Prosthetic & Orthotic Services in Post-Earthquake Haiti

Dave Ritchie, Amanda Barizo

Nathaniel Wheeler, Edward Phinney

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.

• OverviewHaiti, Jan. 12 earthquake, immediate effects, P&O response

• Current P&O practicesSurvey, fabrication trends, training programs

• Challenges, Further NeedsSustainability, standardization, ISPO Code of Conduct,

volunteering

• Acknowledgements/Q&A

P&O Services in Post-Earthquake Haiti

The Republic of Haiti

République d'Haïti

Repiblik Ayiti

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)

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)

The Earthquake

P&O Post-Earthquake

• 2000-4000 amputations (HI), 4000-6000 amputees (GoH)• The need for orthotic services is far greater.

The P&O Response

• Donations

• Parachute Services

• Patient-transport Programs

• Rotational Short-term Projects

• Long-term Projects

I. Donations• Monetary

• Componentry

• New or gently used

prostheses

• Fabrication materials

• Equipment

• In Conclusion• Prosthetic & Orthotic

Component Clearinghouse

(P.O.C.C)

MedShare International

c/o P.O.C.C.

3240 Clifton Springs Road

Decatur, GA 30034

II. Parachute Services

• Discouraged by ISPO

• Neglect in-country services and capacity buildingof Haitians.

• Often leave problems in their wake(Kistenberg, 2010)

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)

IV. Rotational Short-term Missions

Rotational short-term missions

Length of stay and objectives of the P&O clinic

should be considered

V. Long-termProjects

• Adhere to international standards

• Implement training programs

• Offer integration programs and psychosocial support

Current P&O Practices

Current P&O Practices

Post-Earthquake P&O Services

•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

Question #1: What are the most common injuries

and pathologies you have treated?

Fabrication Trends

Question #2: Of your P&O clients, what is the

percentage of those injured by the January

earthquake?

Question #3: What fabrication

methods are most commonly

practiced at your facility (i.e.

Lamination, Polypro sockets,

donated parts, ICRC kits)?

Question #4: Approximately how many

patients have you fitted for a device?

Question #5: What was the follow up

frequency?

TrainingQuestion #6: Is there a training program currently

implemented at your facility?

Proposal of Education in Prosthetics and

Orthotics for Haiti

Question #7: Can you give a brief

description about your facility?

Challenges

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)

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)

Challenges

“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.

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

Code of ConductforProsthetic and

OrthoticAssistance

Non-governmental Humanitarian and Development

ISPO Code of Conduct for Humanitarian

Organizations

ISPO Code of Conduct for Humanitarian

Organizations

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.

Code of ConductforProsthetic and

OrthoticNongovernmental 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)

Code of ConductforProsthetic and

OrthoticNongovernmental Humanitarian and

Development Assistance

What Can You Do To Help?

- Research the Organization

- Security

- Residence

- Immunization Shots

- Travel Insurance

- Registration with Embassy

Volunteer Considerations

For more information, please visit our website

http://haitipando.info.nu

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

- The international community has shown overwhelming enthusiasm for providing prosthetic devices, but orthotic care is far more needed.

- Geographical and technical coordination is a constant problem.

Thomas Calvot, HI's disability and emergency advisor

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

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:

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

Questions?