The Hanger Clinic

We had a slow start to physical therapy because most of the patients are brought by van from Port-au-Prince or Gonaive or other outlying areas.  The transportation from Port-au-Prince is handled by the Catholic Medical Mission Board, and they decide if it is safe to travel.  Patients are usually transported on Mondays and Thursdays, but on the Thursday that we arrived, the resolution of the election runoff controversy (for the election now scheduled for March 20) had been announced, and there were worries of unrest, roadblocks, etc.  Then on Monday, there were rumors that President Preval would step down that day, and again unrest was anticipated and transportation cancelled.

The slow start was good for me because I am so rusty, but Jake was raring to go.  I was able to follow him and learn, and I even suggested that I act as his intern because of the disparity in our current skills.  With our small number of patients, I didn’t feel guilty about not carrying my load, and instead welcomed the learning experience.

David Charles, the one and only staff physical therapist at HAS, is a Haitian who trained in the Dominican Republic (since there are no PT schools in Haiti), and is one of only a few PT graduates to return to Haiti to practice.  He was at the APTA’s National Combined Sections meeting the US during our stay.  Read about him here, on page 4: http://www.apta.org/AM/Template.cfm?Section=Home&CONTENTID=80142&TEMPLATE=/CM/ContentDisplay.cfm. 

A young man named Verna, a graduate of the Rehabilitation Technician Training Program here, was ably carrying the inpatient load at HAS on his own, but Jake went over to the hospital ward to help him, and I tagged along.  Jake continues to help out at the hospital in the afternoons after the clinic closes.

Jake has two patients who are bilateral above-knee amputees. One is a woman who first lost her legs in 1992, got prostheses, and then lost those in a hurricane in 1994!  How much bad luck can one person endure?  She has not had limbs since then.  Bilateral AK patients start on “stubbies”, sockets with feet attached directly to them, so that they can start low to the ground to get used to weight bearing and walking without having to work so much on balance.  Little by little, the height is raised and knee joints are added until the person reaches a functional, if perhaps shorter than original, height.

Jake’s other bilateral AK amputee is Oscar, who had a motorcycle accident about 8 years ago and was getting prostheses for the first time.  He had been here for a week or two before we arrived, and was walking with full height, jointed prostheses and forearm crutches.  It takes an incredible amount of strength and endurance to manage the weight of the prostheses, especially with relatively short residual femurs as Oscar has, but he is progressing slowly but surely.  In one of the most impressive feats any of us has ever seen, Oscar managed to get up from the floor (fall recovery) by getting up to his prosthetic knees, supported by the forearm crutches, then extend first one leg and then the other into a wide triangle stance, then just power himself up to standing with sheer determination and upper body strength.  It was unbelievable.

One of my patients is a 55 year-old woman named Meromise who lost her left leg below the knee in the earthquake, and another is an older lady named Jacqueline who has a left above knee amputation from a car accident 7 or 8 years ago.  One day they spent a lot of time waiting in the PT department for adjustments to their limbs.  They’d sit for a while, lie down on the wooden benches for a while, then sit some more.  When Jake was busy with our only other two patients, I asked the ladies if they would like a little massage.  I took Meromise into a treatment room, had her lie down, and began massaging her shoulders and back.  As she relaxed, I thought:  Now I’ve arrived.  I am in Haiti, giving some love to someone who suffered in the earthquake.

Within a few days, Meromise had progressed well to walking without a cane up and down hills on the rough outdoor terrain.  The final task was to have her carry a load.  We have a bucket full of cement chunks that weighs about 20 pounds.  I brought it to her, and while I was trying to decide which hand she should use, she just hefted it up and started walking, no big deal!  I asked if there was anything else she needed to do, and she indicated that she wanted to carry it on her head!  This she did, walking around the department as gracefully as you please!

By Thursday we had several new patients.  I did my first evaluation on Jean-Carlot, a big, jolly man who lost his left leg above the knee along with part of his right foot in the earthquake.  He speaks French, so I could do most of the communicating on my own.  The evals are quick:  when/how did the injury occur, any pain or sensitivity, any other significant medical issues, manual muscle tests and range of motion.  The prosthetists fit the limbs and adjust them as the patient gets up and starts walking, so I can do lots of observing and questioning before I start gait training.

Another patient, Logista, arrived on Friday.  She is 21 and has a left below-knee amputation and a nearly fused and heavily scarred right ankle from the quake.  As soon as her limb was donned, she walked off with a cane, using a beautiful gait.  She was allowed to take her prosthesis with her back to the group home, and I told her I would visit her there on Saturday.  I did so, and we walked, with no cane, down a steep ramp, around the house on a rough stone sidewalk, and then out and about across rocky, rutted, terrain, over tangled tree roots and up and down inclines.  She just marched on, with a smooth, even gait, “pas de problèm” – no problem at all.  “C’est facile!” she exclaimed, “It’s easy!”  She was just delighted, and kept giggling and hugging me as we walked, as if I was the one who gave her this gift.  It wasn’t me, though, it was HAS, the Hanger program, and her own fortitude that made it happen.