The 7.0 magnitude earthquake which struck Haiti on January 12 of 2010 created the challenge of providing prosthetic and orthotic care to a severely marginalized population that was already lacking in adequate services.
Prosthetic & Orthotic Services in Post-Earthquake Haiti
1. Prosthetic & Orthotic Services in
Post-Earthquake Haiti
Dave Ritchie, Amanda Barizo
Nathaniel Wheeler, Edward Phinney
2.
3. Our intention for this presentation is a proposition,
that although the magnitude of the necessity alone is
no guarantee of an appropriate response, the
Prosthetics and Orthotics professional community, by
virtue of our core principles, disciplines and ethics, and
broad scope of practice, is innately suitable for the
providing of sustainable rehabilitation services and
strategies to the Haitian people. The contingent P&O
enterprises already in place and others yet to be
deployed we consider to be categorically appropriate
to the character and spirit of the engaging discussions
that are so desperately needed in this hour.
4. P&O Services in Post-Earthquake Haiti
• Overview
Haiti, Jan. 12 earthquake, immediate effects, P&O response
• Current P&O practices
Survey, fabrication trends, training programs
• Challenges, Further Needs
Sustainability, standardization, ISPO Code of Conduct,
volunteering
• Acknowledgements/Q&A
6. Pre-Earthquake P&O: Needs Assessment
• 800,000 disabled (GoH, 1983)
• Total disabled people in need of P&O services: 50,000
(WHO 0.5% of ~10 million pop.)
• Number of trained personnel needed:
67 (Cat I/II), 300 (Cat III)
(WHO/ISPO, Guidelines for Training Personnel in Developing Countries in P&O services)
7. Pre-Earthquake P&O Services
Healing Hands for Haiti, PaP
St. Vincents Hospital, PaP
Advantage Program, Les Cayes
Center for Eucharistic Heart, Cap
Haitien
(Eitel, 2010)
13. • Monetary
I. Donations • Componentry
• New or gently used
prostheses
• Fabrication materials
• Equipment
14. • Prosthetic & Orthotic • In Conclusion
Component Clearinghouse
(P.O.C.C)
MedShare International
c/o P.O.C.C.
3240 Clifton Springs Road
Decatur, GA 30034
15. II. Parachute Services
• Discouraged by ISPO
• Neglect in-country services and capacity building
of Haitians.
• Often leave problems in their wake
(Kistenberg, 2010)
16. III. Patient-transport Programs
Highly discouraged by ISPO
• Componentry may not be appropriate for the
patient’s home country
• Traveling to a foreign country can be
disorienting for the patient
• Upon return, patient may be left with a sense of
abandonment
(Kistenberg, 2010)
17. IV. Rotational Short-term Missions
Rotational short-term missions
Length of stay and objectives of the P&O clinic
should be considered
18. V. Long-term
Projects
• Adhere to international standards
• Implement training programs
• Offer integration programs and psychosocial support
21. •Healing Hands for Haiti with Handicap
International
• Hanger Prosthetics Clinic
• Hopital Albert Schweitzer
• Mission of Hope
• Hopital Sacre Coeur
• BRAC Brace and Limb Center
• Haiti Hospital Appeal
22. Question #1: What are the most common injuries
and pathologies you have treated?
23. Question #2: Of your P&O clients, what is the
Fabrication those injured by the January
percentage of Trends
earthquake?
24. Question #3: What fabrication
methods are most commonly
practiced at your facility (i.e.
Lamination, Polypro sockets,
donated parts, ICRC kits)?
25. Question #4: Approximately how many
patients have you fitted for a device?
Question #5: What was the follow up
frequency?
32. Further Needs
Overwhelming enthusiasm for providing LE prosthetic
devices, but orthotic care is far more needed.
• Pediatric orthotics
• Traumatic and chronic disease orthotic devices
Upper extremity prosthetics
(Ingersoll, 2010)
33. Challenges
Sustainability
• Education, materials
Coordination
• Geographical
• Technical
• Governmental
Information gaps (pre-quake, new injuries)
Ethical considerations of P&O groups
• Publicity, previous experience in undeveloped
nations, cultural sensitivity
(Stanfield, 2010)
34. “The sheer quantity of humanitarian assistance efforts
in Haiti is heartwarming and inspiring. But it is also
alarmingly inconsistent, with examples ranging from well
thought out and appropriate relief work to the infamous
charitable group that allegedly kidnapped the children.”
Jon Batzdorff, CPO, Chair of the
International Outreach Committee of US-ISPO.
35. Code of Conduct for Prosthetic and
Orthotic Assistance
Non-governmental Humanitarian and Development
1. Avoid discrimination on the basis of race, religion,
nationality or political party.
2. Assistance shall not require any political or religious
endorsements or behavior in order to receive benefits
3. Respect the local customs and culture
36. ISPO Code of Conduct for Humanitarian
Organizations
ISPO Code of Conduct for Humanitarian
Organizations
37. Code of Conduct for Prosthetic and
Orthotic Nongovernmental Humanitarian and
Development Assistance
4. Encourage and support local capacity for providing
P&O services.
5. Avoid creating dependency of the local community on
the NGO for future follow up, adjustments,
replacements.
6. Materials should be used which can be found or
acquired locally.
38. Code of Conduct for Prosthetic and
Orthotic Nongovernmental Humanitarian and
Development Assistance
7. Avoid overlapping of services
8. Coordinate efforts, planning, and delivering of
services with the local community
9. Consider long-term development goals, not simply
emergency immediate needs.
(Batzdorf, 2010)
42. Acknowledgements
Dan Blocka & Gord Ruder
Al Ingersoll
Healing Hands for Haiti
Shaun Cleaver
Albert Schweitzer Hospital
Katherine Mackenzie, Diana Cherry
Mission of Hope
Monir Uzzaman
BRAC Brace & Limb Center
Ann Culloo,
CRUDEM & Hospital Sacre Coeur
Vern Hostetler, Hanger Klinik
Reninca Hill, Haiti Hospital Appeal
43. References
Batzdorff, J. (2010) Code of Conduct for Humanitarian Organizations. Retrieved from November 30, 2010 from US-ISPO website:
http://www.usispo.org/code.asp
CDA Collaborative Learning Projects (2010) A Brief Background to Conflict in Haiti. Retrieved November 30, 2010 from CDA website:
http://ww.cdainc.com/cdawww/.../rpp_haiti_brief_background_20100203_Pdf_1_1.pdf
Eitel, S. (2010) Haiti Mission Report. Retrieved November 30, 2010 from One Response web site:
http://oneresponse.info/Disasters/Haiti/disabilities/publicdocuments/Eitel%20Haiti%20Feb-Mar%202010%20Report%20-final%20draft.doc
- The international community has shown overwhelming enthusiasm for providing prosthetic devices, but orthotic care is
far more needed.
Groupe de Travail Inclusion, Readaptation et Situation de Handicap (2010) Liste des Services Orthopediques , Appareillage et Readaptation
Haiti.
- Geographical and technical coordination is a constant problem.
International Committee of the Red Cross (2010) Polypropylene Technology. RetrievedCalvot, HI's disability and emergency advisor
Thomas from the ICRC website:
http://www.icrc.org/eng/assets/files/other/icrc_002_0913.pdf
International Committee of the Red Cross (2010) Prosthetics and Orthotics Manufacturing Guidlines. Retrieved from the ICRC web-site:
http://www.icrc.org/eng/resources/documents/publication/p0868.htm
Rencoret, N., Stoddard, A., Haver, K,. Taylor, G., Harvey, P., (2010) Haiti Earthquake Response Context Analysis. Retrieved November 30
(2010) from ALNAP website: http://www.alnap.org/pool/files/haiti-context-analysis-final.pdf
Rogers, J., Kistenberg, R.,Ingersoll, A,. (2010) Creating a Unified O&P Response to the Haitian Tragedy. Retrieved November 30, 2010 from
American Academy of Orthotists & Prosthetists website: http://www.oandp.org/about/press/
Kistenberg, R. (2010) Prosthetics and Rehabilitation Services for People with Amputations in Haiti – Message from the Chair of US-ISPO.
Retrieved November 30, 2010 from US-ISPO website: http://www.usispo.org/message_haiti.asp
Stanfield, M. (2010) Haiti: The International Response. Retrieved from oandp.com website: http://www.oandp.com/articles/2010-05_02.asp
University of Don Bosco (2010) Proposal of Education in Prosthetics and Orthotics in Haiti. Retrieved November 30, 2010 from Physical
Rehabilitation Programs in Haiti Forum website: http://groups.google.com/group/haitiprp/browse_thread/thread/32ac1844d61883f1?hl=en#
World Health Organization (2005) Guidelines for Training Personnel in Developing Countries for Prosthetics & Orthotic Services. Retrieved
November 30, 2010 from World Health Organization website: http://whqlibdoc.who.int/publications/2005/9241592672.pdf
“ Teams drop in, disrupt local facilities and activities, provide services and fly out leaving a group of people in their wake to effectively fend for themselves.” Teams or individuals being sent to Haiti to take casts of amputees, to return in a month or two to fit prostheses made in North America. “ Long after basic services are restored and buildings rebuilt, the amputee population will still be living with their own personal lifelong aftermath of the tragedy. If teams fly into Haiti, find some way to deliver artificial limbs and then return home, what will happen to the patients after the team has departed? How will they receive follow up care and adjustments? “ (from US-ISPO) Use example of Nfld team, and also Fond Parisien experience
For our presentation we needed some information that we just couldn't find anywhere online. So we sent a small email survey, seven questions long. We sent the survey to thirteen different organizations hoping for a few responses and luckily we got a response from seven different organizations. These organizations are: Healing Hands for Haiti, Hanger Prosthetics Clinic, Hopital Albert Schweitzer, Mission of Hope, Hopital Sacre Coeur, BRAC Brace and Limb Center, and Haiti Hospital Appeal. We asked about their facility, injuries they deal with, how many clients are from the January earthquake, fab methods, how many people fitted as well as follow up frequency, and if they had any training programs.
The most common injuries were injuries and infections from the earthquake, and motor vehicle accidents.
The average percentage of clients from the earthquake is around 50%.
Fab methods vary from clinic to clinic, but polypro sockets are the most common, second most common is laminate sockets with donated components, while it seems ICRC kits aren't very common, being exclusively used in one of the organizations we contacted, and occasionally used in a few of the others.
For those of you who don't know much about the ICRC method, I'll give a brief explanation. The ICRC method involves making a prosthesis from a polypropylene socket and components, including knee and foot units. ICRC has developed kits for everything from your average TT to knee and hip disarticulation, as well as trans radial and trans humeral prosthesis. The ICRC method is the recommended fabrication method in low income and developing countries as it is much cheaper than typical fab methods, it requires very few additional materials, it is accepted by international standards, it is very versatile, durable and comfortable, easy to learn as well as to repair, and it is recyclable. Despite all the benefits, as I said earlier, from our survey responses we found that the majority of facilities don't use the ICRC method. We have two prostheses made from ICRC kits if anyone wants to have a look at the end of the presentation.
On to the next question. The number of patients is very dependent on the organization - some have as few as 20 clients, while others have 600 or more. The tendency of follow up appointments is very consistent between all of the clinics - the majority of the clients don't come for follow up appointments. For the people who do come for the follow up appointments, it is usually every 1-3 months, or as needed.
The answers we received about training programs is the same with almost every place we contacted - they are doing informal on the job training with a few Haitians. They are also saying that they are definitely considering a training through the University of Don Bosco when it is available.
A bit more information on this - There is a training program available through the University of Don Bosco, El Salvidor. It is 5 modules over three years. It would be a long distance learning program through printed material, CD's and DVD's. The students would be working and learning in a P&O facility with a UDB tutor circulating the facilities depending on the need. There would be a gathering in Port au Prince for practical instructions 3-4 times a year, and after each of the 5 modules there would be a final exam. This program would give them an ISPO Category II recognition. This course was supposed to be available in September 2010, but as of now it still hasn't started.
The Healing Hands for Haiti facility is partnered with Handicap International. They have a converted supermarket located in Port au Prince and are anticipating the building of a new Physical Medicine and Rehabilitation Institute. . They are a non profit NGO, focused not just on P&O treatment, but also on increasing public awareness of disability, disability prevention, and rehab education and training. They use Polypropylene technology, with pelite liners, with either ICRC and 30mm componentry. They have served about 300 LE amputee patients and dispensed 300 LE orthoses, mostly AFOs since the earthquake.
Hanger Orthopedic Group is a large provider or prosthetic and orthotic services located in the United States. Following the January earthquake they decided to develop a facility in Deschapelles. Their facility has been functional since February 22, and continues to provide quality service to Haitian amputees. They provide rehab services as well as training Haitians to be techs and clinicians. The Hanger clinic has served more than 700 amputees and uses both polypropylene and laminated sockets with all new componentry.
For information on the other organizations working in Haiti, check out our site.
