Three weeks after a major earthquake hit Haiti, we are still focusing our response on providing emergency aid to those affected, and to amputees in particular, who now number more than 2,000, according to our initial estimates. Handicap International is also preparing its long-term response to ensure the case-management of these thousands of victims.
Isabelle Urseau, Handicap International’s rehabilitation manager, explains more in an interview.
What are you doing to help amputees?
Our health teams in Haiti are currently performing post-operative follow-up of people with injuries and amputees, with the aim of limiting disabling after-effects. The goal is to restore their independence, as far as possible, using adapted orthopaedic materials.
What are the conditions for getting a person back on their feet again?
In order to fit an artificial limb onto an amputated limb, the amputation needs to have been performed under satisfactory conditions. The end of the severed bone needs to be rounded and covered with muscle padding. The amputation also needs to have been done a sufficient distance from joints to ensure the satisfactory functioning of the artificial limb.
And if these two conditions are not met?
It is difficult if not impossible to fit an artificial limb. A second operation is necessary, representing an additional trauma for the amputee. In Haiti, it’s unfortunately a situation with which our staff members are familiar, because of the conditions in which a very large number of surgical operations have had to take place in record time. Certain amputations do not fulfil the conditions required to enable the person to be fitted with an artificial limb.
What are the different stages?
Amputees must be case-managed without delay. The first stage, following amputation, is the post-operative follow-up, which includes rehabilitation care to maintain muscular strength and joint flexibility, as well as psychological support. Handicap International is also setting up an amputee database to optimise the follow-up of patients over the long-term.
How quickly are you supplying artificial limbs?
For this type of emergency, we are initially using a temporary fitting technology* that enables people to get back on their feet quickly and begin a more dynamic rehabilitation process, which is also favourable to their psychological state. These temporary artificial limbs can only be supplied after the stump has healed, that is, after several weeks or months. Such a fitting can then be performed within 24 to 48 hours. The patient rapidly regains their mobility, and therefore resumes physical activity favourable to their general state of health. Psychologically, a person’s self-image, sometimes seriously damaged by the loss of a limb, is to some extent restored. Their opportunities for the future are also considerably improved.
So emergency fitting is an intermediate stage?
This approach will enable the rapid identification of people with painful stumps which require specific care and amputations in need of surgical correction. In this case, it is important that the operation takes place as soon as possible, since amputees are understandably increasingly reluctant to see their disabled limbs shortened again as time passes.
How long can the amputee keep these temporary artificial limbs?
For four to six months. The stump gradually takes its definitive form and then enables the fitting of a permanent artificial limb, which is customized for the patient, and more aesthetic. Permanent artificial limbs must then be produced, which must be changed every three to five years in the case of an adult, and around every six months in the case of a child in full growth.
Are you planning to be involved over the long-term?
Given the severity of the earthquake, the challenge which will arise in the very near future is the emergence of an “amputee generation” in need of artificial limbs. This task should be fulfilled by numerous stakeholders, as part of a coordinated and consistent approach. Handicap International is preparing to supply temporary emergency artificial limbs to 300 to 400 people between March and August 2010. We expect to start the production of permanent artificial limbs from July 2010 onwards. And we are planning to train Haitian staff to ensure the future follow-up of amputees in terms of fitting and rehabilitation. It’s a long-term challenge.
*Temporary artificial limbs (also called “training limbs”) are also used in care-management protocols in our countries. In a situation such as Haiti, they are called “emergency artificial limbs” because they enable us to respond to mass fitting requirements in a crisis situation within a very short space of time.
> More information about our response to the earthquake in Haiti
