Prosthetic & Orthotic Services in Post-Earthquake Haiti


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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.

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  • “ 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. 
  • Prosthetic & Orthotic Services in Post-Earthquake Haiti

    1. 2. Prosthetic & Orthotic Services in Post-Earthquake Haiti Dave Ritchie, Amanda Barizo Nathaniel Wheeler, Edward Phinney
    2. 3. <ul><li>Overview </li></ul><ul><ul><li>Haiti, Jan. 12 earthquake, immediate effects, P&O response </li></ul></ul><ul><li>Current P&O practices </li></ul><ul><ul><li>Survey, fabrication trends, training programs </li></ul></ul><ul><li>Challenges, Issues and Outlook </li></ul><ul><ul><li>Sustainability, standardization, ISPO Code of Conduct, volunteering </li></ul></ul><ul><li>Acknowledgements/Q&A </li></ul>P&O Services in Post-Earthquake Haiti
    3. 4. The Republic of Haiti République d'Haïti Repiblik Ayiti
    4. 5. Pre-Earthquake P&O: Needs Assessment <ul><li>800,000 disabled (GoH, 1983) </li></ul><ul><li>Total disabled people in need of P&O services: 50,000 </li></ul><ul><li>(WHO 0.5% of ~10 million pop.) </li></ul><ul><li>Number of trained personnel needed: </li></ul><ul><li>67 (Cat I/II), 300 (Cat III) </li></ul><ul><li>(WHO/ISPO, Guidelines for Training Personnel in Developing Countries in P&O services) </li></ul>
    5. 6. Pre-Earthquake P&O Services <ul><li>Healing Hands for Haiti, PaP </li></ul><ul><li>St. Vincents Hospital, PaP </li></ul><ul><li>Advantage Program, Les Cayes </li></ul><ul><li>Center for Eucharistic Heart, Cap Haitien </li></ul>(Eitel, 2010)
    6. 7. The Earthquake
    7. 10. P&O Post-Earthquake <ul><li>2000-4000 amputations (HI), 4000-6000 amputees (GoH) </li></ul><ul><li>Number of those requiring orthotic services is unknown </li></ul>
    8. 11. The P&O Response <ul><li>Donations </li></ul><ul><li>Parachute Services </li></ul><ul><li>Patient-transport Programs </li></ul><ul><li>Rotational Short-term Projects </li></ul><ul><li>Long-term Projects </li></ul>
    9. 12. I. Donations <ul><li>Monetary </li></ul><ul><li>Componentry </li></ul><ul><li>New or used </li></ul><ul><li>prostheses </li></ul><ul><li>Fabrication materials </li></ul><ul><li>Equipment </li></ul>
    10. 13. II. Parachute Services <ul><li>Neglect in-country services and capacity building of Haitians. </li></ul><ul><li>Often leave problems in their wake </li></ul><ul><li>(Kistenberg, 2010) </li></ul>
    11. 14. III. Patient-transport Programs <ul><li>Highly discouraged by ISPO </li></ul><ul><ul><li>Componentry may not be appropriate for the patient’s home country </li></ul></ul><ul><ul><li>Traveling to a foreign country can be disorienting for the patient </li></ul></ul><ul><ul><li>Upon return, patient may be left with a sense of abandonment </li></ul></ul><ul><ul><li>(Kistenberg, 2010) </li></ul></ul>
    12. 15. IV. Rotational Short-term Missions <ul><li>Rotational short-term missions </li></ul><ul><ul><li>Length of stay and objectives of the P&O clinic should be considered </li></ul></ul>
    13. 16. V. Long-term Projects <ul><li>Adhere to international standards </li></ul><ul><li>Implement training programs </li></ul><ul><li>Offer integration programs and psychosocial support </li></ul>
    14. 17. Current P&O Practices Current P&O Practices
    15. 18. Post-Earthquake P&O Services
    16. 19. <ul><li>Healing Hands for Haiti with Handicap International </li></ul><ul><li>Hanger Prosthetics Clinic </li></ul><ul><li>Hopital Albert Schweitzer </li></ul><ul><li>Mission of Hope </li></ul><ul><li>Hopital Sacre Coeur </li></ul><ul><li>BRAC Brace and Limb Center </li></ul><ul><li>Haiti Hospital Appeal </li></ul>
    17. 20. Can you give a brief description of your facility? 
    18. 21. What are the most common injuries and pathologies you have treated?
    19. 22. Fabrication Trends Of your P&O clients, what is the percentage of those injured by the January earthquake? 
    20. 23. What fabrication methods are most commonly practiced at your facility (i.e. Lamination, Polypro sockets, donated parts, ICRC kits)?
    21. 24. ICRC <ul><li>Cheap </li></ul><ul><li>Requires few additional materials </li></ul><ul><li>Accepted by international standards </li></ul><ul><li>Durable & Comfortable </li></ul><ul><li>Ease of learning & repair </li></ul><ul><li>Recyclable </li></ul>
    22. 25. Approximately how many patients have you fitted for a device? 
    23. 26. Training Is there a training program currently implemented at your facility?  
    24. 27. Proposal of Education in Prosthetics and Orthotics for Haiti
    25. 31. Challenges Challenges, Issues & Outlook
    26. 32. Further Needs <ul><li>Overwhelming enthusiasm for providing LE prosthetic devices, but orthotic care is far more needed. </li></ul><ul><ul><li>Pediatric orthotics </li></ul></ul><ul><ul><li>Traumatic and chronic disease orthotic devices </li></ul></ul><ul><li>Upper extremity prosthetics </li></ul><ul><li>(Ingersoll, 2010) </li></ul>
    27. 33. <ul><li>Sustainability </li></ul><ul><ul><li>Education, materials </li></ul></ul><ul><li>Coordination </li></ul><ul><ul><li>Geographical </li></ul></ul><ul><ul><li>Technical </li></ul></ul><ul><ul><li>Governmental </li></ul></ul><ul><li>Information gaps (pre-quake, new injuries) </li></ul><ul><li>Ethical considerations of P&O groups </li></ul><ul><ul><li>Publicity, previous experience in undeveloped nations, cultural sensitivity </li></ul></ul><ul><ul><li>(Stanfield, 2010) </li></ul></ul>Challenges
    28. 34. <ul><li>ISPO Code of Conduct for Humanitarian </li></ul><ul><li>Organizations </li></ul>ISPO Code of Conduct for Humanitarian Organizations
    29. 35. “ 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. Rob Kistenberg, president of US ISPO, recently put out an appeal to all those prosthetic, orthotic, and mobility organizations offering assistance in Haiti to study and endorse the US ISPO Code of Conduct. ” Jon Batzdorff, CPO, Chair of the International Outreach Committee of US-ISPO.
    30. 36. <ul><li>Avoid discrimination on the basis of race, religion, nationality or political party. </li></ul><ul><li>Assistance shall not require any political or religious endorsements or behavior in order to receive benefits </li></ul><ul><li>Respect the local customs and culture </li></ul>Code of Conduct
Prosthetic and Orthotic
Nongovernmental Humanitarian and Development Assistance
    31. 37. <ul><li>Encourage and support local capacity for providing P&O services. </li></ul><ul><li>5. Avoid creating dependency of the local community on the NGO for future follow up, adjustments, replacements. </li></ul><ul><li>Materials should be used which can be found or acquired locally. </li></ul>Code of Conduct
Prosthetic and Orthotic
Nongovernmental Humanitarian and Development Assistance
    32. 38. <ul><li>7. Avoid overlapping of services </li></ul><ul><li>8. Coordinate efforts, planning, and delivering of services with the local community </li></ul><ul><li>Consider long-term development goals, not simply emergency immediate needs. </li></ul><ul><li>(Batzdorf, 2010) </li></ul>Code of Conduct
Prosthetic and Orthotic
Nongovernmental Humanitarian and Development Assistance
    33. 39. <ul><li>What Can You Do To Help? </li></ul>
    34. 40. <ul><li>Research the Organization </li></ul><ul><li>Security </li></ul><ul><li>Residents </li></ul><ul><li>- Immunization Shots </li></ul><ul><li>Travel Insurance </li></ul><ul><li>- Registration with Embassy </li></ul>Volunteer Considerations
    35. 41. Donations <ul><li>Prosthetic & Orthotic Component Clearinghouse (P.O.C.C) </li></ul><ul><li>MedShare International c/o P.O.C.C. 3240 Clifton Springs Road Decatur, GA 30034 </li></ul><ul><li>Monetary Donations </li></ul>
    36. 42. <ul><li>For more information, please visit our website </li></ul><ul><li> </li></ul>
    37. 43. Acknowledgements Dan Blocka & Gord Ruder Al Ingersoll Healing Hands for Haiti Shaun Cleaver Albert Schweitzer Hospital Katherine Mackenzie, Diana Cherry Mission o f Hope Monir Uzzaman BRAC Brace & Limb Center Ann Culloo, CRUDEM & Hospital Sacre Coeur Vern Hostetler, Hanger Klinik Reninca Hill, Haiti Hospital Appeal
    38. 44. <ul><li>The international community has shown overwhelming enthusiasm for providing prosthetic devices, but orthotic care is far more needed. </li></ul><ul><li>Geographical and technical coordination is a constant problem. </li></ul><ul><li>Thomas Calvot, HI's disability and emergency advisor </li></ul>References   Batzdorff, J. (2010) Code of Conduct for Humanitarian Organizations. Retrieved from November 30, 2010 from US-ISPO website:   CDA Collaborative Learning Projects (2010) A Brief Background to Conflict in Haiti. Retrieved November 30, 2010 from CDA website: http:// ww. cda cda www/.../rpp_haiti_ brief _ background _20100203_Pdf_1_1.pdf   Eitel, S. (2010) Haiti Mission Report. Retrieved November 30, 2010 from One Response web site:   Groupe de Travail Inclusion, Readaptation et Situation de Handicap (2010) Liste des Services Orthopediques , Appareillage et Readaptation Haiti.   International Committee of the Red Cross (2010) Polypropylene Technology. Retrieved from the ICRC website: International Committee of the Red Cross (2010) Prosthetics and Orthotics Manufacturing Guidlines. Retrieved from the ICRC web-site:   Rencoret, N., Stoddard, A., Haver, K,. Taylor, G., Harvey, P., (2010) Haiti Earthquake Response Context Analysis. Retrieved November 30 (2010) from ALNAP website:   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:   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:   Stanfield, M. (2010) Haiti: The International Response. Retrieved from website:   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:   World Health Organization (2005) Guidelines for Training Personnel in Developing Countries for Prosthetics & Orthotic Services. Retrieved November 30, 2010 from World Health Organization website:
    39. 45. Questions?