Hanger Haiti Relief

Change

2011-10-13T14:57:00.001-04:00

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

2011-07-02T10:44:00.002-04:00

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

2011-06-29T13:25:00.001-04:00

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"

2011-06-16T11:21:00.000-04:00

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

2011-04-24T19:49:00.003-04:00

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

2011-04-24T18:45:00.001-04:00

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

2011-04-18T14:40:00.001-04:00

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

2011-04-14T14:31:00.005-04:00

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

2011-04-13T14:27:00.001-04:00

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!

2011-04-12T14:12:00.009-04:00

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

2011-04-10T14:32:00.002-04:00

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

2011-04-07T21:42:00.006-04:00

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

2011-04-03T12:05:00.000-04:00

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

2011-03-27T23:41:00.000-04:00

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

2011-03-25T19:33:00.004-04:00

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

2011-03-20T11:40:00.000-04:00

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

2011-03-15T19:03:00.005-04:00

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

2011-03-13T16:36:00.000-04:00

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

2011-03-12T16:29:00.000-05:00

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

2011-01-17T13:43:00.001-05:00

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

2011-01-12T19:00:00.005-05:00

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

2011-01-06T13:31:00.002-05:00

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.

A look inside Klinik Hanger

2010-11-02T20:14:00.003-04:00

One of the great things we have happening at Klinik Hanger is the multidisciplinary approach of having both prosthetists and physical therapists working together with patients in the same facility. As prosthetists we evaluate, fabricate and fit the prosthesis. On the day of fitting the physical therapists begin training the patients to walk with the new limb. We prosthetists are there to make adjustments as the patient adapts to their new prosthesis and their gait improves. The coordination of services under one roof is ideal for patients and something difficult to duplicate in the USA.

Another aspect of holistic care that we are able to provide patients is a natural support system from other amputees. After providing a prosthesis to an amputee, he or she usually stays at least a week here at the L'Escale house near the hospital compound, returning to the clinic each day for physical therapy and adjustments as needed. During that time the patients develop a community; they are able to learn from and support each other in ways we cannot provide. This support happens both in their living arrangement and in the clinic as they cheer for each other. At home we try to build that kind of community with our patients and here it seems to happen naturally.

Class is in session

2010-10-26T23:18:00.001-04:00

This past week has brought Haiti into the news again with the outbreak of cholera in the Artibonite Valley. The Albert Schweitzer Hospital here in Deschapelles has been at the center of providing care for the cholera patients. They have done a great job of coordinating care and providing education to the surrounding community about ways to prevent contracting the disease.

The outbreak has also affected the inflow of patients from Port-au-Prince to the Klinik Hanger. Since the outbreak was in our area, we didn’t want to unnecessarily expose amputees and possibly spread the disease to new areas. We are utilizing this time to provide additional clinical prosthetic training for our Haitian technicians. I am fortunate to have Paul Armstrong, lower extremity clinical instructor from the Newington Certificate Program in Orthotics & Prosthetics here this rotation. We have been able to cover basic anatomy, socket design, patient evaluations, casting and cast modification. Later this week, as we have time, we will continue with socket fitting and troubleshooting. It has been exciting to see the technicians’ enthusiasm as they absorb all of this information. They have been learning all along from observing the many practitioners that have worked with them, but they seem eager and ready to learn the theory and apply it for themselves. It’s great to see how much they have learned over a short eight month time span.

We hear from the hospital that new admits with cholera have slowed down and we are hopeful that the worst is over, but it is too early to know for sure. At Klinik Hanger we are taking an unfortunate experience with the cholera outbreak and turning it into a great learning opportunity for the technicians.

Daily inspiration

2010-10-02T17:01:00.001-04:00

Get to know some of the patients I had the pleasure of working with this week.

Charles Nobel is a 36-year-old transfemoral amputee who was injured at his home during the earthquake. He was unable to get immediate medical care because of the damage to hospitals in Port-au-Prince, but his family was eventually able to get him seen in Port-de-Paix. 15 days after his injuries he had to have his leg removed due to infection. He was fit this week with a prosthetic leg and took off walking without any assistive devices. It’s a privilege to work with such motivated amputees.
Emmanuel Valcin is a 44-year-old congenital quadrilateral amputee who has an extremely short transfemoral on the right side and short transfemoral on the left. He is also missing both hands above his wrists. He is in terrific shape and walks using custom crutches. His old prostheses were approximately 15 years old and the exoskeletal design made them very heavy. We’re able to fit him with lighter prostheses and crutches and he was delighted. He has perfected the use of his upper limbs and can put the prostheses on including tightening the straps. His attitude, work ethic, determination, and friendly disposition made him a joy to work with. He truly lived up to his name, “Emmanuel”. Here is a picture of three of the other patients I had the pleasure of fitting and working with this week. Their smiles and friendships are the reward.

Humbled & Blessed

2010-09-12T20:50:00.000-04:00

This week I was reminded again that our work is benefiting all amputees here in Haiti. Much of the media attention has been focused on the earthquake victims and the tragedy they suffered. The second group we are equally serving is the existing amputee population prior to the January earthquake. It was exciting to see an older female amputee finally taking her first steps with her new prosthesis after waiting 20 years for this opportunity. Another female amputee, who lost her limb due to a “tap tap” (public transport) accident 8 years ago, experienced the freedom of unassisted ambulation. A third elderly male patient was evaluated for his prosthesis and he is 33 years post injury. He is eagerly waiting for his prosthesis and the chance to walk without crutches. I asked them why they hadn’t tried being fit prior to now and they all said services weren’t readily available and could not afford the cost. I continue to be humbled and blessed to be part of this noble project to provide mobility to all Haitian amputees.

My first update from Haiti

2010-09-04T17:51:00.003-04:00

The sound of a rooster crowing and a turkey gobbling outside my bedroom window wake me up every morning. Yes, this is the same confused rooster that often starts crowing at midnight or earlier. But, after three weeks, I’ve learned to sleep through it most of the time.

My two-week orientation with Anna went by quickly and it felt like a lot of information to absorb in a short period of time. She did a great job of introducing me to Klinik Hanger and the HAS family and staff. Friday night, Aug. 27, a farewell party was held in her honor at Restaurant # 1 in Verrettes, which is approximately 6 miles from Deschapelles. It was a great night of good food, a local DJ with dancing, and heartfelt thank you speeches by Klinik staff. Anna has left her positive imprint on the Klinik like Jay before her, so I have big shoes to fill.

The Klinik Hanger continues to be an amazing place where amputees support and cheer each other on as they start their first steps in their prostheses. I continue to be impressed by the determination of the amputees at the Klinik with many walking independently on the first day after receiving their prosthesis. It is an honor to be a part of this great work here in Haiti. I‘ve had two skilled hard working practitioners the past two weeks and we’ve had a good time providing care to the amputees and working with the technicians.

A shipment of fabricating supplies arrived late last night and by 11pm we finally had the truck unloaded. Tomorrow morning we leave for Port-au-Prince at 4am to drop off Kris and Javier at the airport and pick up the new group of practitioners. The faces change but the same great work continues at Klinik Hanger.

Kris Kittleson from Iowa City, Iowa

Javier Mejia from Richmond, Virginia

Changing of the guards

2010-09-03T16:15:00.002-04:00

Hanger Prosthetics & Orthotics practice manager Vern Hostetler from Zanesville, Ohio recently arrived in Deschapelles, Haiti where he has taken over the role as lead prosthetist at the Hanger prosthetics clinic. Before Hanger practitioner Anna Avakian concluded her three-month term as lead prosthetist, she transitioned her role to Vern during a two-week training process.

Fully functional since February 22, 2010, the Hanger prosthetics clinic in Deschapelles has already achieved notable success and outstanding patient outcomes under the leadership of two prior lead practitioners from Hanger, John “Jay” Tew, from Baton Rouge, Louisiana and Anna Avakian, from Washington, DC. To date, nearly 600 Haitian amputees have received prosthetic care at the Hanger Clinic in Haiti.Before he left for Haiti, Vern talked to his local media about his impending trip. Get to know Vern by taking a look at this Zanesville Time Record newspaper article and this WHIZ-TV NBC clip.

Stay tuned for blog posts from Vern about his experience and work in Haiti.

Mwen p'ap janm bliye nou - I will never forget you

2010-08-30T01:49:00.003-04:00

I went to the beach for my last day here in Haiti. As I walked in the sand along the water’s edge, I turned around to see my footsteps of where I'd been.

Today's been full of moments like that; reflecting on what I've been a part of these last three and a half months. What a pleasure it has been to work with all the talented and caring practitioners that have rotated through since I've been here as well as working with all those in the U.S. who keep this going smoothly. The staff here is fantastic as well and their skills are perfected daily. The scope of those skills has grown in my short time here as well. I will miss them.

On Friday night we had a goodbye party and we all got to go to a little restaurant in Verrettes, a nearby town. The little restaurant is named #1 and it consists of one room with three tables that were pushed together, a hodgepodge of options for chairs, and dim lighting augmented by some candles we brought. The current rotation, all our Haitian staff, our house staff, and some friends from the hospital all joined in the festivities. There was Kompa music, some dancing, a choice of chicken or goat for dinner, and some touching speeches from people. Many of our Haitian staff reflected on the tragedy of Jan. 12th followed by heartfelt expressions of gratitude at what the Hanger Clinic has meant in their lives as well as their countrymen. How humbling it is to have a part in all of this! I am so thankful for my time here.

Looking back at the footsteps I see the waves gradually lap up on shore washing them away bit by bit. I know with time, my memories of Haiti will not be as prominent in my mind as they are now. But, I will not forget this season of life. I do hope that my impact in the clinic would be absorbed as the Haitian staff moves closer and closer to running the clinic independently. And, what's left in its place is the beauty of a top-notch prosthetics facility in the heart of Haiti. To all who have made this possible by your selfless efforts, contributions, and hard work:

Thank you.

Mwen p'ap janm bliye nou - I will never forget you

It’s in the little moments that life is lived

2010-08-22T22:32:00.001-04:00

For the first time since I’ve been here, I am dreading Monday.

Tomorrow brings the start to my final week here in Haiti at the Hanger Clinic. These three months have enriched my life and I wouldn’t give them up, but the ending of something great in life is always hard. But, it’s the sadness you feel that lets you know that what you are leaving meant something. What’s uplifting about this though is that what we’ve done here will continue on. Jay Tew saw the creation of the clinic and initial training of technicians, etc., I was able to see the honing of the skills and carry on what Jay started, and Vern, the new lead prosthetist, will take over from here. I know he will do a fantastic job and the patients will definitely be well cared for.

Earlier today I said goodbye to my last group at the airport. The current rotation of volunteers we have now will be staying one week longer than me. The group that left today was made up of some wonderful guys from the German prosthetics company Medi, who has donated prosthetic components and shoes to the clinic. We had fun these last two weeks and I let my hair down just a bit too. For example, at the end of one of the days last week we had a typical Haitian downpour. It had been one of those hot, sticky, humid days. When the storm hit, all the patients were gone and work was done so we reverted to our childhood selves and went out and played in the rain. I can’t remember the last time I had so much fun. Here’s a picture of us soaking wet and having a ball:

People told me before I came that this experience would change my life and it has, but I’ve discovered that life changes everyday. I am not the same as I was yesterday and neither is anyone else. It’s in the little moments that life is lived. It’s that second when a patient you are walking with finally lets go of your hand and takes her first steps unassisted. It’s the goodbye wave as a patient drives away on the back of a motorcycle towards the rest of his life. It’s a smile from a grateful patient, a giggle from a child, experiences shared with colleagues, and the formations of friendships. This has been another season of life, one that I am grateful for and will look back on fondly. I still have one more week here and it begins with a dreaded Monday.

Passing the torch

2010-08-15T15:58:00.002-04:00

Three months ago almost to the day, I was sitting on the same flight that I am now waiting for Vern Hostetler, the soon-to-be new lead prosthetist, to arrive on. I was enthusiastic, excited, and not sure what to expect. In many ways that seems like yesterday, but in other ways it feels like a distant memory. So much has happened since then. I have been blessed to be a part of the provision of hundreds of prostheses here in Haiti for mothers, fathers, brothers, sisters, children, and friends. Our work here has touched far more people than just those we see in our clinic.

Two weeks from now I will do what I've seen so many of the wonderful practitioners I've gotten to work with do. I will get out of the Hopital Albert Schweitzer (HAS) vehicle, walk to the green airport awning, and fly back to a world so different than the one I've been living in for the past three months. I will no longer say hi to Van Goat in the morning, walk past the chickens and the roosters who have a broken sense of what time it is, past ducks bathing in puddles from the previous night’s storm, or walk past goats and horses. I'll also no longer be able to say "good morning" and "how's it going" in Creole to our amazing staff at the clinic. I also don't foresee having over 40 people at my office each day in the states either!

I've had the pleasure of working with practitioners from all over the U.S., Switzerland and Germany; all coming together to make a difference here.

I have gotten to see so much here too. I’ve seen patients getting to the clinic on the backs of horses or on motorcycles with crutches and prostheses in tow. I’ve seen first steps of children and first steps in years for some adults. I’ve seen smiles on faces and what restored hope looks like in person.

I have been given such a gift in being part of this clinic. Now, it's time to share that gift and pass the torch on to another. These next two weeks will be bittersweet.

A new kind of "slug bug"

2010-08-11T00:58:00.001-04:00

"Blanc! Blanc!"

That is what I frequently hear being called out by children here as we pass, especially in more rural areas. It's basically yelling “white person” which I've discovered encompasses those of Asian descent, Indian descent, Middle Eastern descent, etc. Basically, a non-Haitian. At first this was a bit disconcerting for me to be called out as a white person; however now, it's so common to me that I think it's time we introduce the American game of “slug bug” to the mix. I can just see it now, one kid yells out “blanc” and slugs the other kid who bemoans the fact he didn't see us and call it out first. :)

One of my patients here who is 4-years-old was fascinated with my hair when we were casting her. I think she was more interested in my hair than the measurement and the molding process. Although she no longer plays with my hair, she does seek me out to say good morning and to give me a hello kiss. So cute! Having kids in the clinic adds such joy! I love the times when I walk towards the back to do an adjustment for another patient and walk past the kids sitting at a table enthralled by their coloring books and crayons, or random bouts of laughter that I hear from another part of the clinic, or the sound of one of our little guys who has discovered the hours of fun one of our rolling stools can provide. They are balls of seemingly endless energy! It's also great for them to have other kids with limb loss around to play with as well as getting to see adults with prostheses. It is such a unique setup here in Haiti and this “blanc” is grateful to be a part of it!

Here are some unrelated but no less interesting pictures.

This is one of our technicians walking with a patient after an adjustment:

And this is what we found inside one of our bags we use for Wednesday clinic in Port-au-Prince:

The onset of August & some sadness

2010-08-03T15:31:00.003-04:00

It is just a change of the date on a calendar but somehow the onset of August has brought with it some sadness. My time here will be over at the end of this month and I feel I just got here. It continues to be a blur of prosthetic legs, first steps, and lives changed - including mine.

I know the person who left in the middle of May is not the same one who's returning in three and a half weeks. I don't think I can put words to the change. I may not know for weeks or years to come. But this experience has enriched my life and allowed me to be a part of something amazing! For that I will always be grateful.

In an effort to be positive, I've been trying to think of things I'm looking forward to upon returning. Although I've been able to send letters out with practitioners, I welcome getting back to the regular correspondence with my grandma. Family, friends, a full weekend without work, running water, and twenty minutes without sweating - uh “glistening”, are things I'll enjoy. I already have a plan to go out for some yummy Mexican food with a dear friend upon my return and I must admit I'm really excited to see Toy Story 3 (I'm a bit of a Pixar junkie).

However, I know the minute the van pulls away from Deschapelles, and the distance between me and the clinic grows, the ache in my heart to be back will escalate. But, that is three weeks from now and many more prostheses away.

So, I will be grateful for the time I have been given and let each new day be another day to touch lives and just another change in the number on a calendar.

Here's a photo of the water tower for Deschapelles on yet another of the beautiful days that I have come to love here:

Christmas in July

2010-07-28T18:22:00.004-04:00

It may be in the 90s or more with high humidity that causes me to “glisten” profusely as I work (we girls don't sweat, right?), but it is Christmas of sorts here in Haiti for the Hanger Clinic. A container with much-needed supplies was released from customs today and is on its way to Deschapelles; all made possible by countless peoples' efforts, donations, and prayers! They may be big cardboard boxes but they contain precious materials with the power to change lives— boxes full of first steps after months of sitting or relying on crutches, boxes of renewed hope at the possibilities the future can hold, and boxes of new beginnings.

I always enjoy Christmas and as a child looked forward to what was in those colorful packages. But I can truly tell you that today was substantially better than any box under a tree.

Kim, Bradley, Ron, Esnel, Jude, Ian, Diane, Jay, Eric, the staff at SPS, and countless others – Santa's got nothing on you! Thank you for making this possible!!

Here's a photo of Ronnie, one of our staff, in front of just a portion of the boxes and contents that were released today:

An inside look at Kay Hanger

2010-07-24T22:53:00.002-04:00

There are six of us in Kay Hanger now – two girls and four guys. One American, one German who now works in Switzerland, and four Swiss. The quantity makes the shuffle for the showers in the evening quite an event to see. Like an orchestrated dance the guys float in and out of the bathroom, to their rooms in sequence. We girls are fortunate to only have to split between the two of us and it works well as long as the water isn’t being used in the kitchen which makes our shower not work. What can I say; being a girl has some perks – even in Haiti.

This may not make sense unless you know that we only have running water three times a day. From 6-6:40ish in the morning, sometime midday when we’re not at the house to take advantage of it, and 6-6:40ish in the evening. In the morning and evening we get a warning of sorts that the water is about to come on because just before the water, the electricity goes off for a minute or so while the guys in engineering switch generators. In the morning, the slowing of the fans is usually enough to wake me and if not, sounds of running water seem to. We leave the shower on so the excess water can be collected for use when we don’t have running water, which leads to one of the most unique, ingenious toilet flushing systems I’ve seen. Here’s what it looks like:

So, after doing your business (or before if you’re that prepared) you pump water with the blue plunger-like device through the tube that is attached to the inside of the toilet tank with plastic zip ties. After about ten to twelve good pumps, you get rewarded with the honor of flushing.

Tonight, like clockwork, the lights dimmed, fans slowed to a stop (reminding us how much of a blessing they are), then, the return of electric power and the familiar discussion of who would be first in the shower began in a mix of English and Swiss-German. The first two each went off to their respective cold showers. Another luxury not present here is hot water. It’s usually not too much of a loss since the weather is so hot but I must admit, there are mornings I have to psych myself up to jump in that shower.

P.S. Last Thursday #11, tonight was #12

Haiti Hanger Clinic; a multi-national effort

2010-07-14T23:23:00.000-04:00

We have become trilingual here in Haiti with my new crew which is a team from Switzerland. I can now say such useful words like screwdriver, ballpoint pen, and peanut butter in Swiss-German, Creole, and English. Yes, my language skills will definitely come in handy when I am stranded in a foreign land and my life depends on the ability to find a pen to draw a picture of a screwdriver covered in peanut butter. :)

Tonight, four of us played a card game with a Swiss deck that only has 36 cards. They are quite colorful. Here are some photos: I am so impressed with the team’s ability to practice using English to talk to our translators who translate what they say into Creole.

Getting Haitians back up and walking at the Hanger Clinic is a multi-national effort now. And, in a pinch, I can always ask for a screwdriver!

Rainstorms in Haiti

2010-07-14T21:34:00.001-04:00

I both love and hate rainstorms here in Haiti.

Let me preface this by saying that I have always liked rainstorms when experienced from the comfort of my home. Our whole family would count the beats between a big lightening bolt and the thunderclap that followed. Then, we'd practice dividing by 6 to figure out how far away the lightening was. It always seemed like God's fireworks to me; the way a bolt streaks across a previously black sky is just awesome to watch.

Here in Haiti thunderstorms do not disappoint. They will come up fast and dump copious amounts of rain in a short span of time. I love how the air cools after a storm; a pleasant relief. I've been cold a few times here (which is far fewer than spaghetti and hot dog meals - Tuesday lunch was #10). Each time I've been cold involved rain or once having wet hair and then going into a rare air-conditioned room.

The downsides to rain are muddy, rutty streets and the addition of humidity in the air. After a big storm the night before, the next day can be extra hot and sticky. Our patients suffer the worst of it. It takes so much extra energy to walk with a prosthesis and they will sometimes be drenched with sweat after physical therapy. But, this doesn't dissuade them or dampen their spirits.

Remembering the tragedy that changed Haiti forever

2010-07-09T10:42:00.002-04:00

Six months ago this Monday -- that is when the earth shook and lives in Haiti were forever changed. Loved ones were injured or killed; there were people sleeping in tents outside for fear of returning indoors with the aftershocks; and now countless new amputees are facing a new life with limb loss. Both the emotional and physical scars are a daily reminder to people here who lived through this immense tragedy.

The six month anniversary has brought some renewed media interest of prosthetic care here which is fantastic. Since the Hanger Ivan R. Sabel Foundation is run on donations, any way of getting the word out about the lives we are changing by providing free prosthetic care is certainly beneficial. It's always fascinating to me to meet journalists who spend their lives going to various countries reporting and being in the midst of situations we generally see from the comfort of our living rooms. For me, it's very surreal to be of any interest to people like that. However, I'm very thankful they get to spend some time seeing the difference we are making.

Days are flowing one into another here for me. Another talented team of practitioners will soon say goodbye to Deschapelles and to the wonderful work they've been a part of. Soon, their names and short messages will be added to our wall of those who have come before. We have a turquoise blue wall in the lab where all the people on previous teams sign as they leave. Jay Tew’s block is at the top left corner; a cornerstone of the clinic here in both the physical location of his signature and legacy he leaves.

The current team has been fantastic and has such a great sense of humor. They have left the Hanger house a unique gift – a goat. So we now have a Hanger Haiti mascot named Van Goat. He's a cute little goat that gets to spend his days helping manage the grounds of the Klinik Hanger and his nights trimming the grounds around Kay Hanger; a fun little addition to life here.

Apple pie on the menu

2010-07-02T09:40:00.003-04:00

I can’t believe it has been another week here! Somehow the days are blending together now. Deschapelles, Haiti is no longer a foreign land with strange new experiences, but rather, my home. The rocky streets lead me to where I work or past friends’ houses. The goats, pigs, turkeys, cats, dogs, horses, cows, and confused roosters are no longer an oddity-although I did clock the rooster crowing at 12:55am this morning. Ok, that rooster’s a bit odd :)
Even in a vastly different environment, similar social events occur. For example, many of the girls here get together periodically for a "girl’s night". So, last night we piled into a work pickup truck and went to a nearby town for dinner. It was just fun to giggle and hang out. These women are all involved in extremely important and rewarding projects here ranging from reforestation projects, nutrition, midwifery, and public works projects like rebuilding roads or cleaning out clogged canals so farmers get much needed water to crops. But, we are all still women in need of some time to just be girls.

A highlight of the evening was getting to stop by the one grocery store within a few hour radius of the hospital. I am so excited because I bought the fixings for an apple pie and I’m going to make it for our little 4th of July get together on Sunday.

My grandma taught me to make apple pie and many fun afternoons were spent with her rolling out the crust with the little design in the top part, slicing the apples really thin, and waiting patiently as the aroma of the cooking pie filled the kitchen. Those much-honed skills of pie creation will hopefully prove fruitful here in Haiti.

The clinic is running wonderfully and I have an excellent team here! We have one gentleman who runs a fabrication facility for Hanger so he is well versed in all technical areas and is teaching the Haitian technicians lots of useful tricks like neat ways of making their work more efficient and conserving materials by making fewer mistakes. One gentleman is amazing at modification and has been working with the technicians on modifying. The third practitioner is a computer wiz and has made my life so much simpler by teaching me some things that have made sending needed computer files back to the US much easier. We’re having a blast making a difference!

The rotations coming in and out in two-week periods kind of remind me of when I was a camp counselor. You have the pleasure of getting to live and work with some great people, get used to them, and then they leave and you get a new group. Each group has its own strengths and adds so much to the patients’ lives here. I occasionally get to hear from practitioners who came in the past and I don’t know of one that hasn’t been touched by what they’ve done here. The patients capture your heart and their smiles warm your soul.

I cannot put into words how cool it is that right now, this is what I get to do, and this amazing experience has become my day to day life!

PS: Breakfast today= #9

Tears of joy

2010-06-25T09:16:00.000-04:00

For a girl, I've always considered myself tough. I was a little tomboy growing up. I was the only girl on my roller hockey team, loved camping, I was always running around outside, and I even worked on a 1960 Morris Minor with my dad as a teen. But, I found tears in my eyes today when I saw this: Now, it may not seem like much to you but this is a patient standing who has not walked since she was 5-years-old! She is 21-years-old now and came into the Hanger Clinic walking with flip-flops on her knees.

Here we are today before wearing her prostheses:Jay saw her previously and she underwent surgery to release tightened tendons from years of being on her knees. 16 years – that's how long this vibrant young woman waited to walk. Her proud smile was a glorious addition to yet another amazing day in Haiti.

Oh, and for the record, I still love to camp, hike, etc., but I sure enjoy getting dolled up and being girly now too. Girls are allowed to cry too, right? And tears of joy are just one more benefit of getting to be here.

P.S. Friday night = #7, Tuesday morning for breakfast = #8

Another productive day!

2010-06-23T22:11:00.002-04:00

31 molds, 5 practitioners, 4 fittings, 3 locations, and one tired but satisfied team. We worked hard today!

Tonight most of the team didn't get back from Port-au-Prince until near 8pm. Traffic getting out of the city was crazy. I am so thankful that I don't have to drive here.

The main road that we take 2 1/2 hours each way to and from Port-au-Prince is called a highway here. But, it's a paved road (most of the time) that's only about a lane and a half wide and has no lane markings at all. Pot holes creep up out of nowhere, ready to jar unsuspecting passengers whose car is unable to swerve at the last minute. Other hazards are various types of livestock, other vehicles, and seemingly randomly placed "Polis Kouche". Polis Kouche translates as 'sleeping policeman' and it is what Haitians call speed bumps. Neat name for them I think.

World Cup fever!

2010-06-17T23:59:00.002-04:00

At random times during the last couple of days loud shouting pierced the once peaceful silence of Deschapelles. It originated from a nearby basketball court at a field behind our house. So, I went to check it out even though I knew the cause of the cheers - football (or soccer to us in the US).

Under a makeshift canopy of banana and coconut tree leafs, with a tap-tap's radio blaring the announcers every word, was a huddle of a mass of people. Here's what it looked like from afar:
The closer I got, the more people there seemed to be. Here's what it looked like closer up:
Now, I am only 5'3" tall so I never got to see a screen but some of the kids made sure they got to see by climbing into a near-by tree. Here's the kids:
The World Cup has been a huge topic of conversation and entertainment here. In the lab, the schedule of games is posted and an exuberant announcer's voice fills the plaster room from a radio on the counter top. According to our technicians, most Hatians' favorite teams are Brazil and Argentina. In the streets of Port-au-Prince yesterday, one could have easily assumed that Haiti had adopted one of those country's flags with so many being sold or displayed.

Argentina played today against South Africa and the cheers were abundant.

All coming from a field in Deschapelles, a half a world away from the football action, but you couldn't tell that from talking to people here.

Hard work pays off

2010-06-16T13:40:00.015-04:00

Below is a look at the hard work that takes place at the Hanger Clinic in Deschapelles, Haiti. To date, more than 350 Haitian amputees are walking tall with new prosthetic limbs created at the Clinic.

A new week

2010-06-15T00:30:00.005-04:00

Tonight was #6.

Today was the beginning of another week and the first day for the new rotation of practitioners. They're already doing wonderfully! We even fit one bilateral above-knee amputee patient today with foreshortened prostheses. Foreshortened prostheses are shorter, starter legs that don't have knee joints in them yet so the patient can get their strength and balance before progressing on to higher prostheses with knee joints. The rooster has already welcomed the new guys too.

In Creole lessons this evening I learned a funny (to me at least) phrase. It's "tet poul" which translates to mean literally "chicken head". It refers to the feelings of being lightheaded, tipsy, dizzy, or drunk. I'll never look at someone stumbling out of a bar the same way again.

Oh, and Esther, I know you're reading this so Happy Birthday my friend :)

A one-of-a-kind art project for a one-of-a-kind clinic

2010-06-11T10:42:00.009-04:00

It's rainy season here and we've had rain every evening so far. My rain boots are coming in quite handy. All the roofs here are corrugated metal. In the lab it amplifies the sound and makes the storms seem worse than the really are. In the house, the rain always sounds so peaceful. I love thunderstorms. The lightening and thunder are like God's fireworks.

Yesterday and today after work and my Creole lessons, I got to help paint the clinic a bit. There is an awesome mural project going on in our clinic right now. Local artists are funded through a grant to paint murals. Each of the patient rooms has its own theme. The pink room has birds and flowers, the blue one has some sea creatures on one side and a beautiful mountain scene on the other, the yellow has market/street scenes complete with an amputee wearing prostheses, the green room has jungle-type animals, and the purple has sports scenes-also with amputees. Here are some photos:

The new patient area and returning patient areas have welcome signs with amputees pictured.

On one bottom corner of the welcome area, one amputee has a yellow shirt and blue shorts, thanks to my mastery of kindergarten where I learned to paint within the lines. Here's my contribution: The murals just add to this place and continue to reinforce my view that there is no other prosthetics facility like this anywhere in the world. Klinik Hanger in Dechapelles, Haiti is one-of-a-kind.

A look inside "Kay" Hanger

2010-06-10T16:15:00.014-04:00

"Kay" Hanger is the house where practitioners working at the Hanger Clinic in Deschapelles stay during their rotation. Here's a behind-the-scenes look at the house:

Little by little, the bird makes its nest

2010-06-08T00:16:00.003-04:00

For the record, Saturday night was #5.

Today was the start of another week and the beginning of my second week of Creole lessons. After work, I walk down the rock-strewn road and along a path to the school. It's in a concrete building with screened-in sides. I sit at a cute little biwo (desk), in the plastic chez (chair) and learn all I can from the animated instructor at the chalkboard. Now, I can say things like, "If your leg hurts on the bottom or here (and I point), put on more socks. If the prosthetic leg feels tight, remove a sock". Thankfully, we have interpreters in the clinic and we don't have to rely on my Creole skills but I still use what little I know quite a bit!

Even with some shared language, there are times when we have to work together to communicate what's needed. A while ago I was looking for a specific tool in the lab. I've always called it a deburring tool. It's used to round a rough edge on a piece of plastic especially after it has been cut. The techs and I went back and forth as I attempted to describe how it looked, what it did, etc. I even attempted to draw a picture. Finally, one of them said, "Oh, se General!" They had named it the General. Funny name, I thought, until they brought it to me and showed me that it was labeled General-which must be the brand name. Similarly, razor blades are called Gillett here.

Probably my favorite Creole phrase I've learned is a Haitian proverb: piti piti zwazo fe nich. It translates: little by little, the bird makes its nest. Basically, it takes one step at a time to accomplish anything. I'm frequently reminded of this when patients get their prostheses and start their therapy. Little by little they stand, take some steps and, after a lot of work, usually most of them end up walking without crutches by the time they leave.

Later this week a radiant patient who has been courageously taking those steps will be discharging to start her new life with prostheses. She lost both her legs above-the-knee as a result of injuries she sustained in the earthquake. One of Jay's last days here, she walked about a half mile up hill from L'Escale, the community where many of our patients stay, and finished by walking up the ramp at the clinic. Here's a video of that:

Little by little she worked on her goal, her “nest”. What an honor it is to see her progress so well and to have had a small part in her success.

Mondays here in Haiti are always someone's beginning. That makes it exciting to get up Monday mornings and see what the week has in store for us all.

Momentous milestones & pink polka dot rain boots

2010-06-05T02:17:00.000-04:00

For those of you who are following the blog: tonight was #4. If you don't know what that means, well, you'll have to do some reading :) My first solo week as lead practitioner went quite well and included such momentous milestones as sending my first text message in Creole, having an important business conversation as a goat ate nearby, and my first experience adjusting a socket so someone could adequately squat as low as some Haitians are able to when performing daily tasks here.

The week ended today with a wonderful display of teamwork for the good of a patient. Now, normally, I'll admit, I wouldn't be the happiest camper if I was still at the office at 10pm working on a Friday night. But, tonight there was nowhere else I would rather be. Five of us chipped in to get the absolute best possible result for a patient whose life will be greatly impacted. Smiles and jokes abounded, Haitian music played on the radio in the lab, and we all worked on portions of the project together.

I have always been proud of my profession, but tonight I was part of a team that changed a man's world. We're so fortunate to get to do what we do.

Another neat event this week for me personally was the arrival of a care package from home. A woman who works at HAS had to travel back to the U.S. for a funeral and offered to bring something back for anyone who needed it, so my family was able to ship her the care package and she brought it back to Haiti. Such a treat! The care package included some cute pink polka dot rain boots (which already came in handy now that we're at the start of rainy season), other miscellaneous goodies, but three letters/cards were the true treasures. One from each of my parents and one from my grandma! On the last rotation a practitioner from Raleigh mailed letters to my grandma for me and I got one from her this week in the care package. Through the kindness of others and this blog I still get to correspond with her. It's definitely one of the myriad of things I am grateful for right now.

Day 1 as "Gwo Boss" aka "Big Boss"

2010-05-31T22:37:00.002-04:00

I made it through the first day as 'gwo boss' which translates big boss. We've got a great group of talented practitioners who have already started learning Creole from the techs and are jumping in teaching them too.

Today we saw patients that came up from Port-au-Prince as well as some patients who live nearby. There were quite a few patients leaving L'Escale and others arriving to take their place. L'Escale is a small housing complex on the HAS grounds that provides temporary housing for our patients as they go through the rehab process. Port-au-Prince is a two-and-a-half hour ride away so it's wonderful for our patients to have a place to stay.

We had a heavy rainstorm this afternoon and now the air is cooler. It's been a very nice, relaxing evening. Oh, and tonight was spaghetti with hot dogs yet again. I'm going to keep a running tally so if you see a random number on future posts that will be the hot dog spaghetti meal count. It's currently at 3.

Tomorrow I get to get up and provide more prosthetic care in Haiti. How neat is that!

An exciting adventure with a grand purpose

2010-05-30T01:16:00.002-04:00

On the way to Cange today I sat on the passenger side with the window open. There is a section with a paved road and as we drove along I felt a pang of remembrance of my childhood.

I am blessed to have a wonderful father who was a teacher from the time I was in late elementary school on. So, that allowed for two solid summers of piling into our old, big, black suburban with a tent and supplies in the back, headed off to see America. I got to see many of our nation’s national parks, state parks and a large portion of Canada as well. We camped almost every night with an occasional motel stay to do laundry and freshen up. One time I got to go swimming at a hotel and then we went up into the Grand Tetons and it snowed! So, we have a photo somewhere of me still in a swimsuit and jeans with snow around me.

We did a ton of driving on these trips. Many hours spent looking out the passenger side with the window rolled down and wind on my face.

Now, the scenery is different, the people I'm with are different, and I am different. But I am still on an exciting adventure – this time with a grander purpose.

A lot of things are on my plate now that Jay's leaving. But, for a small section of time today, I had the opportunity to just look out the window, let the wind kiss my face, and savor this time I have here in Haiti.

A send-off for Jay Tew

2010-05-29T00:30:00.005-04:00

Today was bittersweet as it was Jay's last day at the Hanger clinic. It was full of goodbyes, warm embraces, the occasional shared remembrances and final photos. Here's one I took of him with the Haitian staff:

I know Jay is torn -- he is really looking forward to being back with his family but he has also grown so close to his surrogate family here.

Tonight there was a get together in Jay's honor and for a therapist leaving at the same time. From the large attendance you could tell the impact Jay has had here. There were even a couple of patients there which I know was special for Jay.

Jay left some big shoes to fill and no one can be him. He has substantially contributed to the creation of a top-notch prosthetics facility here in Deschapelles and I plan on seeing to it that we continue to excel in providing prosthetic care to the wonderful people of Haiti.

Needless to say; Jay will be missed here. We'll be in touch though.

He may be leaving Haiti for now, but Haiti will never leave him.

Another view of Haiti

2010-05-25T23:04:00.001-04:00

This morning the whole team got up before the rooster to hike to the top of nearby hills to see the sunrise in its pink and orange brilliance over mountains on the other side of our valley.

I left to head back a bit early so I could make it back in time for the morning time slot that our house has running water. I got a bit off the trail on some rocky, sparsely vegetated terrain. I was a bit flustered trying to get back to the path when I saw a beautiful pink flower growing from a crack in the rocks; such beauty in the midst of a seemingly harsh hillside environment.

The patients I get the pleasure of working with each day here are like that flower. The beauty of their smiles just radiate! Yet, so many have suffered so much. My heart breaks to hear how one of our patients was the only one in her family to be pulled from the rubble alive or how another was the only major injury in her family (losing both legs above-the-knees) only to be abandoned by her husband and left with her four children to care for with no home or means of support. Yet, in the midst of such suffering there is the beaming smile of pride when she returned after making a lap around the block here-and it was a feat worthy of celebration! Rocky terrain, sweltering heat, humidity, an upward grade heading away from the clinic, a downward grade coming back and all on two above-knee prostheses, crutches for balance, and pure determination. Amazing!!! And a triumphant smile. To compare that smile to a flower is like comparing an expedition to the top of Mt. Everest with our little morning hike. It pales in comparison.

Photo updates from Jay Tew & Anna Avakian

2010-05-25T11:47:00.015-04:00

Business phone calls Haitian style

Dancing with mama while doing floor exercises at the Hanger Clinic

A patient at the Hanger Clinic kicking the soccer ball around

Hanger practitioner Ryan Russell on Sunday en route to a rare beach day in celebration of Jay's last week in Haiti

This was taken in Cange on a beautiful mountain tree top veranda area of the hospital where hearts were breaking after Jay broke the news to two of his patients Carmen and Mike that he's leaving Haiti. They responded in what has come to be the usual question, "When are you coming back?"
Carmen and Mike continue to do wonderfully.
At a weekly appointment at the Cange clinic

Seeing a different side of Haiti

2010-05-23T23:56:00.007-04:00

Yes, I am still in Haiti but, if I wasn't here looking at this scene right now myself, I wouldn't believe it either.

This is Jay's last Sunday here so in celebration, we all hopped on a tap-tap and came to Indigo Resort for the day. It looks like we walked into a postcard or one of those beer ads on TV. I've not seen anything like it. It's truly an oasis amid the heat and mosquitoes.

In a little while, 12 of us will again hop in a tap-tap for the hour and a half dusty, bumpy ride back to Deschapelles. A tap-tap is the Haitian public transportation. It's basically a pick-up with seats and railings. It gets that name, I'm told, from the way someone lets the driver know they want to stop to get off. They tap a couple times on the side of the pick-up, the driver hears this and stops. There's a little joke here about tap-taps:

"How many people can you fit in a tap-tap?"
Answer: "One more!"

They also transport live animals and goods to the market in tap-taps.

Today is a wonderfully relaxing way to gear up for the busy week ahead. I'm looking forward to tomorrow because the cute little 4-year-old girl from Port-au-Prince that we cast last Wednesday is coming! I'll have my tape measure and hair ready (if this is confusing, scroll down to last Wednesday's post).

When in Haiti...

2010-05-22T02:08:00.008-04:00

This morning I was too tired to hear the rooster, he took a day off from taunting us, or maybe someone had a satisfying dinner last night.

Well, you'd never guess what meal we had for breakfast -- you may have seen it all too recently here on the blog. Somehow no matter how delicious, spaghetti still doesn't seem like a breakfast food. For that matter, neither do hotdogs. But hey, when in Haiti...

Here's what our view was this morning:

Lunch was a tasty goat and okra dish over rice. Dinner was a quiche type casserole with carrots and possibly salami. Each new meal adds an element of mystery to the day. Kind of like those grab bags you'd get as a kid.

My dad is a math and earth science teacher who loves rocks so it seemed like we frequently went to gem and mineral shows when I was younger. These are basically events where one could buy any type of rock/gem/mineral or tools and accessories for working with them. Fossils were also common items sold. Other than spending time with my dad and seeing all the pretty colored minerals, my favorite part was the little grab bags that my dad would usually treat my sister and I to. We'd anxiously wait to open our bags sometimes not wanting to open them right away because our imaginations and hopes of what could be inside only existed when the little brown bags were stapled shut.

I used to always hope for a stone called tiger eye which is neat looking or a mineral called mica which peels off in little sheets providing hours of fun for a kid hanging around a gem and mineral show. Random tidbit of info on mica: they used to use mica as oven windows. I'm sure some poor bored little kid got in a heap of trouble after discovering that the oven window peeled off in little layers.

All that to say that you never know what will end up on our plates here, but one thing's for sure -- it's all been tasty!

Today the amazing teamwork continued and most of the 20 molds that were modified yesterday became full prostheses today. After work, Jay and I met with two PTs and the case manager. It's a regular team meeting to continue to coordinate care for all the patients treated by the Klinik Hanger (Hanger Clinic).

This evening we all got to experience a true Haitian party. One of the guys who works at the hospital has a band and they played while everyone enjoyed hanging out and some of us danced. Thankfully for us gals, Haitian dancing is fairly easy to learn. You just move your feet in rhythm with the music and follow your partner's lead. It was a blast.

Tomorrow Jay and I go to Cange to work with amputees there. It's about 2.5 hours away on a windy road according to Jay.

Spaghetti with hot dogs for breakfast anyone?

2010-05-20T20:49:00.002-04:00

The rooster that previously annoyed the men waged war on the girls’ side of the house this morning. I think he gets some twisted satisfaction of waking us at 4am and taunting us as we try to savor the last hours of slumber. The guys swear he makes his rounds of the house though, so I guess it’s not personal.

This morning we all descended on the casts from yesterday like anxious children opening presents on Christmas day. There were only 3 modifying stands in the cast room but practitioners spread to other rooms for modifying as well. Throughout the day we saw the normal influx of patients at the clinic (or Klinik Hanger) and were able to modify all the casts. Many are already in production! Such teamwork!

Until this afternoon I was starting to think that I’d been spared the rainy season since I hadn’t seen any rain. But, it poured this afternoon! A wonderful change because it cooled off the lab.

When I read blogs I always like pictures so I’ll give you one of an interesting meal we had a couple of days ago. Apparently, this meal is served for breakfast and we saw it for dinner that day. It’s a spaghetti with hot dogs and some spice.

A productive day in Port-au-Prince

2010-05-19T23:27:00.004-04:00

For some reason, mornings here seem to be both too early and yet full of excitement and enthusiasm for what the day holds.

This morning, Jay and I hopped into the back of a small van headed to Port-au-Prince with the type of AC that consists of opening all possible windows and being grateful when the van is moving. The other practitioners stayed at HAS to see patients there. Thankfully, we moved most of the 2+ hours down to the New Life orphanage in Port-au-Prince where a constant stream of amputees were waiting to be cast.

We saw some children from the orphanage, but it also serves as a location to see patients that come in from the Port-au-Prince area. We saw a total of 24 patients and came back with 20 molds. Not a bad day's work! Especially since we didn't start until around 10 and left around 3. Here's a photo of all the casts Jay and I took today:

There was one 4-year-old little girl with an above-knee amputation who was brought by another charitable organization accompanied by her mother. She was a bit shy at first, but after a blown-up rubber glove was transformed into a chicken for her and we played with a retractable tape measure, we became fast friends. She seemed enthralled by my hair and just liked touching it. Very cute! Schneily definitely has some competition. :)

Tomorrow, the morning may greet me earlier than I want but with 20 casts and Haitian coffee waiting for us, it should again be a great day!

Art therapy

2010-05-19T14:16:00.009-04:00

Jay Tew takes a quick break from fabricating prosthetic limbs to color with some of the younger patients at the Hanger Clinic located at the Albert Schweitzer Hospital in Deschapelles, Haiti.

Anna's first day at the Hanger clinic in Haiti

2010-05-17T23:12:00.006-04:00

Wow, what an amazing first day!

It seemed quite early this morning when a confused rooster welcomed the guys around 4am. Such friendly wildlife :)

The deluge of patients started at 8 and we didn't even break for a quick lunch until after 2. But, such rewarding work! The smiles here melt your heart.

Speaking of amazing smiles, I got to see Schneily today. If you don't know who that is, he's an amazingly cute 4-year-old that msnbc.com has been following. A ball of joyous energy and your friend right away. He is doing wonderfully! There was even a visitor today who asked which side his amputation was on! Here's some video of Schneily playing soccer ("football" here in Haiti) with Jay.

In the afternoon I got to work with a wonderful woman who lost a leg above-the-knee and an arm above-the-elbow on the other side in the earthquake. This afternoon, she got her prosthetic leg for the first time and was walking without her crutch by the end of the day! Wow!

*The above is a blog post e-mailed from Anna Avakian.

Arrived Safely

2010-05-16T22:26:00.003-04:00

"You have to rethink normal". That was Jay's comment after telling us some of the unique patients, experiences, and challenges that he's faced here.

So, as you may have gathered, we arrived safely. A smooth meet-up at the airport with Jay followed by a 2 hour or so windy drive up to Deschapelle, unloading bags, tour of Kay (house) Hanger, tour of the amazing clinic/lab, a quick nap, a flavorful lunch. Afterwards, we went on a tour of some of the village surrounding our clinic and L'Escale – the small community where our patients are staying. It's wonderful for there to be a place for them to stay and to build relationships with each other. Almost like a built in support group.

One neat piece of Haitian ingenuity we saw was what they do with some of the goats. I'm told that if a goat gets into another person's garden then the owner of the goat has to pay restitution. So, to keep the goats from sneaking in between the cactus fences here, they put a big 'ol stick on them hanging from the neck. Ingenious! Here's a photo: Well, that bed is calling my name. Tomorrow morning bright and early the patients arrive!

*The above is a blog post e-mailed from Anna Avakian.

An update from Miami

2010-05-15T23:44:00.006-04:00

Well, I successfully packed and am now in Miami. This morning I took a break from last minute preparations to have breakfast with a friend and seemed to be saying goodbye to people all day. A flurry of last phone calls and an occasional hug goodbye.

I also savored creature comforts all day. The bacon with my breakfast, the DC sights I walked by, the diet soda with ice on the plane. Even the air conditioning on the plane that made me thankful for my one sweatshirt I've brought was a reminder of all the comforts we take for granted that I may miss. Kind of reminds me of that book some of my friends read to their children, Goodnight Moon.

I ended the evening by grabbing a snack with two of the other practitioners coming in for a two week rotation. I said goodbye to ice cream. One of the first times I spoke with Jay I vividly remember asking what he missed most. "My family!" was the first response but shortly followed by ice cream.

Here is a picture of me with all of my bags.

Tomorrow begins another exciting chapter in my life-can't wait!

*The above is a blog post e-mailed from Anna Avakian.

Anticipation of the big departure

2010-05-14T12:57:00.005-04:00

The following is a blog post from Anna Avakian who over the next two weeks will be transitioning into the role as lead prosthetist at the Hanger clinic in Haiti:

Wow. In only one day I will be on a plane heading for Haiti to help provide prosthetic care for those affected by the 7.0 magnitude earthquake that struck the country the afternoon of January 12, 2010.

Life forever changed for so many in such a short time. I cannot begin to imagine what living through that would be like. Nor could I imagine surviving such a horror, only to be told hours, days, or weeks later that my injuries would result in amputation. But, I have the amazing honor to be able to make a difference to those dealing with limb loss in Haiti, thanks to the Hanger Ivan R. Sabel Foundation.

One thing I will miss is my regular letters back and forth with my grandmother who lives in California. She's a spry 94 years old, plays piano for church as well as a local choral group, and walks at least a mile a day (most days more but always at least a mile). Yep, she's wonder woman!

So, since the internet is much faster than a letter from Haiti, this blog is kind of a way for me to write her. Everyone else gets to eavesdrop :)

Here are answers to some of my grandma's questions:

Who will you be working with?
Short answer: Many talented people who share the goal of providing sustainable, long-term, high-quality prosthetic care and rehabilitation for Haiti's amputees.

A little background for this answer: The Hanger Ivan R. Sabel Foundation is a 501c3 charitable organization that has partnered with Hospital Albert Schweitzer (HAS), the Harold and Kayrita Anderson Foundation, Physicians for Peace, Catholic Medical Mission Board, and Donald Peck Leslie MD. Together, they have formed the Haitian Amputee Coalition. I could go on but the websites are much better at explaining it – plus they have photos. There's a great one of a little boy fist-bumping Kevin Carroll CP – the VP of lower extremity prosthetics at Hanger. And one of a girl smiling. Here's that site: http://haitian-amputee-coalition.org/

This effort is run on donations. It may not be possible for people to go to Haiti and make prostheses themselves, but your donations will buy the fiberglass to take the mold of a patient's residual limb, the plaster to fill the molds, the plastic and resin to make the sockets (the part that's custom-made for each patient to fit their residual limb), and donations send the prosthetists, therapists, and others who have the privilege of working directly with Haiti's amputees and restoring mobility. The Foundation has also hired four Haitians and is training them as prosthetic technicians. One technician is a bilateral amputee (meaning both legs) from injuries sustained in the earthquake. Now, he is learning and helping his countrymen! What resilience!

Where will you be?
The prosthetic clinic and lab that has been set up is located on the campus of Hospital Albert Schweitzer (HAS). HAS is located in Deschapelle, Haiti which is about 60 miles north/northwest of Port-au-Prince. The hospital buildings were unaffected by the earthquake.

What will you be doing?
The same thing I do in the US with the added challenges of heat, humidity, and mosquitoes to name a few. But, it comes with the added reward of helping amputees who live in the poorest country in the Western Hemisphere, who have come through so much since that January day.

Are you excited?
Yes!

What are you most concerned about right now?
Right now I'm concentrating on packing well and finishing up with patients here in the US so that they have a smooth handover of care while I'm gone. I work with excellent practitioners and staff who are all stepping in to take up the extra load. Thank you Heather, Robert, Hannah, Johnnie, Edie, Jonica, John and Terry!

When do you leave?
This Sat. I'll fly to Miami and Sunday morning I'll fly to Port-au-Prince. So close!

A new face at the Hanger clinic in Haiti

2010-05-14T12:52:00.003-04:00

Hanger Prosthetics & Orthotics practitioner Anna Avakian from Washington D.C. will board a plane tomorrow en route to Deschapelles, Haiti, the place she will live and work for the next three months. Anna has volunteered to serve the next three-month term as lead prosthetist at the Hanger prosthetics clinic at the Hospital Albert Schweitzer (HAS) located 60 miles from Port-au-Prince in Deschapelles, Haiti. Fully functional since February 22, 2010, the Hanger prosthetics clinic in Deschapelles has already achieved notable success and outstanding patient outcomes under the leadership of Jay Tew, a Hanger practitioner from Baton Rouge, Louisiana. Jay, who is currently serving the first three-month term as lead prosthetist, will transition his role to Anna during a two-week training process.

To date, nearly 300 Haitian amputees are walking tall with new prosthetic limbs created at the Hanger clinic in Haiti.

Get to know Anna Avakian, the soon-to-be new lead prosthetist, by watching her talk with her local TV stations about her upcoming departure.

In this news clip Anna talks with her local NBC station in Washington, D.C. and here, Anna talks with her local ABC affiliate.

Stay tuned for blog posts from Anna about her experience and work in Haiti.

An inspiration

2010-05-13T11:30:00.001-04:00

The following is an update from Jay Tew as told to a member of the Hanger team over the phone:

In Haiti, it is very typical for people to carry items on their head. We’ve been working with a lady who had her leg amputated below-the-knee. After we fit her with her new prosthetic leg, she came walking up to the Hanger clinic, up the ramp and onto the porch with a giant bowl containing all of her supplies including food and everything she needed for the day. She had no cane, no crutches, and was just walking with her new prosthetic leg carrying this bowl on her head that weighed probably 20-30 pounds. This is a great example of her returning to a productive lifestyle, consistent with local culture and customs. It was amazing to see.

Welcome to Haiti!

2010-05-10T17:17:00.000-04:00

The following is an update from Jay Tew as told to a member of the Hanger team over the phone:

One day at the Hanger clinic we had a bilateral above-knee amputee come up to the clinic on a horse. We tried to figure out how to get him off but the horse wasn’t cooperating! Once we finally got the patient inside, I told someone, “You think you’ve seen it all – what else will top this today?”

Not two minutes later, a bilateral above-knee amputee rode up to the clinic on the back of a motorcycle. He pulled up to the porch, put his arms up, swung around on the porch and used his arms and body to fluidly walk into the clinic. I thought – "There you go; welcome to Haiti!" That has been my new catch phrase – “Welcome to Haiti!” Because whatever norms you have or whatever you believe your life should be like or what others lives should be like, you just have to adjust and take it all in.

Hugs that will melt your heart

2010-05-03T17:12:00.002-04:00

The following is an update from Jay Tew as told to a member of the Hanger team over the phone:

We’ve gotten the Hanger clinic up and running like an office; everything is flowing and working nicely. We also have a clinic in the mountains in Cange that is also flowing nicely. We travel to Port-au-Prince every Wednesday to see amputees at New Life Children’s Orphanage and we’ve seen some real special guys and girls from there. One girl in particular lost her family and had her leg amputated below-the-knee. When we first met her she was a shell of a little girl just sitting on a couch and not responding or speaking to us or anything. We took her back to the Hanger clinic in Deschapelles and got her fit with a new prosthetic leg and up and walking. Now, she hugs on to me and won’t leg go and hugs everyone! She is playing with the other little kids now too. We just brought her back home after spending a couple of weeks with us at the Hanger clinic and now she is a star at the orphanage!

We met another little boy at the orphanage who is hilarious! We were trying to explain to a little girl what her new leg would look like. We tried to explain that it wouldn’t be covered during the fitting process, but upon delivery of her final leg, she would have a cover on it. She was concerned and said she didn’t want a “pipe” leg. The little boy, who had his leg amputated at the hip overheard this conversation and in his native French Creole language said “I do, I do! I’ll take it!” He just wanted a leg so he could get back to being a little boy. We made him a prosthesis complete with a cover and he immediately started walking on his own; he’s a happy, playful kid again!

An Easter spent in Haiti

2010-04-29T14:21:00.005-04:00

The following is an update from Jay Tew as told to a member of the Hanger team over the phone:

I’m used to spending Easter with my family so this Easter was really different for me. We were in Port-au-Prince transferring patients to and from the Hanger clinic and grabbed lunch before heading back to Deschapelles. While we were eating, my phone buzzed and it was pictures of my daughters in their Easter dresses, my wife, and all of my family. At that point I realized I’ve never had an Easter dinner with anyone but my family. Then I looked around the table at all of the people I’ve been working with in Haiti and realized the people in Haiti are a part of my family now. But seeing my family filled my heart up and recharged my battery and got me going. It was definitely a heartfelt day.

An update from Jay Tew, CP via his local paper

2010-04-21T17:08:00.008-04:00

Read an interview with Jay Tew from his local Baton Rouge newspaper The Advocate. The interview gives a look into Jay's amazing work at the Hanger / Haitian Amputee Coalition prosthetic and rehabilitation center at the Albert Schweitzer Hospital in Deschapelles, Haiti during the past couple of months.

Haitian amputee takes first steps with his new prosthetic leg

2010-04-13T11:00:00.001-04:00

Watch as the clinicians at the Hanger / Haitian Amputee Coalition prosthetic and rehabilitation center work with a patient as he takes his first few steps with his new prosthetic leg.

Take a tour of the Hanger / Haitian Amputee Coalition prosthetic & rehabilitation clinic while it was in development.

2010-04-12T11:50:00.000-04:00

Day 5 of "A look at Jay Tew's experiences"

2010-04-09T14:39:00.012-04:00

In addition to walking tall on their new prosthetic limbs, patients at the Hanger / Haitian Amputee Coalition prosthetic and rehabilitation center are already playing soccer again!

Jay Tew, CP with one of his patients at the Hanger / Haitian Amputee Coalition prosthetic and rehabilitation center at the Albert Schweitzer Hospital in Deschapelles, Haiti.

Day 4 of "A look at Jay Tew's experiences"

2010-04-08T16:38:00.016-04:00

Below are some of the happy patients at the Hanger / Haitian Amputee Coalition prosthetic and rehabilitation center at the Albert Schweitzer Hospital in Deschapelles, Haiti.

Richard Mason, a Hanger prosthetist from Knoxville, Tennessee with one of the younger patients at the Hanger / Haiti Amputee Coalition prosthetic and rehabilitation center.

Day 3 of "A look at Jay Tew's experiences"

2010-04-07T17:04:00.014-04:00

The following is a behind the scenes look at the Hanger / Haitian Amputee Coalition prosthetic and rehabilitation center at the Albert Schweitzer Hospital in Deschapelles, Haiti. This is where, to date, more than 160 Haitian amputees have received prosthetic care since the January 12th earthquake.

Day 2 of "A look at Jay Tew's experiences"

2010-04-06T12:06:00.013-04:00

Casting a patient's leg at the Hanger / Haitian Amputee Coalition prosthetic and rehabilitation center in Deschapelle, Haiti.

In addition to the prosthetic care being provided at the Hanger / Haitian Amputee Coalition prosthetic and rehabilitation center, there is also a training program underway to educate local Haitians to become prosthetic practitioners and technicians for the provision of long-term care in Haiti.

A look at Jay Tew's experiences

2010-04-05T16:36:00.000-04:00

Over the next five days we’ll provide a look back at the last six weeks of work taking place at the Hanger / Haitian Amputee Coalition prosthetic and rehabilitation center in Deschapelle, Haiti.

4-year-old Schneily Similien at the Hanger / Haitian Amputee Coalition prosthetic and rehabilitation center at the Albert Schweitzer Hospital in Deschapelles, Haiti. Learn more about Schneily on MSNBC.com here.

Jay Tew, CP with one of the "cutest kids in the world" at the Hanger / Haitian Amputee Coalition prosthetic and rehabilitation center.

Hanger / Haitian Amputee Coalition prosthetic and rehabilitation center patients with their new prosthetic legs.

Day 3 – Wed., Feb. 24, 2010, 9:26 pm ET

2010-03-02T14:58:00.006-05:00

The below knee amputee I'm seeing today is from Port Au Prince; she is 19 yo. She was coming home from school and a house fell on her. She was attending a prep school.

I'm also seeing an above-knee amputee today from Port Au Prince; she is 15 yo. She was at school watching tv with her mother and friend. No one made it out; they found her alive. She lost her mother and older brother. It's just her and her father left.

We will be fitting a bilateral above-knee, 4 above-knee patients, a below-knee and a below-knee/partial foot pediatric amputee this week.

I was told today there are over 100 amps at a nearby hospital. I have been making rounds with doctors in the morning. There are many more amputees waiting to heal at HAS and many small children injured (especially with burns).

The people here have a great spirit about them, always smiling and ready to greet you around every corner. It's not hard to pour everything and more out for people like this.

Day 1 – February 22, 2010, 7:22pm ET

2010-03-02T14:57:00.000-05:00

I have a special little boy I did a wrist splint and ankle foot orthosis (AFO) on who is need of a very specialized ocular plastic surgeon (he is missing his right eye). If you have any contacts willing to volunteer, it would be greatly appreciated.

Day 1 – February 22, 2010, 8:21am ET

2010-03-02T14:35:00.003-05:00

On rounds evaluating below-knee, above-knee amputees and patients in the pediatric ward. Will start fabrication on a young below-knee patient and an adult above-knee now. Evaluated a below-knee amputee last night under candle light.

Welcome to the “Hanger Haiti Relief” blog

2010-03-02T14:07:00.008-05:00

Welcome to the “Hanger Haiti Relief” blog, developed as a way for our practitioners who are working in Haiti to communicate their experiences. A little background – On February 17, 2010, Hanger Orthopedic Group and its philanthropic organization the Hanger Ivan R. Sabel Foundation partnered with Physicians for Peace, Dr. Donald Peck Leslie of the Shepherd Center, and the Harold & Kayrita Family Foundation to create the Haitian Amputee Coalition (HAC) in response to the immense need in Haiti for prosthetic care since the earthquake devastation on January 12, 2010.

Since then, the HAC has created a long-term prosthetic and rehabilitation center on-site at the Hôpital Albert Schweitzer (HAS), an undamaged local hospital with a high clinical reputation located 60 miles from Port-au-Prince in Deschapelles, Haiti. This clinic will be a sustainable program of medical care, training, education, and supplies for the people of Haiti.

Staffed by U.S. prosthetic experts from Hanger Orthopedic Group and Physicians for Peace in conjunction with local Haitian medical professionals, the Haitian Amputee Coalition prosthetic and rehabilitation center at HAS is fully functional and, in its first week, has already fit local amputees with custom-designed prosthetic devices. More than 13,000lbs of prosthetic fabrication equipment and machinery have been shipped to Deschapelles to create this facility. A mobile prosthetic care unit donated by Otto Bock Healthcare, a global manufacturer of prosthetic products and services, will soon enable the delivery of care to those who are unable to be transported to HAS.

This blog will be from the perspective of John "Jay" Tew, CP (certified prosthetist) from Baton Rouge, LA. Jay is a Hanger practice manager and recipient of the Hanger Excellence Award for Clinical Leadership. Additionally, Tew was awarded the Louisiana Distinguished Civilian Service Award, the Louisiana National Guard’s highest civilian Medal of Honor for his service to wounded soldiers returning from the Wars in Iraq and Afghanistan.

Jay volunteered to serve a three-month term at HAS as lead prosthetist for the Coalition's patient care delivery. He arrived February 22 and has already fit several amputees with prosthetic limbs and orthotic braces.

In honor of full disclosure, the posts within this blog will be the voice and perspective of Jay Tew, sometimes typed directly by Jay himself, other times emailed or dictated by Jay and typed into the blog by members of the Hanger team in the United States. Transparency and accuracy are critical components of this blog; if the perspective or author changes, we will make note of it.