ARTICLE - AMPUTEES CRISIS

Los Angeles Times, February 17, 2010

AMPUTATIONS PUSH HAITIANS CLOSER TO THE EDGE

A teen who was close to graduating from high school lost her father and both of her legs in the Haiti quake. For her and thousands like her, an already difficult life has become much bleaker.

By Mitchell Landsberg

Gonaives, Haiti -- She is 19 years old, with an angelic face and big, heavy-lidded eyes. A bright young woman close to graduating from high school, a rare accomplishment in Haiti.

As her sister runs a hand through her hair, Sounlove Zamour tells how the Jan. 12 earthquake split her family's house in two, how it swallowed up her father, how it robbed her of her legs -- both gone now, below the knee.

She manages a feeble smile.

Zamour belongs to a heartbreaking new class in Haiti: earthquake amputees.

No one knows how many there are, although the number is clearly in the thousands.

And no one knows what sort of future there will be for this new generation of the disabled in Haiti, where the loss of a limb in the past could condemn a person to a life on the margins, in a society where even the able-bodied struggle to get by.

"Before the earthquake, well, the disabled person was not really seen, like in a lot of countries," said Sylvia Somella, a spokeswoman for Handicap International, a nongovernmental organization headquartered in France. "There were no special facilities for them."

It is hard to imagine a more difficult urban environment for a disabled person than Port-au-Prince, the country's teeming capital. There are few, if any, wheelchair ramps. Even without the mounds of debris left by the earthquake, sidewalks and streets are full of obstacles: potholes, ditches, trash piles, street vendors. Only the grandest of multistory buildings ever had elevators.

"Mobility is everything in a Third World country," said Dr. William Gregory, a volunteer physician from South Pasadena who has been working with amputees in Port-au-Prince. "It's difficult in the U.S., much less in this environment."

The World Health Organization estimates that about 200,000 people were injured in the earthquake, and many of those injuries were disabling. Even fractures can leave a person crippled if not properly treated.

The quake created a worst-case scenario for amputations. People's limbs were crushed, and in many cases severed, by falling concrete. Then, as hospitals were overwhelmed and international assistance was still arriving, wounded patients sat for days with only minimal care, if any. Gangrene set in. Many limbs had to be amputated that otherwise could have been saved.

For days after the quake, "some hospitals were performing 30 amputations per day, others 100 a day," Dr. Mirta Roses, director of the Pan American Health Organization, said during a news conference.

Handicap International, which had a presence in Haiti even before the earthquake, is among a number of groups working to help amputees and people with other disabilities caused by the earthquake. It now has a team of about 100 working in hospitals throughout Port-au-Prince to provide therapy and equipment to the disabled, including crutches and, eventually, prosthetic limbs.

One recent morning, a team of six was dispatched to Peace Hospital, a large compound of concrete-walled buildings that survived the quake with mostly superficial damage. The hospital is now largely run by Cuban doctors and nurses, many in matching Che Guevara T-shirts.

In one ward, a Haitian medical student was using an antibacterial swab to clean off the not-yet-healed stump of an amputee's leg.

"You're touching the wound too hard!" Frederick Antoine said, wincing in pain.

When the student was done, Dr. Geraldine Jacquemin, freshly arrived from Montreal as a Handicap International volunteer, examined the stump, which was cut about halfway between the hip and knee. She was pleased by what she saw. It was healing well, she said.

Antoine, a trim and fit-looking 56-year-old with a dash of gray in his hair, was asked if the stump usually hurt and if he could move it. "No, I'm not in pain," he said, "and yes, I can move it." He quickly demonstrated when Jacquemin directed him to try some exercises.

"Everything looks good. You're making a lot of progress," she told him, and promised that soon he would be fitted with a temporary prosthetic leg, followed eventually by a permanent one.

And with that, Antoine's positive attitude vanished.

"I've had a lot of international organizations say that they'll give a leg to me, but I don't have any hope," he said. Nodding toward the Handicap International team, he added, "They don't even have my address, and I'm going home tomorrow."

Jacquemin assured him that they would take down his cellphone number and would follow up after he left the hospital.

But Antoine, a poor man who had worked intermittently as a shoe shiner and chauffeur, said he knew a thing or two about Haiti that these blancs -- these white people -- might not know.

"All this aid is being given to Haiti," he said, "but the people who are giving it don't realize where it's going -- it's going to the rich."

Antoine's skepticism is well grounded in Haiti's history and culture. But the evidence so far suggests that international organizations do intend to help the disabled whether they are rich or poor. And they say that, even before the quake, Haiti was heading in the right direction, having created a new post of secretary of state for the integration of the disabled, and appointing a blind person, Dr. Michel Pean, to the job.

That said, the challenges are enormous, beginning with the sheer number of disabled people and the cost of treatment and rehabilitation.

After the quake, some patients were sent to hospitals in undamaged cities outside the capital. Four hours north of Port-au-Prince, in Gonaives, Dr. Marcel Chatelier said his staff performed 12 amputations among the patients they received, many with wounds that had festered for the better part of a week.

That was the case with Sounlove Zamour, the 19-year-old student.She and her father were home when the quake hit. She remembers trying to run, but the floor split open and she tumbled to the ground as the house collapsed onto her. She was trapped for a full day before being rescued and taken to a hospital in Port-au-Prince. Her father, who provided her sole means of support, didn't make it out alive.

One of her legs required immediate amputation, she said, but she was initially hopeful that the other could be saved. But at that first hospital, she said, the leg was bandaged without cleaning out the dirt in the wound. Four days after the quake, she was piled onto a bus to Gonaives because the Port-au-Prince hospital was too crowded.

By the time she arrived, her wounded leg was badly infected.

It "smelled rotten" when the bandages were removed, she said. She was told it would have to be amputated too.

Now, she doesn't know what the future will bring. "I have no father," she said. "I'd like to continue my education, but I can't." With her father gone, she said, she can't afford it.

A week later, she was still in the hospital. With groups like Handicap International focused for now on Port-au-Prince, she had received no offers of help and did not yet know when she might
return to the capital and begin her life anew.

Times staff writer Scott Kraft in Port-au-Prince contributed to this report.