Page last updated at 12:12 GMT, Saturday, 30 January 2010

Uncertain future for Haiti's amputees

By Karen Allen
BBC News, Port-au-Prince

Emmanuel Etienne is tended by Merlin's Tony Redmond at a Port-au-Prince field hospital
Emmanuel Etienne was terrified he would lose his leg

Emmanuel Etienne may be badly injured in a field hospital set up on an old tennis court but he feels like a lucky man.

Doctors had planned to amputate his crushed leg in the coming days after he was trapped in the rubble of a three-storey house but they have pumped him full of antibiotics and given him extra blood.

It's hard enough in Haiti having both [legs] let alone just one
Emmanuel Etienne
earthquake survivor

Now they have changed their mind. They can salvage the limb after all.

For the 22-year-old, an avid football fan, his odds at returning to a relatively normal life have just improved dramatically.

"I was terrified I was going to lose my leg," he says.

"It's hard enough in Haiti having both of them let alone just one - I don't think I would have lived very long."

It is estimated that some 2,000 people have had limbs amputated as a result of the earthquake.

Many suffered crush injuries or quickly spreading infections which made amputations the only means to survive.

But, like many surgeons, Tony Redmond from the British medical charity Merlin says he is trying to fathom why the figure is so high.

"I've worked during other disasters but nothing like this," he says, speaking from Emmanuel's bedside.

"What we are faced with now are thousands of patients who need prosthetic limbs and rehabilitation. Once the dust has settled, as an international medical community we really do need to look at this."

'Supposed to die'

At the central hospital in Port-au-Prince, the sea of tents transformed into neat wards house hundreds of patients nursing bandaged stumps.

An unidentified amputee at the central hospital, Port-au-Prince
Some 2,000 Haitian earthquake survivors have had limbs amputated

Charity workers are handing out crutches to patients as they leave. One young woman wobbles out through the main gate, trying to adapt to this new world.

Back inside the hospital, dazed and depressed, is 29-year-old Pierre Michelle, a bus driver.

Stricken with grief over the death of his wife and two young children, he is also trying to come to terms with the loss of his right leg, amputated four days after the earthquake. The doctors never explained why the surgery was needed.

"I was supposed to die," he says.

"Life has no meaning for me any more. I know people are ready to help me but how much can they really do?"

The prospect of returning home to his sister-in-law's house offers Mr Michelle some comfort but he knows in a country already gripped by high unemployment his prospects look bleak.

Charities like Handicap International have been busy starting rehabilitation efforts on the patients, promising that truckloads of temporary prosthetic limbs will soon be on their way.

But many veterans of disasters fear the scale of this earthquake will overwhelm such well-meaning organisations because the numbers needing help are simply so great.

Darwinian struggle

There are at least 2,000 people who lost their limbs in the Haiti earthquake - a figure far higher than a similar disaster in Pakistan five years ago, explains Celia Du Pre from Handicap International.

A nurse tends to a patient at a hospital in Port-au-Prince
There are fears that amputees will not receive proper aftercare

She treated patients in that emergency and says the key to success is to get them enrolled onto rehabilitation programmes quickly and re-integrate them back into the community.

But communities have been shattered since the Haitian earthquake and health facilities and health staff have been wiped out in places.

Although there have been huge acts of kindness between strangers in the worst tragedy this country has ever experienced, in true Darwinian fashion it is the fittest who fare best when it comes to food queues.

One of the immediate challenges is to ensure that those disabled by the earthquake are not pushed to the back.

"I am 100% certain that Haiti does not have the human resources to cope in the longer term," declares Dr Henriette Chamouilles, country director for the World Health Organization in Haiti.

"We don't have enough physiotherapists…. We need to make sure we have medical supplies and ensure patients who've lost their limbs are registered with us, so we don't lose them."

For the moment, the scale of the disaster has made amputations big news but Dr Chamouilles is among the many who fear that, without long-term international support, it will slip off the agenda and Haiti's handicapped survivors will be forgotten.

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