs of rehabilitation and prosthetic devices for as many as 200,000 Haitians will be a challenge. According to Partners in Health, the vast majority of Haitians do not have health insurance coverage. Unlike amputees in the USA, most Haitian amputees will need to fund their rehabilitation and prosthetics themselves unless international agencies step in and provide these services and equipment. Not only is the Haitian government in shambles due to the earthquake, its health care expenditures were minimal when it was fully functioning, a mere $2 per capita per year, according to PIH.

Legal Protections for Amputees

In the United States, a 30 year history of anti-discrimination laws fosters an infrastructure and employment climate accommodating to amputees.

In Haiti, there's no equivalent of the Americans with Disabilities Act or Rehabilitation Act to ensure the new amputees access to public accomodations, transportation, education, or employment. Not only are disability protections lacking in Haiti, the society is reputed to be prejudice-ridden when it comes to the disabled. As Patricia E. Bauer wrote about the lives of disabled children in Haiti for Disability News in 2007:

"In the toughest neighborhoods, as advocates for the disabled explained to me, crippled girls are often raped and degraded, passed around until they are of no further use to their tormentors. Handicapped boys can be found clinging to life at the lowest rungs of human existence. It follows that they don't have much of a life expectancy.

Sometimes, as more than one aid worker has told me, these children are dumped - dead or alive - on piles of rotting garbage, left for the hardy, near-feral pigs that roam the Port-au-Prince slums."

Perhaps the sheer number of amputees or the empathy arising from sharing a common earthquake experience will foster greater acceptance of the disabled in Haiti as the country rebuilds. In any case, precipitous societal adjustment will be required for Haiti to integrate large numbers of recent amputees at once in a time of chaotic rebuilding.

Sources: http://www.heraldsun.com.au/news/breaking-news/medics-report-mass-amputations-in-haiti/story-e6frf7jx-1225820638646; http://www.guardian.co.uk/world/2010/jan/21/haiti-doctors-warn-amputee-crisis; http://www.boston.com/business/globe/articles/2005/07/05/cost_of_prosthetics_stirs_debate/; http://www.amputee-coalition.org/fact_sheets/prosfaq.html; http://www.amputee-coalition.org/fact_sheets/assist_orgs.html; http://www.pih.org/where/Haiti/Haiti-background.html; http://www.patriciaebauer.com/2007/12/18/waiting-for-god-in-a-haitian-orphanage-1053/.