Reflections – Rehabilitation is a critical need in Haiti

Today’s post is the third of a short series about the first rehab team we sent to Haiti back in March. Mandy McGlynn reflects on her experience working in Haiti below:

My name is Mandy McGlynn, and I was part of the first response team that Toronto Rehab sent to Haiti, specifically to Albert Schweitzer Hospital (HAS) in Deschappelle. It was an experience I will never forget, and one I was fortunate to share with my colleagues from Toronto Rehab, Angie Andreoli, Edith Ng and Mike Landry.

Before going further, I should tell you a bit about myself. I am a physical therapist and I work as an Advanced Practice Leader in two Toronto Rehab programs, musculoskeletal rehab and low tolerance long duration rehab.

Needless to say, my training and work experiences did not—could not possibly—prepare me fully for the challenge of providing care to those injured in Haiti’s earthquake. The difficulties surrounded not just the extent of their injuries, but also the circumstances of their lives, whether it was the extreme poverty, their dislocation from their homes or the fact that so many had lost family members and loved ones in the devastation.

During our first week, I worked with inpatients and outpatients. We saw an endless stream of patients with a wide spectrum of injuries that included upper and lower extremity fractures, peripheral nerve injuries, spinal cord injuries and, most commonly, amputations.

One of the things that stood out for me was the number of earthquake survivors who presented both fractures and peripheral nerve damage. Drop foot, for example, was all too common. Quite clearly these individuals had suffered crush injuries.

Another discovery that surprised and dismayed me was the large percentage of patients with fractures that had been treated with external fixators. Frequently, these individuals will have to be non-weight bearing for long periods of time, they are at increased risk of infection and they will often require additional therapies that could have been avoided. I have no doubt that the early response medical teams did their best under terrible circumstances in the aftermath of the earthquake, but from a rehab perspective, these patients will have a much more difficult road to recovery than if internal fixators had been applied.

For most Haitians, access to healthcare is a challenge. Distances are often a barrier, travel over rugged terrain can be hard on the patient and the cost is frequently prohibitive. As a result, many of the orthopedic patients we saw were not receiving adequate physician attention or follow-up physical therapy. For example, we met one young boy who still had his fixator in place a year after his injury, when it could likely have been removed within a couple of months.

One doesn’t have to spend long in Haiti to appreciate that Haitians are incredibly family oriented and that community support and involvement is important to them. This trait came through strongly in the way family members, friends and neighbours would rally around and help care for the injured. It seemed that every patient had one or more caregivers on hand to assist in washing, toileting, dressing and feeding. In many cases, the family would literally live under the patient’s bed during his or her stay in hospital.

I realize Haitians often have no choice but to support one another during periods of hospitalization. Indeed, the reality at Hôpital Albert Schweitzer when we were there was that family was expected to provide this care. But a benefit of this practice is that, when patients return home, their surround of caregivers are well informed about what they must do to help the patient get better. This level of family commitment and involvement is a healthcare advantage and is not so easily duplicated here at home.

During our second week in Deschappelle, I worked primarily in the prosthetics lab treating amputee patients. The experiences these individuals had undergone are difficult to imagine. Not only did they lose limbs, but many also lost family members, homes and livelihoods. Despite these obstacles, they invariably showed incredible energy, drive and dedication to their rehab treatments.

Patients requiring prosthetic limbs were supplied a place to stay in nearby L’Escale, where they formed a close-knit, supportive community. Every day, a bus would arrive filled with amputee patients scheduled to receive therapy. With so many patients arriving at the same time, and since many were children and young people, we needed to create activities both for rehab purposes and also to keep them occupied. We would often initiate a game of soccer, encouraging them to have fun, while addressing rehab-specific goals such as balance, coordination and weight shifting onto their new limb.

Prior to taking part in Toronto Rehab’s Haiti response program, I had never been involved in humanitarian work of this type. To say that rehabilitation services are needed in the country at this time and for the foreseeable future is a huge understatement. The ongoing requirement is clear, and I’m proud of the long-term commitment Toronto Rehab has made to this effort. It was an incredible experience working with so many inspiring people and I would go back in a second.

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