Ryan Spill volunteers in Haiti: Helping the Physically Challenged

Hurricanes and earthquakes notwithstanding, medical care in Haiti is an ongoing crisis with not enough health care professionals, clinics, or facilities to serve the population. Many Haitians, especially in rural or underdeveloped areas, have come to rely on visiting medical teams to tend to a variety of conditions.

I’m a prosthetist at RJ Rosenberg Orthopedic Lab (RJR) in Cincinnati, that is, I am a clinician who specializes in the science of design and fitting of artificial arms and legs. On Sept. 23, I embarked on my second week-long trip to Port de Paix to volunteer as a prosthetist with STAND, the Haiti Project (standhaitiproject.org). I was one of two prosthetists on the trip, along with 20 physical therapists and two nurse practitioners.

Port de Paix is a small city on the northern coast of the island and is surrounded by rural communities. Homes are very small, usually one story, built from cinder block, and many without glass in the windows. There are no grassy lawns and outdoor furniture is a hard metal chair or two. Most people drive motos (motorcycles), or scooters, and “Uber” consists of old pickup trucks carrying as many passengers as will fit on the bed of the truck.

Although unaffected by the tragic earthquake of 2010 in Port au Prince, the community is largely void of physical medicine and rehabilitative care as we know it in the U.S. Many individuals suffer from chronic pain sustained from conditions that could have easily been treated on our soil. Amputees do not have access to a prosthetic clinic where they can be evaluated for a first prosthesis or receive follow-up care after being fit with one.

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Establishing and maintaining a sustainable clinic to provide physical therapy and prosthetic services is the goal of the nonprofit STAND. In addition to providing care, it’s a training ground for local nursing and prosthetic students who will eventually manage the clinic. Volunteers, such as our group from the states, help staff the clinic three times a year in programs organized by STAND.

The clinic where we saw patients is in a three-story cinder block structure located on the ocean. There is no beach, per se, but a concrete strip. Most of the traffic on it includes feral pigs and dogs, searching for meals at low tide. The clinic includes a basement and outdoor patio for prosthetic and orthotic fabrication and fitting, a first floor, which houses 20 treatment tables for the physical therapists working with those who have various musculoskeletal disorders, a pediatric room, a second floor with men’s and women’s sleeping quarters, and a roof on which 10 of us pitched tents to sleep in.Air conditioning, hot water, and drinkable tap water were not available for us in Port de Paix where temperatures soar into the 90s with high humidity. All of the volunteer clinicians brought their own water bottles, which we refilled sometimes hourly from five-gallon bottles of spring water.

STAND employed several locals from Port de Paix to help run the clinic, clean the facilities daily, and to cook. The cooks provided three meals per day. Breakfast included homemade fruit juices, bananas, and breads served with a delicious, mildly spicy peanut butter. Lunches and dinners included a meat, usually goat, chicken, or seafood with vegetables. Lunch was served around noon, but there was no official lunch hour. We grabbed food when we could during quick breaks.

On the first morning of the clinic, patients needing care formed a line stretching from the front of the building down the street. All 24 clinicians had their first patients at 8 a.m. continuing until 5 p.m., sometimes later. The other prosthetist, Emily Daham from [city], and I had four amputee patients within the first 30 minutes of the clinic, each with different needs, including replacement accessories, socks, shoes, and other parts for their prosthetic limbs. One female, 38 years old, had not been fit with a prosthetic leg above her knee since a motorcycle accident at least one year ago. A 6-year-old boy had outgrown his prosthetic leg a few months before the clinic, but was unable to be seen since the May clinic for a new prosthesis. An elderly woman was in need of a new sleeve that holds her prosthetic leg to her body. A female in her mid-20s came in for replacement cosmetic hose, the outermost layer to her prosthetic leg; her goals were for the best aesthetics possible.

Our “laboratory” was half outside and half inside the facility. Our air compressor was plugged into a gas-powered generator. We did not have most of the hardware and tooling that we use in the states. This forced us to be creative in terms of finding solutions for people; for example, a 9-month-old girl born with a shortened right leg was provided with a stand consisting of a donated ankle brace (coincidentally from Cincinnati Children’s Hospital) mounted to a very thick swimming pool noodle. This stand will prepare her for her first prosthesis, which will be fit next year.

This clinic relies heavily on donated supplies. These donations consist of many over-the-counter medications, shoes (people can’t afford to have several pairs of shoes), and prosthetic arms and legs. The Cincinnati community has been very generous in terms of people donating their old prosthetic devices. One of my patients here at RJR, an 18-year old female, donated all of her old prosthetic legs including those from when she was a young child. The recipients of these donated prosthetic parts don’t get a chance to meet the people who donated them, but the smiles on their faces say it all.

My time in the clinic was spent sweating, drinking water, taking advantage of the cold showers to cool off when I could, and working until dark every day. When people ask me how to describe it, I tell them that it was the hardest week of work that I can’t wait to do again!