Haiti Amputee Relief Blog

​Welcome to the “Haiti Amputee Relief” blog, developed to communicate the prosthetic efforts of the Hanger Ivan R. Sabel Foundation and the Haitian Amputee Coalition at the Albert Schweitzer Hospital in Haiti.

Illustration of the Hanger Haiti Relief efforts.Final Reflections from Jay Tew's Most Recent Trip


Jay Tew recently returned to Haiti for a fourth rotation as lead clinician at Klinik Hanger. Following is his last blog post with reflections from Jay about the trip.

June 10, 2012

It’s time to depart once again. This time there is no one scheduled to greet the new person coming into Port-au-Prince; I am leaving and there’s no transition clinician to pick up the new person coming in. Joel realized this and asked if he could go and help with the new clinician pick up, “cause someone has to be there, right?” he says. I said, “Ok, that sounds like a good idea Joel, thank you”. The last I heard he is still making the Port-au-Prince run at 4am, headed over the mountain or down the coast to Port-au-Prince, greeting the new volunteer for Klinik Hanger.

Truck with illustrations on it. I was there before the Klinik was built when Van (the founder of the Hanger Ivan R. Sabel Foundation and Haitian Amputee Coalition) introduced the mission and goal of the group. A sustainable clinic is the end result – send a focused group of professionals to a location in need, build a clinic, teach the people, and leave a sustainable clinic so the people of the land can continue to give care to their own in future times. Well Van, you did it. I couldn’t have dreamed it any better.

Posted by Hanger Ivan R. Sabel Foundation at 10:35 AM


 

Reflections from Jay Tew - 11

  A team standing by the Hospital Albert Schweitzer truck.Jay Tew recently returned to Haiti for a fourth rotation as lead clinician at Klinik Hanger. The next several blog posts are reflections from Jay about his most recent trip.

June 8, 2012

This is a monumental day for Klinik Hanger and Hopital Albert Schweitzer (HAS). The rehab department led by David Charles has set up the first community outreach program. They have scheduled ten appointments with homebound patients in need of orthotic and physical therapy care. A group of us leave early in the morning including David Charles PT, a physical therapy assistant, Joel, Klinik Hanger technician, and myself. We head to the community of Leoncoeur through corridors, back alley-like roadways, and very rough terrain at times even hard for the land cruiser to pass. We have to head out on foot many times. We evaluate ten patients and head back with eleven casts. Our day lasted from 7am to 3pm. It was a long, hot day but worth every drop of sweat.

Team walking through a village.One of the best moments, and scariest for me, was our first patient visit. We got our gear and walked through alleyways to a cement-like structure of a home. The family helped bring out an older lady who was post-stroke with drop foot. I start placing our supplies out to cast for an ankle-foot orthosis (AFO) and as I remove the cast saw from the bag, it hits me like a freight train – there are no plugs here; we’re far away from any electrical source in this region. At this point I get cold chills (and it’s brutally hot); I’m trying to think what can I do. I still look at David and say with a quivering voice “guess there’s no electricity“. He just looks at me with a smile and says “no”. What an ignorant question but I had to try. Then I look to Joel and he says no worries boss I have my casting blade (utility blade that hooks away from patient to allow cast to be cut off safely). I cannot tell you how happy I was at that moment. I tell Joel he has saved the entire day my friend. He say’s “hey boss you always tell me be three steps ahead, so I bring it”. That was a great time and turning point for me because although I have had a great deal of time here, I still think like a foreigner at times. A Haitian clinician understands the needs and situations best for their people; what the system is like and the needs once out of the protective walls of the clinic. I look at Joel and say, “Today is your day, I’m your assistant”. We evaluated everyone together and Joel applies and removes all casts today. I’m very proud to be here to assist the first Haitian rehabilitation community outreach program in this region we know of.

Team working with patients in village.Team working with patients in village.Team working with patients in village.
Team working with patients in village.Haitian_Team.jpgTeam working with patients in village.


Posted by Hanger Ivan R. Sabel Foundation at 3:01 PM


Reflections from Jay Tew - 10


Sacred Religions Waterfall: Seau d’eau.Jay Tew recently returned to Haiti for a fourth rotation as lead clinician at Klinik Hanger. The next several blog posts are reflections from Jay about his most recent trip.

June 7, 2012

The clinic is closed today because it is a religious holiday in Haiti, and the clinic observes the holidays of Haiti. Some of my Haitian friends invite me to a sacred religions waterfall to celebrate the day in the cleansing waters. We travel very far up the mountain to a magnificent waterfall called Seau d'eau. People light candle for prayer and bath in the pool beneath. We trek up the falls to the top where the fall feels like a load of gravel build dumped on you from above. We spend the better part of the day here. It still amazes me to see such despair and then see such beauty in the same place.

Posted by Hanger Ivan R. Sabel Foundation at 9:28 AM


 


 

Reflections from Jay Tew - 9


Jay Tew recently returned to Haiti for a fourth rotation as lead clinician at Klinik Hanger. The next several blog posts are reflections from Jay about his most recent trip.

June 5 – 7, 2012

There has been steady work in the Klinik, mostly fabrication and a few walk-ins these couple of days. Josef has left for Port-au-Prince. He is needed there to help with organization of a second prosthetic relief center. My German friend, I will miss you. I wish I had a little more time to work with him. It is a great thing to share your clinical and personal time with people from all over the world. You can learn so much from others whether it’s technical ideas or philosophical. Other than the purest form of giving and helping others who can’t help themselves, one of the most rewarding experiences is working over the past three years with all the Hanger and other volunteers here in Haiti. Getting to learn and take a little bit of each of them to make me into a better prosthetist and I believe, person as well, is priceless. I know I am not the same person who arrived in Haiti that Feb. 2010. I have been taken out of my bubble where my mind has expanded greatly and I’m a better person today. I wouldn’t trade it for anything in the world!

Posted by Hanger Ivan R. Sabel Foundation at 11:18 AM


 

Reflections from Jay Tew – 8


Team discusses molding a prosthetic limb. Jay Tew recently returned to Haiti for a fourth rotation as lead clinician at Klinik Hanger. The next several blog posts are reflections from Jay about his most recent trip.

June 4, 2012

Today is a great day – everyone works the day through like a well-oiled machine. We are picking up orthotic pediatric patients every day. We had two more today for night splints, and one of the children was a little girl. She was nine-years-old, but about the size of a four-year-old. She was a sweet child with nothing but smiles.

Team works on molding a prosthetic limb. One of our prosthetic clinicians, Alex, hurt his back at home. I believe it to be compression fracture of the lumbar (lower spine). He saw a doctor at the hospital and he said to brace it and don’t lift anything for a few weeks. This was a perfect time for him to learn about custom lumbar sacral orthosis (LSO). We all got together and casted Alex for his LSO. We filled, modified it, and instructed the whole way through the process using a broken branch from a tree, two pieces of a ½ round rasp and electrical tape. The guys learned the basics of bracing, above and below the injury. Then we pulled the LSO and trimmed it out to fit Alex. I only explained what and why we were doing the steps but the technicians did all the measurement, modifications, fabrication and fitting. The LSO fit very well and Alex is pleased and very proud of the work.

Posted by Hanger Ivan R. Sabel Foundation at 2:22 PM

Reflections from Jay Tew - 7


Jay Tew recently returned to Haiti for a fourth rotation as lead clinician at Klinik Hanger. The next several blog posts are reflections from Jay about his most recent trip.

June 2 -3, 2012

This weekend I have off, so I have time to meditate and scout around the town and countryside. I take long walks and visit my friends down the corridor of Deschapelles. A group of friends are going to the public beach and ask me to come along. I agree and we take a tap tap to St. Marc then to Armani beach. We sit most of the day talking and enjoying our solitude. The UN soldiers are here and having their r & r. It all seems so normal to be here; I never thought I would be doing this in a million years. Then I remember the guy walking down the wall behind me whistling, twirling a shotgun and it merrily brings me back to reality; I think he’s the security guard.

Posted by Hanger Ivan R. Sabel Foundation at 10:56 AM


 

Reflections from Jay Tew – 6


Team works with pediatric AFOs.Jay Tew recently returned to Haiti for a fourth rotation as lead clinician at Klinik Hanger. The next several blog posts are reflections from Jay about his most recent trip.

June 1, 2012

Today is another consistent day of patient flow. It consisted of adjustments, walk in patients, a new bilateral below-knee patient, and a new above-knee patient. Our pediatric population is growing; we had three more knee-ankle-foot orthosis night splints for the hospital today. Rickets, a disorder that leads to softening and weakening of the bones, is still commonly seen here.

Posted by Hanger Ivan R. Sabel Foundation at 2:05 PM

Reflections from Jay Tew – 5


Jay Tew recently returned to Haiti for a fourth rotation as lead clinician at Klinik Hanger. The next several blog posts are reflections from Jay about his most recent trip.

May 30, 2012

Today we fabricate most of the day and see a few walk in patients. One of the big projects of the day is reorganizing components, mainly feet. We have a great deal of boxes of feet from Physicians for Peace that we need to organize in the bins. If we don’t take time to organize, things will not flow when we’re busy.

May 31, 2012

Feet, feet and more feet! We try to finish our feet project today; even Roselean and her friend are helping. We finally finish later in the day. We spend most of the day talking about our objectives for the future. We go over orthotic principles of control and stabilizing of the body. We have mainly seen amputees in the clinic, but now we are starting our orthotic objective.

Posted by Hanger Ivan R. Sabel Foundation at 4:32 PM

Reflections from Jay Tew – 4


Jay Tew recently returned to Haiti for a fourth rotation as lead clinician at Klinik Hanger. The next several blog posts are reflections from Jay about his most recent trip.

May 29, 2012

Today the Catholic Medical Mission Board (CMMB) brings a van load of patients from Port-au-Prince. We see mostly adjustments of below– and above–knee amputee patients with a few new castings, just like a normal orthotics & prosthetics clinic.

We finish up our humeral fracture orthosis and go to hospital to fit the patient. Joel took charge of this case. We modified and he independently did the rest of the orthosis. I feel confident he will be able to handle the next one on his own. Everything went very well with the fitting; the patient is stabilized and in more comfort than before.

Posted by Hanger Ivan R. Sabel Foundation at 1:54 PM

Reflections from Jay Tew – 3


Team works with patient.Jay Tew recently returned to Haiti for a fourth rotation as lead clinician at Klinik Hanger. The next several blog posts are reflections from Jay about his most recent trip. 

May 28, 2012

Well, Haiti is still hot! I start my day as always – totally drenched in sweat early in the morning. It usually takes about three days for my body to acclimate. As I walk to Klinik Hanger I see my old friend along the way. I walk in and it’s like being home. Joel, Tchoe, Alex, Cira, Roselean and Yvener are all as before, sustaining the clinic.

For my first day our patient load is a consistent flow of below– and above–knee amputees, and now, pediatric patients in need of ankle-foot orthoses (AFOs).  

We get a call from the hospital about an unstable humeral fracture in the ER. So Joel and I are off to evaluate and treat. We arrive at the ER and the patient has a left spiral fracture of the proximal humorous (also known as a broken shoulder) and distal break, so we cast and start fabrication immediately.

Posted by Hanger Ivan R. Sabel Foundation at 1:25 PM

Reflections from Jay Tew - 2


Jay Tew recently returned to Haiti for a fourth rotation as lead clinician at Klinik Hanger. The next several blog posts are reflections from Jay about his most recent trip.

May 27, 2012

Josef with a Hanger Klinik patient. I arrive in Port-au-Prince to be greeted by Josef Dobler, a German prosthetist from medi who is the current lead clinician at Klinik Hanger in Haiti. I get settled into our new home, Kay 11. It’s a little different than our last accommodations, but I’m thankful to have it. We live in the general volunteer area now and share our home and meals with all the volunteers from around the world. I like the change – it’s nice to live and learn with people from many different walks of life. My roomies are from Switzerland, England, Haiti and Germany.

Posted by Hanger Ivan R. Sabel Foundation at 3:21 PM

Reflections from Jay Tew – 1


Jay Tew recently returned to Haiti for a fourth rotation as lead clinician at Klinik Hanger. The next several blog posts are reflections from Jay about his most recent trip.

May 26, 2012

Happy Birthday to me! I left New Orleans to travel to Miami, and then I’ll continue to Port-au-Prince the next morning. We have a layover in Miami as we always do. There, we typically meet our teammates, organize supplies and prepare to hit the ground, ready for our mission.

There are usually three to four of us that come in together, but this tour is much different for me. We have moved to our next phase of relief at Klinik Hanger. We no longer need teams of three to four now that the Hanger Clinic has evolved to a sustainable prosthetic, and now, orthotic clinic as well. I am not concerned going in alone since this is my fourth tour. My thoughts are filled with anticipation of seeing the progress of the clinic and all of my friends. The only way I can describe it is like having a child and having to leave them behind. You know you have to leave but will return and the excitement is overwhelming as you arrive back. Clinically my thoughts are to help further education, assess needs and assist.

On a lighter note, I decided to take myself out for my birthday. My plane arrived earlier than usual so I went to South Beach for a walk and dinner. The best part was when I grabbed a cab back to the airport hotel my cab driver was an older gentleman whose name was Joseph Jean St. Pierre. I recognized this name so I said “koman yea” (how are you). He looked back in surprise with an intrigued look. He says “pa pe mal” (not so bad). “Mwen rele Jay”, I say. He says “mwen rele Jean; Ha Ha ou pale creole?” We started speaking to each other about how I can speak Creole. Jean was very excited learning about our efforts in Haiti. I was able to bring him back home even if it was for a very short time. When we arrived at the airport hotel he wished me well and said the ride was on him, “Mesi zanmi mwen” (thank you my friend).

Posted by Hanger Ivan R. Sabel Foundation at 3:04 PM


 

Job Satisfaction – Reflections from Former Lead Prosthetist Anna Avakian


One of the things I’ve always loved about this field is that we get to make a tangible difference in peoples’ lives. Getting up, out of bed and into work can mean Ms. Smith gets to walk on her preparatory prosthesis for the first time or Mr. Jones will walk out of the office behind the wheelchair he arrived in. I love the joy that comes with making a difference.

Sometimes in life, we do not get to see first-hand the results of our efforts.

The first time I left Haiti at the end of August 2010, I knew the work started would continue. Vern Hostettler took over from me and I had the confidence that he would continue on in the training of the technicians and running of the clinic. But, a part of me was saddened that I wouldn’t get to see the results.

But, I did.

After Vern, followed Brandon Khoury, Chris Blades and Spencer Mion. Jay Tew also returned for a stint in early 2011. Last October I had the honor of returning to Klinik Hanger and seeing how far the efforts of so many had gone. The Haitian technicians: Alix, Tcho, Joel, and Cira were taking charge and almost running the clinic. When the patients arrived they would flock to the front, grab patient charts and escort the patients to the rooms to make a repair, take a new cast, or do a fitting. I watched in giddy satisfaction to see a clinic that needed very little of my help. Our education program has been a success – we not only have provided prosthetic care, but taught Haitians how to care for Haitians, creating a lasting impact. Those with limb loss in the Artibonite region of Haiti no longer have to take multiple tap-taps (a Haitian form of transportation) and struggle to get to Port-au-Prince to receive care. Mothers of children born in this area with a limb deficiency will no longer agonize over if their child will have a chance to walk, play, or kick a ball like other kids. And, in Deschapelles, amputees receive respect and excellent care to get them back to living. This care, for the most part, isn’t coming from a “blanc” but from another Haitian who speaks their language, knows their culture, and will be there for them for years to come.

Talk about job satisfaction!

For each and every person who contributed and continues to contribute to the Hanger Ivan R. Sabel Foundation in Haiti, thank you for the impact and difference you’ve made!

Posted by Hanger Ivan R. Sabel Foundation at 8:52 AM


 

An Update from Former Hanger Klinik Lead Prosthetist Anna Avakian


Leaving Haiti last October was kind of like saying goodbye to a dear friend when you’re moving far away.

You don’t know when you’ll see them next but there are constant reminders or flashes of experiences that bring you back, reminding you of their impact on your life, and how much you miss them.

For example, my friend Esther is forever linked to grocery store tomatoes. She’ll never let me forget a hilarious evening that started with me “squeezing tomatoes” to choose the ripe ones. This involved a mad rush back to the store since I had left the rental video near the pile of tomatoes because I just “had” to buy a couple more on the way out. In my defense they were perfectly ripe and an amazing price!

Reminders of Haiti are everywhere, too.

Summer has returned to the Atlanta area – hot and humid. So far, I’ve resisted turning on my AC at home and have an oscillating fan keeping the night air pulled in through the window to cool me off and lull me to sleep. It feels just like Haiti, and many nights my thoughts drift back there; the experiences and people that have changed my life.

A photo of some of those people, our amazing group of technicians and staff in Deschapelles, hangs on my wall at work. Their smiles forever ingrained in my memory. Above that hangs a colorful painting by a local Deschapelles artist reminding me of the vibrancy of life in a little town worlds away.

A book of Creole Proverbs sits on my shelf at home where, a couple of weeks ago, I even heard a rooster crowing in the middle of the night. I wonder if the time-confused rooster in Deschapelles is still around?

And, I will never be able to look at a hot dog the same way again. For the rest of my life, they will remind me of Haiti and the hot dogs and spaghetti meal that’s a common breakfast there.

I’m hopeful I’ll get to go back. A chance to spend time with a dear old friend. Time has changed us both. Situations are different. But, the love and connection I feel for Haiti and its people is unwavering.

Posted by Hanger Ivan R. Sabel Foundation at 11:29 AM

Change


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

Change.

Sometimes it seems to be the only constant in life.

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

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

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

Posted by Hanger Ivan R. Sabel Foundation at 2:57 PM


 

A Recap of Weeks 4 & 5


Team HangerI 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 Group of Haitianstechnicians 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.”

Posted by Hanger Ivan R. Sabel Foundation at 10:44 AM


A Recap of Weeks 2 & 3


Joel and group presenting certificate.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, Alex, 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 clinicians and be able to practice patient care.

Posted by Hanger Ivan R. Sabel Foundation at 1:25 PM

Returning "Home"


Kennda posing for a photo.Last year Hanger Clinic 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 clinician 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!”

Posted by Hanger Ivan R. Sabel Foundation at 11:21 AM


 

Hangertat for Humanity


Tim and Brandon building a roof for Hangertat for HumanityFriday 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.

Tim building a roof for Hangertat for HumanityWe 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 any time 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.  

Posted by Hanger Ivan R. Sabel Foundation at 7:49 PM


Niekka Love Returns and an Update on Baby Brahms


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

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

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

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

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

Posted by Hanger Ivan R. Sabel Foundation at 6:45 PM


 

Recap of the Remainder of the Week


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

Posted by Hanger Ivan R. Sabel Foundation at 2:40 PM


 

Trip to Leogane


Casting a patient by headlights.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.

Posted by Hanger Ivan R. Sabel Foundation at 2:31 PM


 

Learning More about the Haitian Culture


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

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

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

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

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

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

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

Posted by Hanger Ivan R. Sabel Foundation at 2:27 PM

Brahms Returns!


Group sitting with baby Brahms.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!

Baby Brahms pulling on prosthetic device.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.

Posted by Hanger Ivan R. Sabel Foundation at 2:12 PM

8-year-old Wanley


Wanley kicking a soccer ball.Week five brought a new group of clinicians, Dave and Ken, and a new special patient for me. This particular one was cast during my first group of clinicians. 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.

Posted by Hanger Ivan R. Sabel Foundation at 2:32 PM


 

Blog Contributors  

 
Christopher BladesChristopher Blades, CPO, Portland, Maine  

Portland, Maine resident and Hanger Clinic prosthetist Chris Blades, CPO is currently serving as lead prosthetist at the Hanger Clinic at the Hôpital Albert Schweitzer (HAS) in Deschapelles, Haiti.

Fully functional since February 22, 2010, the Hanger Clinic in Deschapelles has already achieved notable success and outstanding patient outcomes under the leadership of four prior lead clinicians from Hanger Clinic:

• John “Jay” Tew, from Baton Rouge, Louisiana
• Anna Avakian, from Washington, DC
• Vern Hostetler from Zanesville, Ohio
• Brandon Khoury from Quincy, Illinois



Jay TewJay Tew, CP, Baton Rouge, Louisiana

Clinic Manager and recipient of the Hanger Excellence Award for Clinical Leadership, Tew was also 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, 2010 and fit several amputees with prosthetic limbs and orthotic braces.



Anna AvakianAnna Avakian, CPO, Washington D.C.

District of Columbia resident and Hanger Clinic prosthetist Anna Avakian served the second three-month term as the lead prosthetist at the Hanger Clinic at the Hôpital Albert Schweitzer (HAS) in Deschapelles, Haiti.


 


 


Vern HostetlerVern Hostetler, CPO, Zanesville, Ohio

Zanesville, Ohio resident and Clinic Manager Vern Hostetler served the third three-month term as lead prosthetist at the Hanger Clinic at the Hôpital Albert Schweitzer (HAS) in Deschapelles, Haiti.


 


 
Brandon KhouryBrandon Khoury, CPO, LPO, Quincy, Illinois

Quincy, Illinois resident and Clinic Manager Brandon Khoury, CPO, LPO served as a lead prosthetist at the Hanger Clinic at the Hôpital Albert Schweitzer (HAS) in Deschapelles, Haiti.

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