Rehab Medicine Team Witnesses Changing Attitudes Toward Disability In Haiti
Sentia Weche’s greatest fear the night she arrived in Haiti – two months after the earthquake – was not the hot, crowded working conditions, or the shipment of crutches and wheelchairs that hadn’t arrived, but whether the Haitian people would seek out rehab treatment.
“I was born in Haiti, I grew up in a Haitian household, and I knew there is no concept of rehabilitative medicine in Haiti,” says Ms. Weche, a physical therapist at New York-Presbyterian, who was part of a seven-person team, organized by faculty and staff from Columbia University Medical Center in partnership with Weill Cornell Medical College and New York-Presbyterian Hospital, that recently spent a week in Port-au-Prince. “If you have a broken leg, you go to the hospital and get it fixed, but after that, you are on your own.”
Dan Freed-Pastor, a physical therapy student at CUMC, teaches a young girl with a foot amputation how to use her crutches. Mously Almoza, MD, a PM&R resident at New York-Presbyterian Hospital and also a Haitian-American, feared that people disabled from the quake would be too ashamed to go outside and seek treatment, since disability in Haiti is considered a punishment from God and the disabled are often shunned.
But what they saw gave both clinicians hope that views toward disability and therapy for the disabled may be changing among Haitians.
“People weren’t hiding, but were out on the streets and participating in society,” Dr. Almoza says. “I was amazed to see a man with an amputated arm working at the airport as a baggage handler.”
“People sought out treatment and were grateful for the care we provided and the knowledge that they can move forward with their lives despite their injury,” Ms. Weche says.
Nicole Cunha, physical therapist at NYP-Weill Cornell, and NYP resident Mously Almoza, MD, provide wound care to a young man with an external fixator to set a broken arm. An estimated 200,000 Haitians sustained injuries from the January earthquake and about 2,000 to 4,000 required amputations.
Debra Tupé, PhD, assistant professor of occupational therapy at CUMC, and Danielle Butin, an adjunct instructor in occupational therapy at CUMC, had already been planning a program designed to train local Haitian community workers in rehabilitation when the quake happened.
Instead of going to rural Haiti as planned, Dr. Tupé and Ms. Butin sent the team to Port-au-Prince where a tent city had sprung up around the grounds of Gheskio, a HIV/AIDS clinic run by Weill Cornell since the early 1990s. The six therapists and one physiatrist arrived on March 13, exactly two months after the quake. Ms. Butin, with Afya, a charitable organization she founded three years ago, also helped gather and ship donated crutches, wheelchairs, and other supplies.
The most common problems the team encountered stemmed from severely contracted muscles and tendons, which happens when arms and legs haven’t been moved in weeks.
“We saw people who had been in their beds for almost two months. They had never gotten up. They didn’t know how to stand up or use crutches because no one had told them they could do that,” Dr. Tupé says.
One new mother who broke her leg in the earthquake came to the camp with her legs completely frozen, her knees unable to bend. “In just the week we were there, she made amazing progress,” Ms. Weche says. “We got her knees to bend about 40 degrees and taught her and her husband how to continue making progress after we left.”
The team worked without imaging machines, or the electromyograms they usually use to pick up muscle and nerve damage. And most of the time they worked without any medical history of their patients’ recent injuries, something Dr. Tupé says needs to be addressed in future disaster responses.
Members of the team instruct Haitian trainees in range of motion exercises. “Knowing how an ankle was broken and how it was repaired is important to the rehabilitation process,” Dr. Tupé says, “because in some cases, you can do damage if you start therapy too early.”
Other patients came to the clinic with infected wounds and or surgical repairs that will need revisions because the fractured bones didn’t join properly or didn’t join at all. Traumatic brain injuries seemed to be underreported, or initially diagnosed as post-traumatic stress disorder.
Many of the patients the team saw developed complications that could have been avoided if more physiatrists and therapists were part of the original emergency medical response that arrived in the first few days following the disaster.
“Almost everyone who had fractures could have benefited from earlier rehab,” Dr. Tupé says. “Some became even more disabled from the contractures they developed from not moving. Others would have progressed faster.”
“It’s important to get people functioning as quickly as possible: rehabilitation of the individual is part of the restoration of society.”
Since returning to New York two weeks ago, Dr. Tupé and Joel Stein, MD, the Simon Baruch Professor and Chair of Rehabilitation and Regenerative Medicine at CUMC, division chief of rehabilitation medicine at Weill Cornell, and physiatrist in chief at New York-Presbyterian, are beginning to reach out to their professional societies to find ways to enable earlier deployment of therapists and physiatrists into future disaster zones.
And they’ve been talking to Gheskio about sending therapists and physiatrists to Haiti every few weeks.
“Helicopter medicine – where we drop in for a week and then leave – isn’t the best approach” Dr. Tupé says. “The people who came to our tent everyday for therapy, you could see the change in them as the week went by. Hopefully what we’ve done will help lay a basic foundation for rehab medicine in Haiti.”
Published April 27, 2010