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Haiti: reaching out to the most isolated people

Katia Eloi Cénat is a 32-year-old Haitian nurse. After the earthquake which struck Haiti on 12 January 2010, her right arm was amputated. Katia worked as a Psychologist’s Assistant for MSF, before joining Handicap International in October 2010, where she received on-the-job training as a Rehabilitation Technician. She speaks about her experiences here.

“Today we visited Mr Augustin,” explains Katia. “He is 54 years old, and was working in a funeral home when the earthquake hit. He was the only survivor in the building. He had to undergo a mid-thigh amputation and his other leg remained extremely weak, affecting his balance. Handicap International provided him with a walker and fitted him with a prosthesis, which allowed him to recover some mobility.

However, he cannot yet make full use of this equipment as he is still unable to stand up straight and has to spend a lot of time in his wheelchair. Despite all this, every Friday he makes his own way to church using his walker and prosthetic limb. We worked with him at home to improve his balance and strengthen his muscles, and referred him to the Handicap International Orthopaedic Centre in Port-au-Prince to deal with his healthy leg. His case is extremely complicated but he is very brave, always encouraging others at the centre, even though his own progress remains limited.

“At the centre, we provide rehabilitation services for amputees like Mr Augustin and we make prostheses and orthoses. As a Rehabilitation Technician, I assist physiotherapists, with the aim of making people with disabilities more independent. I am also part of a mobile team, along with a Physiotherapist and a Prosthetics & Orthotics Technician, providing patient follow-up at home and identifying problems they may encounter in their daily lives, such as stairs or obstacles in the house.

“When an amputee arrives at the centre, we start by taking measurements and producing a cast of their stump. Then we prepare the socket and make an appointment for the patient to have a static trial of their prosthesis. If this is successful, dynamic trials are then carried out once a week for one to five weeks. The number of sessions depends on the patient’s physical capacity – for example, elderly people may tire quickly, whereas children adapt much more easily.

During these sessions we carry out functional rehabilitation using muscle training exercises and give the patient exercises to do at home. If the amputee is suffering from psychological trauma, such as difficulty accepting their condition, we refer them to our psycho-social team. For problems related to their home environment, our accessibility team can carry out alterations to make their homes or the plot of land where they live more accessible.

“The patient has follow-up appointments, every two weeks at first, reducing to once a month, then once every two months. During these sessions, we check that the patient feels comfortable with their prosthesis and we train them to carry out day-to-day activities, such as carrying heavy loads. We also check their stump and gait cycle, to ensure they complete the stance and swing phases correctly, and address any abnormalities through specific exercises.

“The idea is to help amputees become as independent as possible in their daily lives so they can use the toilet, take a shower or cook unassisted. If necessary we can resolve problems on the spot by adapting their living space. We analyse what the patient can and cannot do in their home and, where necessary, provide them with technical aids that we make in our workshop. For example, a brush for washing clothes that can be attached to a leg, nail clippers that can be operated using an elbow, or a chopping board that can be fixed to the table with a clamp.

“We may also suggest simple techniques to negotiate obstacles like steep slopes, stairs, rocky paths or ditches. Some families live in houses built on the edge of a cliff or ravine and use bags of earth to make steps or section off a plot of land, making it very difficult for someone using a prosthesis to access the house. We may ask a patient’s family for support if a patient finds it difficult to put on their prosthesis, or to help them do their daily exercises.

“On average we see three or four patients a day, but sometimes we may only see one patient if they live in a particularly isolated area. Port-au-Prince is not very suitable for vehicles so we often leave the car and finish our journey on foot through the city’s alleyways. We spend around one hour with each patient, sometimes longer if the technician has to work on the prosthesis. What is really important is that we reach the most vulnerable and isolated people.

“Some cases are more complicated than others. Each case is different, depending both on the level and type of amputation, and the family and physical environment. The aim is to find the right solution for each person, and that is what I like best about my work.”

Handicap International is an international aid organisation working in situations of poverty and exclusion, conflict and disaster in over 60 countries worldwide.