Eight months after the earthquake that claimed hundreds of thousands of
lives in
Haiti, wave after wave of trauma-related infections resulting
from amputations and surgeries performed in suboptimal conditions continue to
plague specialists in all fields.
Lack of shelter and decimated infrastructure may also be contributing to
increases in infections, ranging from vector-borne diseases to gastrointestinal
diseases and respiratory infections.
The common theme among health experts, with a range of experiences in
Haiti, is uncertainty. But not all of the news is bad.
Beyond medicine, a spirit of togetherness among
Haitians, medical personnel and volunteers is driving the effort past mere
survival and into the realm of hope. Saving lives by any means necessary is no
longer required, as medical tents and facilities have been mostly organized by
specialty, and patients are being treated for conditions and released rather
than spending weeks in acute care.
Early estimates
Despite this progress, with WHO and CDC surveillance data likely more
than a year from showing any real effect, medical personnel are left to deal
with devastating injuries and illnesses with few resources and, often, little
information about the big picture.
Data from several organizations, including WHO and UNICEF, indicate that
in addition to 220,000 deaths, the earthquake caused about 300,000 injuries and
led to roughly 4,000 amputations.
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| © 2010 iStockphoto.com/Claudia Dewald |
Al Ingersoll, CP, BA, prosthetics and orthotics program director for
Healing Hands for Haiti International Foundation, believes
these early estimates are inflated due to record-keeping issues and previous
health conditions within the country. He moved with his wife to Haiti in April
to focus on addressing people’s health care needs, as well as creating
education plans and assisting in the rebuilding effort.
“In my opinion, the early estimates of 2,000 to 4,000 persons with
amputations caused by the earthquake and who survived is too high and will
likely be between 1,000 to 2,000,” Ingersoll told O&P Business
News. “Most first-response organizations did not keep accurate
records for the first few weeks; injured were transported around seeking
service and were repeatedly counted; medical personnel moved a lot and
over-estimated their numbers; and, unfortunately, some of the injured did not
survive because of infection and other complications.”
Ingersoll also noted that pre-quake Haiti already had an elevated
population of amputees who did not wear prosthetic devices.
“In my opinion they were observed to be post-quake injured,”
he said.
Infection
Regardless of the number of people affected, trauma-related infections
are still a major problem, according to Daniel Fitzgerald, MD, of the division
of infectious diseases at Weill Cornell Medical College. Fitzgerald spent
extensive time in Haiti for several years before the earthquake through work
with the Haitian Group for the Study of Kaposi’s Sarcoma and Opportunistic
Infections (GHESKIO) organization.
“We have seen hundreds of amputations, complicated fractures and
external fixations,” he said. “These surgeries were done urgently in
less than optimal conditions and followed up with equally suboptimal
postoperative care. Patients are coming back with malunions of bones needing
recurrent surgeries due to infections.”
According to Dominique Bayard, MD, an internal medicine physician at
Boston Medical Center and a first- generation Haitian-American, “Soft
tissue infections, especially in post-trauma and postoperative patients, are
rampant. Patients are coming in to seek care after the infections have
progressed significantly.”
The future
With so many pressing issues to deal with, including infection control,
reproductive health, injured patient rehabilitation and the availability of
medication and other supplies, Fitzgerald said the relief effort is a marathon,
not a sprint — a statement that most individuals and organizations agree
with. Ingersoll added that upper extremity prosthetic fittings are not
proceeding as fast as necessary, and the prosthetic education training program
he and his organization are trying to institute has been slow to receive
approval.
Still, Ingersoll said he is impressed with the international response.
“In less than 6 months [more than] 1,000 lower limb prostheses have been
delivered and service capacity continues to increase. Hundreds of people have
been fit with custom and off-the-shelf orthotic devices,” he said.
“Healing Hands for Haiti [also] partnered with Handicap International
immediately after the quake to open a new physical rehabilitation center near
the center of Port au Prince.”
Fitzgerald said public-private partnerships will be key, given the scale
and influence of the private sector in Haiti. “We have been encouraged by
the willingness of private nonprofits and [nongovernmental organizations] to
work with the Haitian government, and vice versa,” Fitzgerald said.
Ingersoll also noted that his efforts have received a lot of help from
the graduates and instructors of El Salvador’s University of Don Bosco
prosthetics and orthotics program. In addition, Handicap International brought
in ISPO Category I management from France, Togo, Indonesia and, most recently,
Pakistan.
As of press time, 11 O&P facilities were completely functional and
another six were in the process of getting up and running. Before the
earthquakes, Haiti only had one full-time and two part-time facilities.
“Healing Hands for Haiti continues to receive significant support
from the International Committee of the Red Cross Special Fund for the Disabled
(ICRC-SFD) and other donors,” Ingersoll said. “We are excited to
announce the ICRC-SFD and American Red Cross will fund building of a new
O&P and therapy clinic on our grounds in the center of Port au
Prince.”
They hope to break ground in December.
Ingersoll said his surprises continue to be outside the P&O clinic.
“Inside, the camaraderie and determination are universal and contagious
whenever groups with similar stories are together,” he said. “So much
of daily life is completely back to ‘normal’ – a
hard-to-describe term.” – by Rob Volansky with additional
reporting by Jennifer Hoydicz
I was asked if I was interested in volunteering for the Hanger Ivan R.
Sabel Foundation to go to Haiti and set up the clinic with our team and I
immediately accepted. I knew in my heart that I was going to be there at some
point. I was there from the end of February through the last day of May.
In the first patients that we started seeing, there weren’t many
smiles at all. We had a group of young people who came up from Port au Prince.
We had this one girl who was practicing ballet and she became a transfemoral
amputee. Everybody was solemn. Of the group, the young girl was the first to
stand. She was just sitting there looking at this leg-like device and she was
probably just trying to figure out what was going on because we weren’t
able to communicate effectively. When she first stood up, electricity went
through the room. It was palpable. She immediately started smiling and everyone
in the room started smiling. Everybody cheered and she started walking and then
she started giggling and laughing. The translator told us that she was so happy
that she could walk. At that point in our clinic, you could see all this
tension release from the room. It was amazing. From there on, everybody knew it
would be alright and it just started to spread. The hope and the positive flow
started to get going.
Now I definitely know the difference between wants and needs in my life.
I appreciate everything that I have much more. I am not the same person that I
was when I went. I’ve just learned that no matter what, the people there
are amazing people. They taught me how to look forward and work hard and be
happy with what you have.
You can say that you’re a “glass is half full person.”
The people of Haiti taught me that I’m just happy I have a glass.
— Jay Tew, CP
Volunteer, Hanger Ivan R.
Sabel Foundation and area practice manager, Hanger Prosthetics and
Orthotics
