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Prosthetic problems for Haiti

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Matt Smith:

Welcome to the La Trobe University Podcast. I will be your host, Matt Smith and I'm here today with Rowan English. He's the head of the National Centre of Prosthetics and Orthotics at La Trobe University. Thank you for joining me, Rowan.

Rowan English:

Thanks, Matt.

Matt Smith:

You're here today to talk to me about the amputee situation in hazardous conditions. Recently in Haiti there was an earthquake on the 12th of January. It was a magnitude of seven, there were 52 aftershocks. I've got the numbers of 230,000 dead but I'm sure there is more to come as they dig through the rubble.

Now, the government in Haiti have said that 6,000 to 8,000 people have lost limbs or digits and the number from Handicap International is at 2,000 to 4,000 underwent amputations. Now, what sort of situation does this lay the country and where it's got now a high number of people to say but what sort of experiences would this country be going through as a developing nation?

Rowan English:

Although we're having some significant problems, obviously they'll be dealing with all the issues immediately post-earthquake; the early traumas issues around health care and sanitation and so on.

But specifically for the amputees or people - others with the disability, that is those that already are amputees or disabled will have problems getting about the place and actually accessing services. So that's one critical component. The rest of those are those who have suffered some sort of trauma either causing amputation or leading to amputation from subsequent surgery. And that is a huge increase in the percentage of amputees in the population.

So the problems they will have are many folds firstly, the only rehabilitation centre that deals with fitting prosthesis and amputee rehabilitation, I understand has been destroyed. So other services need to be set up. Non-government organizations such as Handicap International dealing specifically with the ongoing management of the amputees and as with other orthopedic-related disabilities, the issue for them there is to look after the existing amputees and get enough personnel and facilities on the ground to be able to deal with the new amputees.

For new amputees the crisis of course is they'll have the amputation and presumably there will be some sort of injury that has led to amputation surgery. They will need to recover from that so it's a matter of surgical procedure. There is quite a bit of recovery involved in it. In Australia, for example, if someone wants to have a below-knee amputation who would probably fit a prosthesis to them within two to three weeks and they will be up and mobile fairly soon after that.

Matt Smith:

Two to three weeks.

Rowan English:

It's fairly early. That's a lot early than you would imagine. And fitting the prosthesis actually helps the rehabilitation process. It helps the wound heal and helps get rid of a lot of the fluid that's built up. In somewhere like Haiti post-disaster, they're not going to have access to all the facilities and the personnel that we would have here, for example. There'll be ongoing post-operative management which will usually just be bandaging and making sure the wound heals appropriately and that's the most important thing, that they get healing. Some stage a little bit lighter in the process that we fitted probably with the temporary prosthesis and undergoes some physical rehabilitation with the physio and the prosthesis to attempt to get that person mobile again and a little lighter on they'll get the more permanent prosthesis. And of course, when I say permanent prosthesis, that will need to be updated and adjusted every year of their lives from there on in.

So with the huge increase in the number of amputees there will be huge demand on any personnel that are there. It will be difficult to deal with the medical situation. There'll be a lot of challenges in actually getting prosthesis fabricated and fitted and those people rehabilitated so they can actually mobilize properly.

Matt Smith:

Well, the percentage that I saw was Haiti had 8% disabled before the earthquake and I'm sure they haven't gotten around recalculating it now and they haven't got a final figure ready for this podcast but how does the society go about adjusting for that?

Rowan English:

It is going to be significant burden on the community. For a country that has had economic problems, has high level of disability, and a health care system that is struggling, this will place a much greater burden on it and a greater burden on all those in the community. The community like that is not as well set up for dealing with the disabled as we are here in the first world country so it makes it quite difficult as well. I guess one of the things with these disasters is it's very much in the media in the first couple of months post-earthquake in this case but this is a situation that we all deal with the life.

Individuals, obviously, who have had an amputation and not going to grow a limb back and will need to have access to prosthetic services and rehabilitation services for the rest of their lives, the process that they will need to follow is to get prosthetic services established across the country to be able to deal with this number of amputees. So the issue there is to be able to have enough people and that's where education and training of local people to work in those areas becomes quite significant.

Matt Smith:

What's the reality of that? Is that sort of a problem likely to take priority in this situation?

Rowan English:

That's something I'm not sure of. My best guess is would be that other things would take party and rightly see things like health and sanitation and medical care for the overall population is a high priority.

Matt Smith:

What about in other cases that are not Haiti, was the problem dealt with sufficiently? Can you think of any?

Rowan English:

There's similar issues in other countries. The ongoing management, funding available for, and people available to do it tend to be very thin on the ground. So it's quite difficult. For example, again if we look at Australia and in prosthetics, we have a high number of prosthesis per 100,000 population in this country compared to some way in a developing area -- developing country that generally have a much lower number of prosthesis and they are trying to a much lower level. So the services available significantly less and at a significantly lower level.

Matt Smith:

What would the reaction be if a similar disaster happened in somewhere like Australia or America or a developed country in Europe? Would there be the same sort of, say percentage of amputations, would there be quicker rehabilitation, would we be better set up to deal with this sort of problem?

Rowan English:

I'd like to think that we're much better set up to deal with this problem but having seen the handling of the aftermath of the side plan in New Orleans it was a bit scary how poorly that was managed. I think in Australia we would manage a whole lot better, building codes are better, we have a better hospital system, we have -- recently good triage management, we actually, in this country, plan for that disaster scenarios and practice for that but something on this level would be obviously unprecedented so it would be a huge burden but we have rehabilitation facilities across the country, much high level of education and we have more money. So that makes it a whole lot easier.

Matt Smith:

You've been to developing countries doing work within prosthetics. Can you tell me about some of the experiences that you've had during that?

Rowan English:

Well specifically, we ran an education program for students from some developing countries to upgrade to the level of education we provide here and that's been particularly successful. In that process, I've had the opportunity to go and visit a number of places with our graduates who are now working and the sort of situations we're finding is that there are a lot of disabled people in these countries I'm talking specifically here about Cambodia and Laos, lots of disabled people fairly rudimentary services available and limited number of materials that are available, lack of funding in comparison with our own situation so the components and the materials and the fabrication facilities and techniques are at a much different level.

As more people are being trained at a high level and going into those countries, locals who have been trying going back to their own countries, the awareness of these area and of the disabled people is increasing and the level of skill is increasing and those people are going on to assisting, teaching others in the country. So it becomes a more sustainable process.

Matt Smith:

Is there social stigma attached to people who've had amputations in those situations?

Rowan English:

It varies in different countries with different cultures but, yes, definitely. I've heard stories of children who have got deformed limbs at birth but are left to die because there is such a social stigma on having a child. The mother is often blamed for the child having a disability. Part of the process and part of improving awareness that these children can be assisted and be valuable members of the community. If you can't work, you are a burden on the family, they have to pay for you. So it is difficult.

There are many stories of people who have lost limbs through accidents or unexplained ordnance in some of those countries that had they not received assistance with prosthesis and rehabilitation, probably would be living as beggars or dead but if they can become mobilized, if they can work again and function in the community, then they are valuable members of the community, they can hold their jobs, they can work, go back to a farm or go back to another job and they're quite functional.

Matt Smith:

And what is the situation in countries were they've got hazards like unexploded land mines still from -- that are left over from war era?

Rowan English:

Still a significant problem there. Laos for example, during the Vietnam war had more bombs dropped on it during that time and all of the bombs in all of the countries in the Second World War it's a lot and the country wasn't even involved in the war. So the biggest problem is that 30% of those bombs didn't explode when they were dropped and loaded them across the bombs so the large bombs made up of little bomb ones. There are many, many hundreds of thousands of these still left lying around the country.

One of the problems has been that people would collect these bombs for the metal in them and sell the metal but often the bombs went off or they would come across them in fields and so on and so a lot of people have been killed or disabled because of all these unexploded ordnance.

In Cambodia, there has been more recent news of land mines and so there's more anti-personnel bombs scattered around in various places of the country with another good record so there are land mines still in many places of the country that for particularly children or mothers looking for firewood have managed to explode and land themselves or children or others because of those. And they're particularly nasty injury, standing on a landmine actually accelerates the foot upwards at a huge velocity.

So you don't get a clean amputation and you get something that's got a whole lot of dirt and muck and other bits and pieces all squashed into the nasty trauma of what used to be a leg. So surgery is often difficult and you end up with very difficult residual limbs which makes it difficult to fit prosthesis and therefore difficult to rehab and difficult for the amputees subsequently. So it's an ongoing and an awkward problem.

Matt Smith:

Rowan English, thank you for your time today.

Rowan English:

Thank you very much.