Sunday, January 24, 2010

Simple solutions may work best for amputees in Haiti

From the St. Petersburg Times in Florida. In the picture, Vemah Cade’s leg was severely injured when her home collapsed in Haiti. Her leg was amputated Tuesday morning.

The Haiti of tomorrow reveals itself in earthquake news photos and videos that show doctors performing innumerable amputations of hands and feet, some of them with tool-shed hacksaws. The images unveil a new mass population of amputees in a country where the able-bodied barely get by, where begging is the occupation of amputees, where the disabled are judged a burden, even a curse.

An hour's flight away, the United States boasts amazing new prosthetic technology, including bionic hands and feet powered by tiny motors, microprocessors and sensors that adjust to stairs or hills. It's a country where amputees dare to compete in Olympic track events. It has manufacturers who are eager to help.

But our technology won't do much good in Haiti, say prosthetists and doctors who work there. Microprocessors fizzle in water and exotic alloys shatter on rocks. It's little things that matter most: Is the foot the right color? Does it look like a foot? Does it have toes? Can its owner, asks one physical therapist, "beat the daylights out of it?"
The Red Cross has a foot that's almost indestructible. To make it requires a hunk of plastic, an oven and a pocket knife.

Before the earthquake, Haiti had two shops that made prosthetic hands and feet.

One has been run by Healing Hands for Haiti for 10 years in Port-au-Prince. The other was run by the St. Vincent's Center for Handicapped Children, established in 1945. The earthquake claimed both shops. Healing Hands has seven workers unaccounted for and 75 percent of its compound in ruins. At St. Vincent's, six were killed.

Executive director Eric Doubt said Healing Hands may be starting from scratch.

Before the earthquake, Doubt estimated Haiti had 800,000 disabled people. No one has ever counted. "The handicapped are a huge burden for families and usually abandoned," he said. "Government focus is zero. They are the bottom of the pile."

Many U.S. organizations are gearing up to offer aid. The Hanger Orthotic Group announced an initial donation of $250,000 in cash and equipment. It's the same company that developed new materials and technology to create a prosthetic tail for the injured dolphin Winter at the Clearwater Marine Aquarium.

But in poor countries, infusions of technology and expertise sometimes backfire.

David Lawrence is a physical therapist and amputee specialist in Richmond, Va., who works for Physicians for Peace. He co-founded that organization's Walking Free program to help amputees in poor countries, including Haiti. Its philosophy is to train local people to make and repair prosthetics.

He tells a story about a donation of 500 wheelchairs for the handicapped in Belize. Because the wheelchairs were designed for tile floors, they fell apart on rocky roads. But the donation of all those wheelchairs had caused Belize's only wheelchair repair shop to go out of business.

"If well-meaning people come in, donate prosthetics and leave, what happens when a component breaks?" he said. "It's almost more damaging to give a child something that can't be replaced."

Jeffrey Bigelow, a resident neurologist at Yale University who surveyed the needs of Haitian amputees for Healing Hands in 2004, said even simple, locally produced devices have to be skillfully made or they're just too painful to wear. In his survey, only 25 percent of amputees ever wore a prosthetic. Crutches were more common.

A famous success story involves a prosthetic called the Jaipur Foot, designed in the 1960s by a semiliterate craftsman in Jaipur, India, out of rubber, wood and tin. It could be worn without a shoe, could be used for squatting or for climbing trees, and it had toes. A half-million people began wearing it. It revolutionized prosthetics in poor countries.

One successor is a Red Cross design called the ICRC Foot, made from plastic. An Internet Red Cross manual shows how to make one, including how to shape the foot with a pocket knife and warm the pieces in an oven (to 250 degrees). The Red Cross says the foot is durable, easy to fix, adaptable to any climate and compatible with prosthetics standards.

What Haitians have going for them is their toughness and the fact that, in those terrible video and photo images, many of the earthquake's amputees are young and strong. They may change attitudes about the disabled, said Doubt.

"We have a club foot program for children. To get to it, some of the children start out miles away on donkey, continue on foot for more miles, then hitchhike as they get close to Port-au-Prince. They go home the same way. Then the children do the same thing the next month.

"Resilience is born in them."