Change

Anna Avakian, CPO, a former lead prosthetist at the Hanger Clinic, has returned to serve another term as lead clinician. Following is her first blog post since her return to Deschapelles.

Change.

Sometimes it seems to be the only constant in life.

In the past year I've experienced a lot of change: a new position within Hanger, a move to a new city/state, a new home, and recently a new boss.

But now I am back in Haiti. Back to the heat, the 3 minute walk to work, and working with the same great Haitian guys that have been our technicians since the doors opened here in February of last year. Many things are familiar here and it's like returning home in some ways; although, it's more like returning to a childhood home as an adult. The same, but changed.

One wonderful change to see is the growth in both the knowledge and skill of the four Haitian technicians. They now take the lead and we come alongside to instruct or guide as needed. They are confident in casting and modifying basic below-knee amputee patients, can fabricate all types of prostheses, and cast above-knee amputee patients well, too. It is a pleasure to see this change here. So many people have joined together and volunteered their time to make this reality that I have the pleasure of seeing. It's a nice change :)

A recap of weeks 4 & 5

I dropped off the last group of volunteers at the airport and waited for the new group to arrive. They weren’t too hard to pick out as they walked down the long walkway toward the parking lot. Jeff, Mark and Rolf all had that typical “deer in the headlights” look as they were being whisked along in a sea of people. We headed back to Deschapelles and, after a quick tour of the hospital grounds, got them settled into Kay Hanger. Since this is the rainy season, transportation becomes problematic for the patients traveling to HAS / Hanger Klinik. There is quite a bit of apprehensiveness for people to leave their homes for fear of not being able to return. Since our buses were not bringing patients in at the frequency of earlier rotations, we decided to make these next two weeks much about education. Joel, Cira, Alex, and Tcho have learned so much already and are more than capable of casting, fitting, aligning and delivering prostheses practically unassisted. The focus during this period of lighter patient loads will be to educate them further on some of the reasons why they make the adjustments they do and to associate a little anatomy and physiology with the cast modification techniques.

Joint teaching time with physical therapy students:
The physical therapy students were covering the psycho-social aspect of being an amputee in Haiti and we were able to join their classes. We had a great discussion group with both classes and our patients in the Klinik. There was a lot of sharing during this session and the technicians, therapists and patients gained knowledge from this opportunity. They were also able to learn about prevention of Cholera as this is the Cholera “season”.

Casting:
I also taught them a new way to cast above-knee amputees. We outlined a casting and modifying course while using Mark, one of our volunteers, as the patient model. The four technicians gathered around, taking notes and asking pertinent questions throughout the whole demonstration. We modified the cast together and they fabricated the standard AK prosthesis, which we would use later during the alignment portion of the course.
After day three of this rotation, we started to pick up again as the buses poured in from Port-au-Prince, Leogane, and Gonâve. While all four of us stayed very busy casting, fitting and delivering bilateral and unilateral above-knee and below-knee prostheses, we still had some time in the afternoons to integrate more education into our mission here.

Anatomy and Physiology:
We took some time to discuss some anatomy and physiology as it pertains to the above-knee amputee. We went over some very basic boney landmarks of the pelvis so they can see how they relate to the fit and alignment of the AK socket. We emphasized problematic areas such as the ramus and distal/lateral femur. This helped reinforce why certain cast modifications were made and why certain boney landmarks (such as the trochanter) are critical to proper AK alignment. Again, they all took several notes and were not afraid to ask questions. The questions they asked indicated that the information was making a lot of sense to them.

Alignment:
Later in week two of this rotation we went over AK alignment and some typical gait deviations they have seen over this past year. We put together a chart that shows the classic schematic man exhibiting the most common deviations such as, lateral trunk bending, circumducted gait, abducted gait, knee instability, and medial/lateral whips. The chart lists some basic causes and possible solutions. We used Mark and the prosthesis they made for him to put the lesson plan into practice. Starting with a perfectly aligned prosthesis we changed one variable at a time. They were to identify the deviation, the cause, and then practically apply the solution. This section of the course provided the most discussion and feedback. They all got a chance to problem solve and associate the reasons why they have been intuitively making these adjustments over the past year. While this group of technicians are extremely mechanical, it was good to show them why a gait deviation is not always associated with alignment but rather, the fit of the socket as well.

Last year, in the early weeks of this relief effort, the focus was to provide as many quality limbs as possible. However, with that said, I am grateful to be a part of the instructional efforts here. Providing 20 to 30 limbs over a two-week rotational span is nothing when compared to teaching four very highly motivated and talented Haitians to provide for their own people. This cliché is unfortunately overused but no words describe our efforts better than, “Give a man a fish and he eats for a day. Teach a man to fish and he will eat for a lifetime.”

A recap of weeks 2 & 3

After a great first week I was excited to really dig my heels in and get a lot of work done. The first task was to drop off the current volunteers and pick up my first group at the airport – Tom Sandy from Ohio and Carton Blasburg from Kolm, Germany. It was a good transition and we began our two-and-a-half hour journey back to Deschapelles. It is exciting to see new people come in to Haiti. I get to play tour guide for a while and show them the ropes. These guys really fit in well and have done a great job in the Klinik and made some new friends in the process.

Some other exciting news was the education and testing that Brandon and I started in my first week culminated in all of the technicians (Tcho, Cira, Alix, and Joel) passing an exam to become recognized for their hard work. They were presented with certificates for Technicians I. I was so honored to be a part of this experience. As I presented them with their certificates I could see how proud they all were. This is very important here as certificates are not given out on a regular basis. It is not just a symbol of recognition; it truly means a great deal more. These guys certainly deserve this honor. Thank you all who have been a part of the Haiti Klinik. The technicians have learned a lot from you.

In the upcoming weeks I will continue to increase their knowledge base in fabrication skills and introduce some more formal classes. We will begin teaching general terms, anatomy, and improving casting skills to allow them to improve their clinical skills. They will learn to become practitioners and be able to practice patient care.

Returning "home"

Last year Hanger prosthetist Chris Blades from Portland, Maine volunteered at the Hanger Clinic in Haiti for two weeks, and is currently serving a two-month term a as lead prosthetist at the Clinic.

I have been very excited to return to Haiti and Deschapelles. I had been looking forward to seeing my friends here again, and wondering how well they would remember me from my first two week rotation one year ago.

It was a great feeling arriving at Kay Hanger after the long journey from Port-Au-Prince. As Brandon had stated on his arrival it felt like coming home. As I saw each of the staff I was always met with big hugs. “Bon Jou!!” “Sak Pase!!” (The customary greetings). I was thrilled they all remembered me and were just as excited to see me. It felt more like a family reunion.

It was a quick week of learning the lead practitioner role and responsibilities. Brandon has done a great job and already having been here I already knew the general flow of the Klinik.

On Monday, the van from Port-Au-Prince arrived and out came one of my patients from a year ago. Kennda is a young teenaged woman who had great difficulty wearing her below-knee prosthesis. She had a very sharp tibia and despite many attempts to relive her pain in the prosthesis she could not get comfortable. We discussed with the surgeons at HAS the possibility of a revision of her residual limb. This was done the very next day (two days before I returned back home). We saw each other one last time to say goodbye on our last night here. I had prayed for her hoping the surgery would make the difference. To my surprise, Kennda stepped out of the van, walking so well you would never know she had a prosthesis at all. When she saw me she ran up to me and gave me a big hug and thanked me again for what we had done for her. It was a great start to my return to Haiti.

The week continued and I saw a few more patients that had returned for adjustments that all remembered me. I love this place; I love these people. It is amazing what an impact we all have here. It is a wonderful thing or as the Haitians would say “ Bon Bagay!”

Hangertat for Humanity

Friday was the day we put into action a plan that I had been working on for about a week now. I call it “Hangertat for Humanity”. I spoke earlier about how Joel’s mom’s house was partially covered by her roof, since the time I saw it I have been working out the details on how take care of this issue for her and Joel. Our trip home from the beach afforded us easy access to the materials in St. Marc. We stopped at the local “Home Depot”, or at least the Haitian version of it, and picked up three 12’x6”x1” boards, 16 pieces of roofing tin, and an assortment of the needed nails. While we were in St. Marc, we also took advantage of having access to the local Deli Mart, a grocery store chain with actual air conditioning. I picked up some milk and cheese, items that aren’t readily available at the Deschapelles market.

As we were getting ready to head back home, Tim realized that we miscalculated and we only purchased half of the needed boards for our project. Thankfully he realized it while we were only five minutes away, as opposed to 45 minutes away. So we returned to “Home Depot” and picked up the additional boards we needed, then we were on our way. Another miscalculation on our drive home nearly forced us to return again. One of the boards came loose while driving through the valley and flew off the back of the truck. Luckily, no one was following too closely behind us, but when the board hit the road, a two foot section broke away. Joel quickly brought our truck to a stop and Franz, the owner of the truck, jumped out and ran after the board. Just before he got there, an on-coming vehicle ran it over instead of maneuvering around it. It broke the remaining 10’ board into two 5’ pieces. This created a new problem for us, seeing how the spans between the support beams on the house were 6’. But, instead of turning around and going back for a replacement, we decided to keep going and figure out a way to make it work when we got there.

We had plenty of time to figure it out because our trip was severely slowed by presence of multiple Ra-Ra bands. Ra-Ras take place for several weeks leading up to Easter. They are a makeshift band that marches down the middle of the road while a large crowd of young Haitians follow as they dance and celebrate. There is man with a whip at the front who will help guide traffic past the band by using his whip to keep people in line. This isn’t the first time we have run into Ra-Ra bands, but since it is the day before Easter, they were particularly prevalent. Historically, the Ra-Ra bands were used to help reduce inbreeding within the various slave groups. The bands were organized as social events and the man with the whip would prevent slaves from trying to run away. On one hand it was sad to think that the youth would continue a tradition that reflected the days of slavery here. But, on the other hand, they did look like they were having a lot of fun! Some of the crowds got so big that they clogged the street and created a human roadblock. Joel would turn us off the main road and we would find another way around. 8 bands later and we were home.

Saturday afternoon, on the 23rd, was spent doing the work on Lorencier’s (Joel’s mother’s) home. She was very excited and was expecting us. Joel and Franz drove all the materials up to her house so we didn’t have to carry them up the mountain. She lives probably 20 minutes away from the hospital, but is probably a third of the way up the foot of the mountain. It is not a very steep climb, but it certainly would not have been any fun having to carry all the supplies. Unfortunately, we still had to carry all the tools, including a 6’ ladder. But, we made the trek and didn’t waste anytime before we started working. Tim must have been sent from God because he had a lot of experience installing tin roofs and nearly put the entire thing up himself. It didn’t seem like long before we were out of sunlight, but we weren’t quite finished. We still had to install the peak of the roof, but that had to wait until another day.

Niekka Love returns & an update on baby Brahms

Monday brought a welcome surprise for me. Niekka Love returned for a follow up and adjustment. If you remember, this was the little girl that broke my heart when I didn’t get to say goodbye. Her mother reports that she has been doing very well and that Niekka said she wanted to stay for a few days. But, she is in school in Port-au-Prince and will be returning as quickly as she arrived. Since our time was limited, we didn’t waste a second. As soon as she was happy with the adjustment I made, out came the soccer ball. Michele joined us at the clinic, and got to kick the ball around with Niekka while I saw other patients. I’m glad she will get to see many of the patients I talk to her about. It is now a memory we can share, instead of a story I can tell.

Another patient she has heard a lot about, returned on Monday as well. Baby Brahms made an appearance for his first tune-up. It was difficult to properly align an infant. His tentativeness, lack of balance, and weak leg muscles masked a few issues that would normally be spotted at first glance.

Last week, when Brahms would stand or walk, it was mostly in a half crouched over position. Today, he was standing up straight, a clear sign that he was becoming more comfortable with his new prosthesis. It also clearly demonstrated that the initial height setting of the prosthesis was too short. When mom tried to let go of his hand, he would have difficulty balancing and wouldn’t take a step without her. After we corrected the length issue, Brahms took off after the soccer ball like a horse from the starting gate. It was probably as close to running as you could get without officially running. We also made an adjustment to the suspension sleeve that holds the leg on securely. We made it tighter, because his Mom said he could kick it off when he would throw a temper tantrum. I think the adjustment help significantly, because Brahms’ self confidence seemed to elevate rather quickly. In fact, I would later catch the little boy that would barely let go of Mom’s hand, walk across the clinic, go outside, and walk the entire length of the front walkway without any help at all. Not only that, but he would do it while carrying a beach ball! A small beach ball, but a beach ball none the less.

So, two of my favorite patients made the day for me. And you better believe that I got my goodbye hug from Niekka this time. Brahms, however, would be staying with us for a few days.

I got a big surprise on Tuesday that kept me busy for the next few days. On March 18th, a cargo ship left Miami carrying some supplies that would help sustain the clinic into the future. It was thought that the shipment would not be received for several months, after I would have already returned home. But, Tuesday would bring box after box of supplies. We took the opportunity to rearrange a few things in the shop to help accommodate the additional stock and it seemed like my first week all over again… counting inventory! It seemed like every time we would finish sorting and counting our stock, a new wave of boxes would arrive. This would happen for the next two days, and a few boxes would linger in during the following week. This particular week would end quietly though. Thursday and Friday was HAS holidays in recognition of Easter. I found the timing perfect though, it allowed my wife and me to take a few days off and enjoy an overnight trip to the beach on those two days.

Recap of the remainder of the week

Thursday and Friday were spent working on the models from Wednesday’s marathon casting session. It was an excellent opportunity to have our technicians gain more experience with the modification process. I asked Dave and Ken to step back as much as possible and oversee the techs while they modify, answer any questions, and show them the various methods we use to prepare the cast for socket fabrication. Everyone did well, but we have a few left over for next week. It will be nice to let the new group of practitioners get their hands dirty on the first day!

Sunday the 17th marked my halfway point for my rotation. I can’t believe it has already been a month and a half. It was also the day that my wife, Michele, flew in for a two week visit. Our first 6 hours together were spent at the Visa Lodge as we waited for another HAS member to arrive at the airport. It was a long wait, but having her there made it worth every second. Along with my wife, I picked up our two latest Hanger volunteers, Tim and Mark. This was Tim’s first trip to Haiti, but Mark had been here for two weeks nearly a year ago. I knew this would be a good group, because Mark was a veteran and Tim exuded enthusiasm. The 2.5 hour ride home was rough for him though. Our transport unit was packed with luggage, leaving minimal foot space. Tim is about 6’5” tall, so it did a number on his feet and knees.

Trip to Leogane

Wednesday brought a new adventure as well. A few weeks ago the Foundation received an email from a gentleman who recently returned home from a mission trip in Leogane. Leogane was the epicenter of the earthquake a year ago. This email described a speech he heard at a local church which mentioned the need for prosthetic treatment in the area. He passed along all the contact information and asked that we do what we can to help. Our friends at Catholic Medical Mission Board (CMMB) tracked down the gentleman who spoke that day and arranged for us to travel to Leogane to cast patients in need.

Ken and I left Deschapelles at 8am and embarked on a 6.5 hour journey. It was supposed to be a 3.5 - 4 hour drive, but the Port-au-Prince traffic had a different idea in mind. Every time we asked the driver how much longer it would be, he answered “thirty minutes”. It got to be humorous when he would say “thirty minutes”, thirty minutes after he said “thirty minutes”. But we finally arrived around 2:30pm and setup a casting area behind the church. By 3pm we began casting. Jill and Seneq helped setup the patients’ charts, then left to meet with another prosthetic group in the area.

The Johanniter group has been in Leogane for some time, but they have limited resources to handle the demand. They discussed how we could assist them with their patient load, and provide services to a back log of over 140 patients. Unfortunately, their limited resources only allow them to treat 6 patients per month. We may be able to help this group by providing the initial prosthesis to the majority of their patients and allow them to more efficiently continue with vital long term follow up care.

Ken and I continued non-stop with the castings for four hours. We took a break long enough to down half a bottle of Sprite, then we were back to it. By the time we got to the last two patients, we ran out of daylight. We moved around the corner of the building so we would be directly in front of our vehicle. My last cast of the evening was of an above-knee amputee by car headlight, yet another first in my career.
The final tally of casts were 8 below-knees, 10 above-knees (two of which were for a bilateral AK), 2 bent knees, and 3 partial feet. 23 casts in all. Not a bad days work, but I was beat and ready for bed. Good thing it is only “thirty minutes” back to our hotel…

Learning more about the Haitian culture

On Friday the 8th we received some bad news – Joel’s grandmother passed away. She lived a long life, but had been sick recently. Since Joel is one of the few men in his family with a steady job, the funeral responsibilities fell to him. Monday was the wake and the funeral yesterday. He asked me to go to the party after the wake, and I accepted his invitation.

Monday evening was the party Joel setup following his Grandmother’s wake. He was supposed to pick me up at 7:00pm, but got delayed until 9:30ish. I was tired and getting ready to head to bed. I figured he was busy and didn’t have time to get away and come pick me up. But, just before I called it a night, he pulled up on a motorcycle with Alix. I hopped on the back of Alix’s bike and we were off. The ride was quite bumpy and was made a bit more exciting when a goat jumped out from behind a fence in front of us. Alix is a good driver and handled the surprise well. After a few more minutes we were there safe and sound.

I was a bit surprised to see how many people were there at almost 10 o’clock. I would have to say there were at least one hundred people. The first stop we made was at Joel’s mother’s house. It was approximately 10’ by 20’, stone wall construction with concrete mortar. The roof was only partially finished. Maybe one third was complete and covered her bedroom. But, there was a 1 and ½ foot gap exposed over her room. So, when it rains, it rains in her room. She was very nice and invited me in. She kissed me on the cheek and offered me something to drink. It wasn’t long before two of Joel’s cousins came in to meet me, followed by two of his brothers. They were extremely friendly and spoke excellent English. I was happy to meet his family.

We walked around a bit and I tried to soak up as much as I could. There were so many different activities going on that it was hard to keep track. Some people were singing, some dancing. Others were playing cards or dominos. A few were cooking various types of food, while a couple of ladies were making coffee and tea in giant pots.

I found the domino game interesting. Not the game itself but the dynamic between the players. The game was being played on a makeshift table. One gentleman in particular would slam his domino on the table as if to say “take that!” All the dominos would bounce up in the air about 6” and land in a scattered mess. But, it was essentially a “nothing” move. I figured out that the real game had nothing to do with dominos. They didn’t even keep score. The real game was to identify how the other team was cheating. You see, the game was played in teams. The teammates sit across from each other. Everyone cheats. The trick is to figure out how they are cheating and call them on it. Once cheaters have been “found out”, they are kicked out of the game and replaced with the next team of cheaters. The guy who kept slamming his dominos was sending a signal to his teammate. The other team figured out what the signal meant and kicked them out.

While we were watching the game I started asking Joel some questions about his mothers’ house. I wanted to know why the roof wasn’t finished and how much it would cost for him to finish it. He told me what I already knew, which was that Haitians build their houses themselves. They build what they can, when they can afford it. I believe this is one of the reasons why there were so many buildings that failed in the earthquake. When you drive through a city like Port-au-Prince, you start to notice that when a building collapsed, one floor may have remained intact. For example, I saw a three story building in which the top floor crumbled into the second floor. The second floor remained largely in one piece, but the first floor crumbled underneath it. I think it demonstrates that when they build structures as they can afford them, some areas are made better or worse than others, and with better or worse materials. The cost of the materials that Joel will need to finish the house is exceptionally modest by US standards, $250. But in Haiti, that constitutes almost one quarter of the average income for an individual. What makes it more difficult in Joel’s case, is that he had to spend whatever money he had saved for his mother’s house, on his grandmother’s funeral. It was obvious that the roof issue weighed heavily on his mind. The rainy season is just a few weeks away and he doesn’t have the time or the money to complete the project before then.

It seemed as though I was shuffled off as quickly as I arrived. Alix received a series of phone calls from his wife before he finally said, “we have to go, my wife wants me home.” Without hesitation we all said goodnight and away we went. I think most of us married men knew that when the wife says it’s time to come home, it was time to come home!

Brahms returns!

Monday the 11th, was the day I had been waiting for, for a few weeks. Brahms came in! I have to admit that I was a bit nervous. I put a lot of pressure on myself and felt like there was a lot riding on this case since Brahms had never walked before the earthquake, and will never walk without the use of a prosthesis in his entire life. It is a concept that I have never experienced before and I found it difficult to express my emotions when I began his fitting. I can only say now, that it was one of the most “awe”some experiences of my life.I started the fitting with a very thin sheath, a minimal fabric barrier between his skin and the foam lining. It was loose, and I almost forgot what to do next. It was like I panicked and forgot all my training. When I snapped out of it, I went over to our supply shelf and picked out a couple of socks of various thicknesses. Using socks is a basic part of maintaining the fit of a prosthetic socket. I think that I put so much pressure on myself to make everything perfect, that I momentarily forgot the basics. When I fit the thinner of the two socks, I found that the socket fit well. What a relief!

Now it was time for Brahms to stand. I rolled up his suspension sleeve and his mom stood over him for support. I don’t know if he didn’t know what to do next, or if he just didn’t like everyone staring at him, but he didn’t move an inch. Then, one of the physical therapist had the idea to get out the soccer ball. And in an instant, Brahms took his first steps ever. He held on to mom’s hand, but when the ball got just a little too far for him to reach, he let go and took two steps all on his own and grabbed the ball. It was absolutely amazing to watch, and the smile on his mom’s face was worth every second of the angst I put myself through. She told me earlier that she just wanted her son to grow up and have a “normal” life, but she didn’t think it would be possible after his amputation. Today, we showed her that he will be able to do whatever he wants, he just has to want it enough. Sunday, that soccer ball would have been out of reach. Monday, we watched in awe as Brahms took his first steps of many, to reach his goal.

8-year-old Wanley

Week five brought a new group of practitioners, Dave and Ken, and a new special patient for me. This particular one was cast during my first group of practitioners. Her name is Wanley.

She was seen by Mike about 3 weeks ago. I remembered how shy she was, she wouldn’t even look at me when I said "hi". She just tucked her head or looked the other way. I learned that she was 8-years-old, but she had the outward appearance of a four or five-year-old.

Wanley’s shyness would soon be replaced by a giant smile and a young girl that liked to kick the soccer ball around. It was amazing to watch how fast she learned to walk and run with her prosthesis. But, it was even more amazing to watch her open up and become a fun loving little girl. By the end of her time with us it was hard for me to imagine that this girl, who would barely let go of my hand, would not even look at me a few weeks ago. I hope I get to see her again before I go.

R.I.P. Van Goat

Wednesday, April 6, 2011 was a sad day at Kay Hanger. Van Goat, our Haitian Hanger pet, died unexpectedly.

The day before, Max came down to the Klinik in the afternoon and asked for some money to take him to a local vet. He said it would only cost $5 so I gave it to him out of my personal money. I didn’t think anything of it, but when I got back to Kay Hanger at the end of the work day, I went around the side of the house to check on him. I noticed him leaning up against the tree, but my initial thought was that he got himself tangle up in his rope and couldn’t get loose. When I approached him, he tried to walk over to me. I saw that he wasn’t tangled up, but rather his legs were wobbly and he was using the tree for support. He could barely keep his balance and his eyes appeared to wonder. It was obvious that he knew I was there. His little tail wagged with excitement as it usually did, but I could tell he was sick and I didn’t want to get too close. As I walked away, I watched as he leaned back up against the tree.

When I woke up the next morning, I looked out my bathroom window and saw him lying away from his usual spot. He wasn’t moving and I knew he probably didn’t make it through the night. I walked outside and spoke to Max. He told me Van Goat died and he was clearly upset about it. Max took care of Van Goat and I imagine he thought of him as his own pet. I too thought of him as my adopted pet. I have three dogs at home, so it was nice to see a wagging tail again when I came home from the Klinik. It’s not the same here without him.

A first in my career

Week four ended with a first in my career. It was the first time I cast an infant for a prosthesis.

Brahms was just 6 months old when he was injured in the earthquake. I spoke with his mom and she told us his story. Brahms was lost in the earthquake and thought to be dead. His parents had given up looking for him in the rubble and knew it was unlikely that such a small child would have survived such a terrible ordeal. But, six days later, while searching for the remains of those who perished, Brahms would be pulled from the rubble. Unconscious and battered, he would spend the next three days in the hospital while the doctors tried to save his leg. However, the infection would not improve and his leg would have to be removed below the knee in order to save his life.

It did not dawn on me until a few days later, but I realized that the first steps that Brahms would ever take would be with a prosthesis I made for him at the Hanger Klinik. He is just shy of two years old now and I cannot wait to see how he does.

Another great week at Klinik Hanger

Since we had Sunday off for the election, I took the time to introduce Amir and Amy, our new clinicians, to our Klinik. I walked them through the process and when patients arrived on Monday, they were ready to go. A number of these patients were those who were casted the week before, including Richard and Derilus.

Richard is a young bilateral above-knee amputee that was injured in an electrical accident. Bilateral amputees are always challenging, but bilateral above-knee patients are particularly tough. He was cast by Michael and myself last Thursday and will soon be fit.

Derilus was fit by Amy. He was so anxious and full of energy that his first steps were better described as a jog instead of a walk. We knew this patient would be a go-getter because before he was fit with his prosthesis he could not sit still in his chair for 2 seconds. Every time I passed by he would point at his limb and ask if I was done yet. So when the time came, we fit him and cut him loose. After only 3 – 5 minutes of alignment adjustments, he started working on his dance moves. He was quite the entertainer. If he wasn’t dancing, he was jogging. If he wasn’t jogging, he was doing a back flip in the parallel bars. By the end of the first day, he was riding a bicycle up and down the walkway in front of the clinic. He did so well that we applied his cover the next day, and away he went.
Next week we are looking forward to getting Richard on two feet again and will be welcoming a new set of practitioners by week’s end. It’s always exciting to see what the new week will bring.

8-year-old Neika Love

One of the most memorable patients from the week is 8-year-old Neika Love. Neika suffered the loss of her left leg above-the-knee, as well as the loss of her father in the earthquake. Holly took a plaster hand cast of Neika and I modified the mold the next day. Typically, the patients are casted in Port-au-Prince and will make the trip to Deschapelles for their fitting and therapy. But on this particular day, since many patients made the trip out for casting, they will stay at HAS and be fitted early the following week.

Neika was one of those patients who would stay. By the time we were ready to fit her prosthesis, excuse me… “faux pie”, as she would put it, it was clear that her time waiting was not wasted. Typically, I walk the patients through the process of donning their socks and the socket, but Nieka had a different plan. She snatched the prosthesis away from me and quickly went through the routine she had seen repeated countless times by other patients over the last few days. She did everything correctly, brushed me aside, and was on her way. I had to chase her down just to make some minor alignment changes. Within the first five minutes she was walking up and down ramps, up and down stairs, and outside of the clinic along the gravel roads. She was so good that later in the day I caught her walking down the road playing with an mp3 player that one of our techs gave her to use. She was quite an amazing little girl.

We had fun playing with her over the next few days; we spent time painting behind the Klinik and writing our names on each others hands. I was sad to see her go, but even more sad that I didn’t get to say goodbye; she left while I was working in the lab. I know I may not see her again, but at the same time, I know she will be back. Just four days after receiving her faux pie, she would use it to begin the next phase of her life. As she grows, she will need to be refit with a new prosthesis, and it makes me happy to know that the work that has been done to establish this Klinik will allow it to be here in the future when she needs it. Best of luck, Neika.

Wrapping up week 2

Saturday brought an end to Michael and Holly’s two weeks here in Haiti. We usually rotate practitioners in and out on Sunday, but this particular Sunday was the Haitian presidential election. I learned earlier in the week that travel was not permitted between geographical departments, so the folks back home adjusted the travel arrangements for both the incoming and outgoing groups, a task that was further complicated by spring break in Miami. But, after all was said and done, it was another smooth transition from one group to another, and once again, a two-and-a-half hour trip back home to Deschapelles from Port-au-Prince. Luckily, I spent a good portion of the last three years traveling two hours to see my wife on the weekends. That’s a long story which finally ended on March 1st of this year. At this point I have to say “sorry” to my wife because three days after we were reunited; I left her again to come here. That fact was difficult to bear, but I know she will be here to visit soon.

A look back at my first week as lead practitioner

Monday I introduced our newly-arrived rotating practitioners to the Clinic. Our first patient of the day was a gentleman who is a bilateral below-knee amputee who lost his legs approximately 11 years ago due to an infection. He arrived by motorcycle and walked into the Clinic with no problems. I guess I should clarify something here – when he walked in, he had not yet been fit with his prostheses. Eleven years of walking on bent knees afforded him a nice ½” thick callus pad to walk on, and a bit of independence. He was able to dismount from the motorcycle without assistance and walked across our concrete floor to the fitting area. There Michael and Holly, two volunteering clinicians, proceeded with his first prosthetic fitting ever. The fitting was certainly challenging, as many bilateral fittings are, but the short length of his remaining limbs didn’t give us much surface area to work with. After several adjustments, it was time to walk. He pulled himself up in the parallel bars and away he went. It only took 3 or 4 passes in the bars, and a few alignment tweaks, before he signaled that he wanted to walk outside the bars. For his own safety. we felt it was best to slow him down a bit at that point, but he would be back soon for physical therapy and gait training. Not a bad end to our first day!

When our technicians returned on Wednesday, it was clean-up time! We all pulled together to straighten up the exam and fabrication areas. This may surprise my wife because she would be the first to tell you that I HATE to clean! But, it was certainly rewarding to get rid of the clutter and have a nice, well-organized shop to work in. Then, back to inventory. Thankfully, it was cut short again by a couple more first-time patients. Holly took charge on the fitting of our first above-knee delivery, and Michael headed towards the first casting. I bounced back and forth between the two to help wherever I could. Since I have been here before, and will be here for 3 months, I wanted Michael and Holly to experience as much as they could, other than inventory.

The casting also provided another welcome experience – cast, modify, fabricate, and fit a patient from start to finish. One of the best memories I have from my rotation last September was being able to fit a patient that I had casted during the first week. You see, the typical routine is that you either fit a prosthesis that a previous rotating practitioner casted, or you cast a patient that the next group will fit for you. So the opportunity to start and finish a patient fitting is an exciting one. But the prospect brought back memories of Kensyon, the only patient I cast and fit, during my first rotation, and I wondered how he is dong. He had an amazing story surrounding his amputation. I learned that he underwent not just one, but two amputations, both of which were caused by Tap-Tap accidents. The result of the first accident was that he lost his leg below-the-knee. The second led to a revision above-the-knee. He did amazingly well and took only one step with a crutch before he handed it back to me and said he wanted to do it by himself. Sorry for the flashback, but it is amazing how vivid the memories of this place are once you leave. I have a picture of Kensyon hanging in my office in the U.S. and I will never forget him. I hope he is doing well.

Thursday and Friday rounded out the week with a few more patients. The cause for a joyous celebration was that the inventory was finally complete! We also got word that there were four new castings scheduled for Saturday. Unfortunately, when Saturday came, the patients didn’t. A car issue prevented them from making the trip, but they are supposed to come sometime next week. We look forward to their arrival. Fingers crossed that next week provides us with the opportunity to help as many people as we can.

Getting reacquainted with the Hanger Clinic

A large Carnival was celebrated on Monday and Tuesday, so our local Haitian technicians were able to take a few days off. I think the timing was good for me though; I had a chance to get reacquainted with the routine – the rooster crowing at midnight, the kids playing tennis across the street at 6am, and the electricity shutting off and on for a moment signaling the welcome arrival of running water. It also allowed Vern and me to go over some details of the operations that are specific to the clinical leader. Luckily, my previous experience made me aware of the day-to-day operations, so we just had to fill in some details. Of course, there is an excellent support staff available to answer any questions I have, and I thank them for it.

Arriving in Haiti for my three-month term as lead practitioner at the Hanger Clinic

Last year Hanger practice manager Brandon Khoury, CPO, LPO from Quincy, Illinois volunteered at the Hanger Clinic in Haiti for two weeks, and is currently serving a three-month term a as lead prosthetist at the Clinic.

My first week back in Haiti has come and gone. As I look back, the thing that sticks out the most in my memory is how easy it was to come back. There was an overwhelming feeling of comfort as we pulled up to Kay Hanger. Similar to the feeling you get when you return home after a long, tiring, road trip. There are few places in my life that give me that feeling, but this is definitely one. As easy as it was to come back, it was actually not that easy for me to get here. Let’s just say that I have the honor of being the first and only Hanger practitioner to get bumped from a flight heading towards Haiti; but in the end, I made it to Port-Au-Prince and began the long car ride to Deschapelles. That night, there was a going away party by the pool for the departing clinicians. It was nice to see my friends Joel, Cira, Tcho, and Alex again. Everyone here says “hi” to Mark, Jeff, Paul, and Vern. Thank you all for your time and help here. Oh, and Tcho says Pi….. never mind…. inside joke.

The week in review

We've been at it for a week with our full crew – myself, Erica Webster and Kevin Harrington, two other Hanger practitioners. We followed up with Schneily and everything went very well. He grew an inch so his socket was very loose. After lengthening and tightening the fit, we kicked the soccer ball in the alley and rode his bike. This kid is full of energy and endless smiles. The only thing that went wrong was I grabbed what I thought was my metric and standard set of Allen wrenches but upon arrival, I realized I had two standard sets. Unfortunately, the standard set wouldn’t work for the adjustments I needed to make on Schneily’s prosthetic leg. Luckily, I planned for my misfortunes on the road and I brought my Dremel tool; I found a power source off of a generator and sized down the standard set to metric. I was able to successfully make a 3mm out of the standard. The adjustments went on and everything worked out.

Last week we also observed the one-year anniversary of the earthquake; a beautiful day shining the light of the Haitian people on hope and perseverance.
We have had really busy days at the Clinic; patients are coming in from everywhere seeking our assistance. I don't have exact numbers, but I believe last week we did about 37 adjustments, fit 6 new limbs, and did 7 socket remakes due to the many adjustments and changes of the residual limbs over time. Wow, we have a standard prosthetic shop just like home! It is great to see the patients keeping appointments and coming in on their own for help. Things are working just as we planned.

The patient living quarters have improved as well. Hôpital Albert Schweitzer (HAS) has been working on a new housing development called Kay (house) 52. It is great; it has running water three times a day, working private plumbing, and electricity. It also has two long cover porches that will be great for gait training. Most of the patients walked to the clinic this morning. This is great practice for ambulating in our natural environment. The streets of Haiti are not a smooth floor like our clinic.

On a personal note, Sunday I attended a local church service. Rony Bern, an employee of our Clinic is also a local pastor. He has been helping to start a church in a village outside of Deschapelles. Myself, my family, Hanger employees in Baton Rouge, and my church back home, donated funds to start the roof of the church. My mom also sent musical instruments last year. It was really nice to listen to the children play them and sing. So far away, but still close to home.

Reflections – one-year anniversary of the devastating earthquake that forever changed Haiti

Today was everything it should have been. We met with our Haitian staff yesterday and asked them what they wanted to do. Jill (the head of physical therapy at the Hanger Clinic) and I didn't believe on a day such as this we should decide what was appropriate. The Haitian staff didn't want a party since there is nothing to celebrate. Instead, they wanted a happy day to highlight the good that has come over the past year – the spirit of the Haitian people to over come adversity and push on for a better life.

Our day started with music played by patients and local artists. I spoke of the beginnings of the Hanger Ivan R. Sabel Foundation, getting to Haiti, and my personal feeling for the people of Haiti. I talked about how I have never known the true meaning of determination, compassion, humility and selflessness until now in life. I also spoke to the road of the Hanger Ivan R. Sabel Foundation towards a Haitian-run Clinic.

Our technicians spoke of their love for their people and Hanger for giving them the opportunity to help the people of Haiti. They never would have dreamed in their life they would have such an honor.

Patients including a bilateral above-the-knee mother and a young bilateral girl spoke of their triumph to regain their lives and an above-the-knee male patient expressed his appreciation. A bilateral man also ran out of the grounds and back to show his ability with his new prostheses.

The art school that is located in our backyard performed an act about the quake and cholera outbreak.

We finished by hosting a reception at Kay (house) Hanger.

The Pittsburgh Post-Gazette joined us for the special day as well as another photo journalist. WBRZ-TV, a television station from my hometown of Baton Rouge conducted a lengthy phone interview with me shortly after the activities ended. They were very pleased to hear of the Hanger Ivan R. Sabel Foundation’s efforts. I thanked them for staying with Haiti because so many have forgot but the Haitians still need our prayers and aid.

If you’d like, you can check out the Pittsburgh Post-Gazette article here and the WBRZ-TV news story here. The Pittsburgh Post-Gazette also posted some great photos of the one-year anniversary ceremony which you can see here.

Today was an emotional roller coaster and I am grateful I was here to ride it. I couldn't imagine another place on Earth I would rather be right now.

First Hanger Clinic lead practitioner Jay Tew returns to Deschapelles for another clinical rotation

Jay Tew, CP, was the first prosthetist to serve a three-month term as lead practitioner at the Hanger Clinic in Deschapelles. The Clinic achieved notable success and outstanding patient outcomes under the leadership of Jay, providing prosthetic care to 300 Haitian amputees in just three months. Following Jay’s return to the States, two other Hanger practitioners served as lead prosthetist including Anna Avakian, from Washington, DC and Vern Hostetler from Zanesville, Ohio. By the end of 2010, under the leadership of Tew, Avakian, and Hostetler, the Hanger Clinic provided prosthetic care to nearly 700 Haitian amputees. Today Jay returned to the Clinic to serve a 6-week term as lead practitioner. Stayed tuned for updates from Jay during his time in Haiti.