In my March column, I mentioned that I had gone on a prosthetics mission to Haiti recently, which was organized by one of our patients, Kevin Valentine, a pastor at a local church. I was chosen to go along with my colleague, Michael Littles, CP, to make the week-long trip. We had no idea what we were getting ourselves into.
We arrived on Saturday, settled in on Sunday, and began seeing patients first thing on Monday. We worked 12-hour days, arriving at Prosthetics of Hope promptly at 8 a.m., breaking one hour for dinner at 5 or 6 p.m., and then coming back to complete our work until about 9 p.m.
Mike and I did not realize that our stay would coincide with the one-year anniversary of the earthquake. The media frenzy was tough to handle at times, disrupting our workflow the day before and the day of the anniversary.
The weather was another challenging factor. Living in Florida, I enjoy the comfort of air-conditioned indoor environments—I didn't realize just how much I took that for granted until spending a week in Haiti. It is hard to describe how oppressive the heat feels not only after working in it all day, but sleeping drenched in sweat all night. When I woke up in the morning, I never felt like I had gotten truly restorative sleep.
As a patient who, until about six months ago, was constantly going through volume fluctuations, I always felt like it was a matter of time before I would need a new socket. This has taken on new meaning in my short time as a practitioner. I have learned that there is no such thing as a finished patient. I like to think of their prostheses as works in progress—some are just more complete than others. People outgrow sockets, and some sockets just flat out don't fit anymore. This was the case when we arrived in Haiti.
All seven patients we worked with in Haiti were earthquake victims. Six of them had previously been fitted with a prosthesis; the seventh we fit from start to finish. There was no official patient list, but more like a running tab of who needed a replacement socket the most. We hit the ground running on our first day, casting four of the seven patients we would tend to that week. There were countless others who needed follow-up care, but in one week, seven is all that we could get to.
We used an infrared PDQ oven much like the one I used in school, but this one was a little quirkier. On our first transtibial patient we attempted to do a check socket, but several hours and failed sheets of plastic later, we realized that this would take more time than it was worth, and time was what we had the least of. The oven and the plastic seemed to have minds of their own. The oven heated slowly and unevenly, making the PETG bubble, so Mike and I left the plastic pulling to the two Haitian technicians, David and Nonue, who seemed to have learned the nuances through a lot of trial and error. David and Nonue worked their tails off while we were there but were still rough around the edges with their fabrication skills. It is hard for them to grow their skills consistently when they work only when a visiting practitioner is at the clinic. When there isn't a practitioner at the clinic, they work only on minor adjustments, as needed, with existing patients. They are waiting for the prosthetics school to open in Haiti and aspire to be two of its first students.
Learning to Simplify
After the first day, we decided we needed to simplify our processes. Patients with transtibial amputations were casted and after modifications the casts were turned straight into definitive sockets—brown polypro-copoly blend plastic with a pelite liner and neoprene sleeve. Each patient with a transfemoral amputation got a test socket, which was then mounted onto a plate with plaster and wrapped in fiberglass to get the alignment. We then did a second modification and made the final socket with the brown plastic, a distal end cap, and TES belt suspension. All sockets were fabricated with grace plates.
On one of my last days, I decided I needed to get some fresh air and went out for a five-minute walk. One of our older patients, Mary, was being carried to our facility piggy-back style by her son because she was unable to navigate the rough and rocky terrain. They both had huge smiles on their faces. Although she had lost her leg, she still had her son, her family. So many others have lost so much more.
Ronald Dickson is a graduate of the bachelor of science in orthotics and prosthetics program at St. Petersburg College, Florida. He is a resident at Prosthetic and Orthotic Associates, Orlando, Florida, and will be sharing his experiences as he completes his residency.