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Haiti day 3: Amputees


Bel Jean still hopes to be a priest. But there is a problem. "You need two arms to elevate the mass," explains the 29-year-old, raising his stump in the air.

The young man (pictured above, left) was in Port-au-Prince studying for the priesthood when the earthquake struck on Jan. 12. During the night that he spent trapped beneath the roof of his school, he mostly cried. Then he prayed. The loss of his arm has him devastated. What he wants, though, is to replace his missing right arm with a new one so that he can hold high the sacrament during Sunday mass.

I'm in a ward at Paul Farmer's hospital in Cange, a 2.5-hour bumpy car ride further north deep into the island nation from Hospital Albert Schweitzer in Deschapelles, where I have been staying the past few days. I'm traveling with members of the newly-formed rehabilitation team from HAS, to fit prosthetics for four of five of the amputees at Farmer's hospital, which is similar in size and mission to HAS.

In a mad dash to begin to meet the overwhelming demand for artificial limbs in this country, where amputations have become the defining injury of the quake, HAS has quickly built a prosthetics lab, working with the Bethesda, Md.,-based Hanger Orthopedic Group Inc., a provider of prosthetic and orthotic products and services. The effort began 10 days ago. Within five days they had made 10 prosthetic limbs, and had five amputee patients up and walking.

Ian Rawson, who runs HAS, describes the situation during the earthquake on his blog:

Patients who arrived at HAS with crushing injuries to the extremities were managed by a specialized nursing wound care team, and the surgeons were very conservative in their management of these cases, exercising limb salvage strategies to the greatest extent possible. Only 15 long-bone amputations were required for the patients at HAS, but soon after the earthquake, we began to receive referrals from other hospitals for patients who required revisions of their original amputations.

HAS is an 80-bed hospital with an all-Haitian staff of 16 doctors and about 50 nurses. Today's patient count hovers around 120 patients. Most of the amputees at the hospital are newly homeless. They'll need to stay at least a week for fitting of prosthetics and then rehabilitation therapy to teach them to walk or to use their new prosthetic arms. Since most have no home to return to, the hospital is housing them at a place called L'Escale, a former tuberculosis village, a short walk past a village market from the hospital. Where they'll go from there, no one really knows, but at least they'll be able to walk away when they leave. Most will try to return to jobs in the fields or as laborers.

Estimates of crushing injuries that resulted in the emergency removal of limbs within the week after the quake range from 2,000 to 4,000. Eleven patients at the hospital are at some step of the limb making process right now. Today, the HAS rehabilitation team will add four more from Farmer's hospital.

As the news gets out that HAS has perhaps the only functional prosthetics laboratory in the country - two were destroyed in Port-au-Prince during the earthquake - the demand is likely to spiral out of control. "Soon we'll start to get people showing up at the hospital doors," said Shaun Cleaver, one of two foreign-trained physical therapists in the entire country. He works at HAS. "It could get a little crazy."
The rehabilitation team, including Cleaver and John "Jay" Tu, a prosthetist with the Hanger company, measure Bel Jean's stump, then examine how well the stump has healed to determine if he's ready for the casting process. That's the first step. The cast will be taken back to the lab to create a mold that can be used to design a limb to fit the patient. Often the stumps of the earthquake victims have to be repaired surgically before being fitted because the initial operation was done under emergency situations in tents in the first few days after the quake.

"It was my last year in college to be a priest," Bel Jean says. He shrugs. Now he doesn't know what his future will hold. "You have to able to write if you're a priest in Haiti, to run schools," he explains. He lost the hand he writes with. His amputation is described as "above elbow." The girl beside him is a double amputee, both "BK," or below knee. The girl in the bed next to her is a single amputee, below knee. The plan is to transfer all three to HAS after their new limbs have been fabricated. They'll stay there for the weeklong rehab process. After that, no one's sure.

"I'm Roman Catholic," Bel Jean says. "I used to love to see the Priest celebrate the mass when I was a child. I had one year left of school to become a priest." He shrugs again and smiles. "Now, I don't know."

Tracie White is a Scope contributor and writer in the medical school’s communication office. She is presently in Haiti to write about the situation there. You can see all of her updates in our Haiti category. More details on Stanford's Haiti relief effort are available here.

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