Mirtho Belle Fleur, 21 years old, was receiving physical therapy from Kirsty Luard at Handicap International’s orthopedic center in downtown Port au Prince. Mirtho lost his right leg above the knee in the earthquake when his house in the Nazon neighborhood collapsed on him. Although he was pulled from his home the next morning otherwise intact, his crushed limb couldn’t be saved. His path to this point, doing exercises wearing his permanent prosthetic to accustom him to changing direction, stepping over obstacles and maintaining his balance in general, has been a long, but well defined one.
Handicap International, which works to improve the living conditions of people in disabling situations in post-conflict or low income countries around the world, was the co-recipient of the 1997 Nobel Peace Prize as a co-founder of the International Campaign to Ban Landmines. HI arrived in Haiti in 2008 in response to the series of hurricanes that raked the country that year and by the time the earthquake struck on January 12, 2010, it had a local staff of 100, plus seven expatriates. This presence, which as of June 18 had grown to 400 national staff and approximately 70 expatriates working with and paid by Handicap International, plus 96 national staff who are working with Handicap International but are paid by its partner organizations, allowed HI to mobilize quickly in Haiti. In addition, Handicap International’s headquarters in Lyon, France dispatched an assessment team that was on the ground within a few days.
According to Lea Radick, Handicap International’s Communications Officer for its U.S. office, and Sylvia Sommella, who fills this role in Haiti, since the earthquake HI has been providing care in hospitals and sending mobile teams to aid people with injuries, including amputees, in their communities. By February, HI had established nine tent clinics (antenne in French), eight in Port au Prince and one in Petit Goave, with another about to open in Gonaives, to follow up on patients who had left hospitals or, in some cases, had never made it to one. The mobile teams operate out of the antennes, offering rehabilitation and psychosocial support in the surrounding community.
By March, in addition to operating the antennes, HI opened the prosthetics and orthotics center in Port au Prince and began to produce temporary prostheses (replaces the limb or a missing part of the limb) and orthoses (supports a paralyzed or weakened limb) and to fit patients with them. Mirtho entered the system, as most patients do, by way of a referral from an antenne, a hospital or another aid organization.
On arrival at the center, Mirtho registered and received a patient number. Patient numbers are serial, that is, the first patient was patient number one. HI then collected information on where Mirtho lives for follow up purposes. Once a patient is in the system, the first substantive act performed by HI staff is to examine the stump to see if it is ready to be fitted with a prosthetic. In general, a leg requires four to five months to recover from an amputation to a point at which a permanent prosthesis can be fitted. But before this is done, the patient will receive a temporary prosthesis and the type depends on whether the amputation is an upper or lower leg.
In the case of upper leg amputations such as Mirtho’s, those where the leg is amputated above the knee, a temporary, pre-fabricated kit prosthetic can be used in emergency situations because the thigh stump is not terribly tender. But with below the knee amputations, the kit prostheses won’t work because the nerve endings in that part of the leg are too sensitive. So in these cases, HI manufactures a temporary prosthetic made of bands of Dynacast, a type of plaster, in its onsite workshop. However, in both cases the process begins with the stump being measured in relation to the other leg. Once Mirtho was fitted with a temporary, kit prosthesis, HI began working on a permanent one for him.
HI strives to work with existing national organizations and to build the local capacity by having national staff produce its prostheses and orthoses. At the orthopedic center in Port au Prince, HI is working in partnership with Healing Hands for Haiti, the only organization with a prosthetics workshop in the country before the earthquake, to produce prostheses and orthoses that are appropriate to the living situation of people in Haiti. The earthquake destroyed Healing Hands’ workshop, but the staff was able to salvage most of its equipment. From this base, HI is working with six technicians from Healing Hands for Haiti and it will expand its manufacturing operation by training other Haitians.
To make Mirtho’s permanent prosthesis, the HI staff confirmed his measurements and cast a mold of his stump. Once the mold was cast, it was wrapped in polypropylene, softened by being heated in an oven, and cut to fit. Mirtho then had several sessions with a technician and physical therapist to make adjustments. During this period, Mirtho’s permanent prosthesis remained at the HI workshop, as is customary.
Even after Mirtho completes the process of receiving his permanent prosthesis, he will return to the orthopedic center, or be visited by a mobile team if for some reason he can’t, once a month for check-ups. And this permanent prosthesis will only be the first of many he will have during his lifetime. It is normal for prostheses to have to be replaced, both because they wear out from use, especially in an environment as harsh as Haiti’s, and because of changes in the wearer’s body. But, as each new prosthesis becomes necessary, Handicap International will be there to accompany Mirtho through the increasingly familiar fitting process.