Haiti's amputees take their first steps to recovery

© William Daniels Jerry (right) a boy whose leg was amputated in MSF Chancerelle hospital in Port-au-Prince. He has received care at an MSF medical facility. He is here his mother, Louisemerre.

© William Daniels

© William Daniels

After the operation, Jerry is back on his bed. The physiotherapist talks to him about the exercises he will need to do so he is prepared to receive his prosthesis. Viviane Hasselmann, physiotherapist from Handicap International, works together with an MSF team at Hospital Isaie Jeanty in Chancerelle, Port-au-Prince.

© William Daniels

© William Daniels

© William Daniels Jerry stands up for the first time after the operation. The routine should start straight away. He needs to strengthen his other leg and his arms and keep his mobility so, in three months time, he is ready to receive a prosthesis and can start walking again, says Viviane Hasselmann, physiotherapist from Handicap International, working together with an MSF team at Hospital Isaie Jeanty in Chancerelle, Port-au-Prince.

Jerry is seven, and was severely injured in the January 12 earthquake that devastated Port-au-Prince, Haiti. Trapped under the rubble when his house collapsed, he emerged with a severe open fracture to his femur.
Louisemerre, Jerry's mother, lost two of her five children in the quake. Determined not to see a third child die, she immediately brought Jerry to one of Médecins Sans Frontières' (MSF) hospitals in Port-au-Prince, where he received emergency medical care.

MSF put Jerry on antibiotics straight away to keep the infection in his open wound at bay. He was then taken to an operating theatre (OT), where an MSF surgeon performed a debridement &#– a complete cleaning of the wound. A few days later the doctors brought Jerry back to the OT for the rechecking and recleaning of his wound and discovered the infection was still raging. There was an immediate concern that it would spread to the rest of his body and threaten his life.

"The wound was very near the groin, so if the infection went above it there would have been very little we could have done to save him", said MSF's Dr. Karin Lind in Port-au-Prince. "We knew we had to amputate if we wanted to keep him alive."

In the 20 days following the earthquake, MSF teams treated more than 11,000 patients. During that time, MSF surgeons worked around the clock, carrying out over 1,300 surgical operations. Just above one-tenth (140) of those operations were amputations, and they were always the last resort in the effort to save the life or limb of the patient. However, in some cases MSF had no other choice than to carry out an amputation.

"We cared for scores of open fractures as a result of this disaster, and we managed to save so many peoples' limbs," explained Rosa Crestani, MSF's emergency medical coordinator in Haiti. "But sometimes a doctor has no other choice than to carry out an amputation - either because a limb is in such a bad state that it is impossible to save, or because the wound is so badly infected that keeping the limb means risking the patient's life."

An amputation only goes ahead once MSF surgeons receive a patient's consent. Then, MSF psychologists work with people before their operation, to help them come to terms with the loss of the limb. The psychologists also work with the patient's family to help prepare them for what this means for their shared future.

"They already have to cope with the trauma of the earthquake and the trauma of losing loved ones, so an amputation is yet another layer to their suffering," said MSF psychologist Renaud Sander. "After the amputation, we try to make sure the family will support the patient. But it is very difficult to tell a mother to be strong for her child after she has lost her husband and everything else she had in the earthquake."

After amputation is physiotherapy and is essential to improve mobility and prepare the patient for their prosthesis.

"It's crucial to start early to prepare the patient for an artificial limb," explained Viviane Hasselmann, a physiotherapist from Handicap International who is working together with MSF staff at Isaie Jeanty hospital in Port-Au-Prince. "So, with physiotherapy we work to strengthen the muscles in the limb that will receive the prosthesis, and we also work to strengthen their other legs or arms. After three months, the scar should have had enough time to heal and the skin should be strong enough for the patient to receive the prosthesis."

Physical recovery after major surgery can take a long time and patients need specialised care. In addition, many of MSF's patients lost their homes in the earthquake so, without a clean shelter in which to recover, leaving hospital too early after surgery would be a major threat to their recovery process.

However, in Port-au-Prince today there is an overall shortage of beds for this longer-term care, as hospital places remain filled with the injured. To cope with the large numbers of patients in need of prolonged assistance, MSF set up several medical structures specialising in post-operative care.

"We need to carefully follow-up patients after surgical operations and at the same time make space in those hospitals where we still provide surgery, as there is an ongoing influx of patients," added Crestani. "Thus, we are increasing the number of places we can provide this type of long term care."

One such place is Mickey, a former kindergarten school, which MSF turned into a post-operative centre. It is one of four centres that MSF established following the earthquake to cope with the significant needs for this care. Last week MSF constructed a new medical tent in Mickey's courtyard, doubling the number of beds available for post-operative patients, so that now up to 60 people can receive this essential treatment there.

In Mickey an MSF team of nurses, doctors, psychologists and physiotherapists work together to closely follow-up patients - cleaning and dressing wounds, providing psychological support and helping them through a routine of exercises. It is here where young Jerry went to recover after his amputation, under the attentive eyes of his mother.

Through this close attention and quality care, Haitians wounded in the earthquake, like Jerry, can take the first steps back to recovery.