Arielle's Story

There are no coincidences in Haiti

By Lauren Lyons, MSPT

I had the privilege of spending two weeks at HAS working with the staff of the Hanger Clinic and HAS's Rehabilitation Services Integration Initiative (which includes the Rehabilitation Technician Training Program). My time at HAS was preceded by a week teaching rehabilitation to nurses at the Justinian Hospital in Cap Haitian.

During our time in Cap, we met two journalists from an organization called Food for the Poor, who were staying at the same hotel. Upon hearing that we were therapists, they immediately brought out their cameras to show us a child they wanted us to meet.

Six-year-old Arielle both sustained an injury to her right hand and lost her left leg below the knee in the earthquake that struck Haiti on January 12, 2010. After the quake, her family was relocated to Cap Haitian for medical care and since their formal discharge had been living in a makeshift shack in a swamp. Her mother had been severely injured in a car accident eight years prior, and had also sustained a partial foot amputation.

Our new acquaintances wanted to know what we could do, if anything, to help. However, our time in Cap Haitian was limited, and so we did not have the chance to go meet Arielle. Even so, we took her name and contact information, as we were aware that there was no one in that area doing prosthetics.

In a short time, we left Cap Haïtien for Deschapelles and HAS Haiti, without having seen the little girl, and not sure whether we ever would. However, after the first two hours that I spent in the Hanger Clinic my first day at HAS, I knew it was the right place to bring her. Food for the Poor helped us contact her, and even arranged transportation to HAS. She arrived two days later. Our incredible prosthetists, Chris Blades and Eric Ramcharran, cast artificial limbs for both her and her mother, turning them around in less than twenty-four hours. Arielle and her mother lived in the LaScale housing community so that she could receive physical therapy and training with her new leg. She quickly made progress, building strength, and soon she was able to walk. Within a very short period of time she even started running and climbing the steps.

Although Arielle was experiencing having an artificial limb for the first time, this was not the case for her mother. This woman came in with an ancient prosthesis, which had been almost completely destroyed and was hardly usable. She was also fit with new bracing, and as a result she was able to get rid of her crutch and walk with an almost normal gait pattern.

And, what is more: Food for the Poor is in the process of building them new housing so that this small family has a home to return to. The amazing work being done by the Hanger staff, in partnership with HAS and this collaboration with Food for the Poor is truly putting people back on their feet again. It was my blessing to be a part of the amazing work being done there.

Tout moun gen you bwa dèyè bannan yo ~ Everyone has someone to support him.

About the Images:

Top Left: Arielle and her sister upon arrival

Middle Right: Arielle being fitted for a cast by Chris, Mom being cast by Eric.

Middle Left: Arielle's cast ready for socket fabrication.

Bottom Right: First steps with Lauren and Chris.

Courage for the Disabled at HAS Haiti: An audio slide show by Martha Rial

Click the image above to view the audio slideshow!
(FYI::Captions for the images are available by clicking on the word "captions"
in the lower right hand corner of the view box!)

Pulitzer prize-winning photojournalist, Martha Rial, journeyed to Haiti in the summer of 2010 to photograph our work at Hôpital Albert Schweitzer Haiti. This is the first of two audio slide shows that she compiled about two very exciting collaborations that are taking place at the hospital, one with the United Nations, and another with Hanger Orthopedic Group.

This particular video shows images of Haitians who have suffered the loss of a limb, whether as a result of the January 2010 earthquake, motor vehicle accident or illness. Hanger Orthopedic Group is working in collaboration with HAS's revolutionary rehabilitation program to fulfill two major needs in Haiti that were greatly escalated since the earthquake: jobs for unemployed or internally displaced Haitians, and new artificial limbs for amputees.

The young man whose voice is heard in the background of this video is singing a rap song that he wrote called "Kouraj pou handicape," or "Courage for the disabled."

Even before January's devastating earthquake, living with disability in Haiti was often synonymous with a loss of livelihood. Haitians with disabilities often live isolated existences, shut away from much of the outside world, and heavily reliant on friends and family to provide for them. For years now, HAS Haiti and the "Friends" have been trying to change this situation, by integrating rehabilitation services into their vision for improved health care in Haiti.

This new effort in collaboration with Hanger Group, however, brings wholly new meaning to the phrase, "Courage for the disabled." A picture, of course, is worth a thousand words.

Click here or on the photo above to view the audio slideshow.

News from Deschapelles and Rehabilitation at HAS

The following is an account sent by email to us from Denise English, the director of the Rehabilitation Technician Training Program. Denise is currently in Deschapelles, Haiti, at HAS.

I find my telling of this new beginning far differently than I imagined. It will remain an account of hope and reaffirmation.

We arrived, Chuck Gulas and I, on January 4, 2010. Chuck flew in from St. Louis. Ian Rawson and I flew in from Pittsburgh. Chuck was waving from the curb outside the airport, having arrived ahead of us.

The trip up from Port au Prince to Deschapelles went smoothly. The vistas spectacular. Haiti never disappoints.

Chuck Gulas, PT PhD, is the Dean of the School of Health Professions at Maryville University in St. Louis, Missouri. This is his third trip to Haiti as volunteer faculty for Health Volunteers Overseas www.hvousa.org.

Beginning the second Rehabilitation Technician Training Program at Hopital Albert Schweitzer (HAS), brought us back. We’re a team. Class started on January 6, 2010.

We find ourselves sharing knowledge and laughter with our six delightful students – each one different – each one engaging – each one expressing their desire to become part of the health care community here assisting the disabled.

They are pioneers. Rehabilitation in this country is in its infancy. Chuck has a way with students. Knowledge delivered with humor. Yesterday class finished with laughter.

The last several days have been quite somber. The students each know someone who has been affected by the earthquake in Port au Prince. Most have family there. Yesterday phone service began to return with news of family and friends. Some good. Some devastating.

Patients began arriving at HAS before dawn on Wednesday. We’d felt the quake here late in the afternoon Tuesday, and the after shocks continued into the next day. We’re not certain, but we think that we felt some slight ones yesterday.

Most medical facilities in Port au Prince were rendered inoperable. Hôpital Albert Schweitzer is one of the few operating without interruption, having been spared the damage of the earthquake. It is now a key rescue facility.

Wednesday continued to see the arrival of vehicle after vehicle of the injured from Port au Prince. Many have been identified as from this area, or having family here. We are 70 miles by road from the capitol.

Our classroom at the hospital has been turned over for patient care. The Physiotherapi room is cleared out and functions as a ward.

Yesterday, we had class here at the house. The day began with discussion of news the students had received. The day ended, as noted above, with laughter. A good decision to spend the day together yesterday. A sense of purpose in a situation that is full of uncertainty.

Chuck and I were privileged to witness the initial mobilization of the hospital staff and community members in response to the arrival of the injured. A sense of calm – in the midst of suffering – prevailed. Patients were carried in the doors – often in the arms of security staff and other hospital employees called into action. Community members came to assist. We began to fill up fast. A search began for additional beds and mattresses. The staff began evaluating and then designating people for radiology and surgery. The nurses moving quietly between patients. Soon it appeared that every possible place was filled.

Hallways were impassable at times.

The patients continued to arrive through the night Wednesday and were still coming last night, Thursday, when I returned to the house around 11:00.

There was not as much heart-wrenching wailing this evening. Hymns could be heard being sung in the wards

Earlier last evening, Tomasz Skowronski, our HVO onsite contact and my partner in coordinating the HAS end of the training program needs for our teachers, was helping to coordinate and effort to secure more beds and mattresses. Now we were spilling out into the courtyards. The halls had long ago been filled to capacity – and then some.

The decision was easily made to press into service a bed and two mattresses that we were not using. Why we didn’t think of it sooner I don’t know. Tomasz arrived shortly with his team and whisked them off. We slept better knowing that someone else did as well. It was touching to watch Tomasz work along side of the others here.

David Charles, PT - the Director of Rehabilitation Services here at HAS – has been a leader in the efforts here – moving amongst the patients and assisting the physicians and nurses. Today we hope to be able to begin to work with him as patients are identified as ready for rehabilitation services.

The injuries are sobering – fractures, spinal cord and head injuries, amputations.

The families are remarkable – caring for and comforting, supporting one another.

Last night we were remarking that when we are in the midst of this we feel hopeful.

We are certain, more than ever, that the training of rehabilitation workers here will impact the lives of many that they touch. It already has. A reaffirmation.

Those who provide that service – our HVO Volunteers – and the sponsor organizations, Hôpital Albert Schweitzer and The Friends of HAS, are key.

In times like this, heroes are mentioned. They are indeed here in Deschapelles. We’ve seen them.

To make a donation to the Hôpital Albert Schweitzer earthquake relief fund, click HERE.

Stanley

Stanley is ten years old and lives in scenic Petite Riviere with his mothers and sisters in a small, but attractive painted house. Late this summer he was rushed to the hospital after an oil lamp toppled over by his bedside, and burning oil poured onto his legs. His legs and thighs were very badly burnt. 

After extensive skin grafts and surgery, Stanley was able to be moved and begin his rehabilitation. Not only did his muscles have to be excercised back into use, but special attention had to be paid to control scarring, which might have detrimental impacts on his everyday mobility and physical functionality. 

He left HAS and rehab being able to walk, and his mother was taught what daily excercises he needed to practice in order to continue proper healing. 

A few weeks ago, a team of RTTP and HAS staff members went to Petite Riviere to check up on Stanley. He hadn't checked in at HAS or any other clinics in the area for a long time, and some people were growing increasingly anxious to know how he was. 

Stanley wasn't very easy to find, since he hadn't checked in or scheduled any appointments. Although the hospital had records of him living in Petite Riviere, and some physical therapists recalled the neighborhood he lived in, there was still no clear notion of where to find him. 

After dozens of phone calls, a small team from HAS hopped from clinic to clinic, to local community leaders, trying to follow every lead as to where he might be. Eventually they found Stanley and his family. Much to the team's excitement, Stanley's mother had been very diligent with is daily exercises, and Stanley showed visible improvement. Although he is still mostly confined to his house and can't wear pants due to the irritation they cause for his wounds, Stanley was doing remarkably well.  After David Charles, one of the leading physical therapists at HAS sat down to test his range of motion and examine his overall flexibility, it was clear that he was indeed healing quite well. Stanley could even run, and demonstrated an impressive range of comfort in different movements. Some of his wounds were infected and needed cleaning, but Stanley denied that he was in any pain at all--what a trooper! 

We are all very confident that Stanley's family is taking his healing very seriously, and is being careful to make sure that he continues his daily exercises every day, and actively recovers through the rehabilitation techniques they learned at HAS, in the Physio-therapi department. 

Above: Stanley and his mother at home in Petite Riviere, after months of at-home rehabilitation and recovery.

To learn more about RTTP and other Friends of HAS projects, click here. 

A note from Ian Rawson, HAS Board President, in Deschapelles

After one year, RTTP has seen its first class through a successful graduation. Hired in July of this year, David Charles is HAS's first Haitian physical therapist, and Dr. Ian Rawson, president of HAS's Board of Directors, sent us some updates from a recent meeting at the hospital.

Ian writes,

"David Charles made a lovely presentation today to the medical staff about the rehabilitation services.

He explained that in the first month of services, over 110 patients were seen by himself and the graduating students. These patients were referred by hospital doctors from among inpatients, mostly surgery and trauma. They also saw a number of patients who had been discharged and who returned for regular sessions as outpatients.

He has recently spent days at the dispensaries in Plassac, Bastien and Verettes, where he saw a number of new cases, mostly stroke, who will need active follow-up.

He explained that at HAS the philosophy for rehabilitation goes beyond mere physical therapy, but to needs which the patient encounters in his immediate environment and home, or Lakou. All of the factors of the social environment, both supportive or otherwise, are considered in developing a treatment plan.

Dr. Maibach [HAS Medical Director] closed by saying that HAS is unique in Haiti for having sch a well-developed program, and for having a philosophy of care which is drawn from the dominant philosophy of the hospital, Reverence for Life.

Love and congratulations,

Ian"

The Rehab clinic at HAS.

Happy Belated Birthday, RTTP!

September 5th was the one-year anniversary of our Rehabilitation Technician Training Program (RTTP), which is perhaps the only program of its kind in Haiti. Ok, are you ready for all these acronyms? Let's see: RTTP was designed by the Friends of HAS Haiti (FHASH) as a way to professionalize Hôpital Albert Schweitzer Haiti's (HAS) rehabilitation service with its limited resources. Health Volunteers Overseas (HVO) came on board as a partner, as HVO affiliated teachers had been seeking a site in Haiti to operate. This collaboration between FHASH, HAS, and HVO set a platform in place to allow each of the partners to achieve their goals.

That said, we'd like to introduce you to the individuals that have made this program into the fledgling success story that it is today!


Meet Shaun Cleaver –
Coordinator of Rehabilitation Services Development

Shaun Cleaver is a Canadian physical therapist who has spent more than a year in Haiti. Shaun moved back to the country in April 2008 to work as the Coordinator of Rehabilitation Services Development for the RTTP. In this role he was responsible for establishing the framework of the training program and the system for providing rehabilitation services.

Shaun fulfilled numerous roles for the RTTP. When the training program started in January, Shaun was first and foremost the onsite contact for the training program, orienting teachers to life in Deschapelles and being a consistent face for students amid the constant changes seen with the teacher rotation. This role also makes him the interface with the RTTP and other political and independent social institutions in Haiti, including HAS of course, but also the Haitian government and local Disabled Persons’ Organizations. Shaun also works with the HAS staff to improve the current provision of rehabilitation services and facilitates the expansion of services and hiring of new employees. This included traveling to outlying areas where he stays at and works out of small health centers, seeing patients and collaborating with local employees to integrate rehabilitation. Besides this field work, he also spent a good deal of time with his hands on the keyboard and eyes on the screen, communicating with RTTP stakeholders, drafting documents to help the program raise funds and planning budgets and schedules.

Focusing on immediate needs, though, Shaun’s biggest job at RTTP's inception was to select the students and the local translator. The RTTP searched for the best candidates in these roles and engaged in a rigorous process to identify these people. For Shaun, this was a new and interesting challenge that at the time required better knowledge of the Haitian education and labor systems.

Outside of work, Shaun is known locally for his morning 3 mile runs and Kreyol fluency, allowing for animated banter and joking with the area’s residents. He is also fluent in French and often fulfills ad-hoc translation duties in HAS. He enjoys gardening, hiking and the wide variety of personalities, both visitors and local, that frequent Deschapelles.

Shaun has stayed in Deschapelles for over a year at this point. While he is currently facilitating his own transition away from his position in Haiti, he has already put systems in place which have allowed this to happen on its own. Despite the challenges, RTTP is a success after one year, and you will be sure to hear of some of the trials & triumphs of this project both in real-time and retrospectively. Shaun plans to complete his PhD in order to seek an academic appointment integrating teaching, research and service. More generally, Shaun’s career focus is integrating rehabilitation therapy in resource-poor environments and across cultures. It is likely that he will return to South America or Sub-Saharan Africa where he has traveled, worked and lived previously. Nonetheless, with a record that includes substantial, and repetitive, time living in Haiti, it is likely he will stop by here again too…

Meet Denise English – Program Director

Haiti has been an important part of Denise’s life for over 12 years. She has fulfilled a variety of commitments in Port-au-Prince, Lacroix (near Gonaives), St-Louis du Nord and now Deschapelles. In her role as Program Director, Denise is responsible for all of the educational aspects of the RTTP. It was really through Denise's efforts that RTTP was founded as an official program of the Friends of HAS. Denise established the vision for the training program, led the curriculum development, recruited teachers and oriented them to the program and providing guidance for important decisions regarding student selection, evaluation and discipline.

Denise’s affiliation in the RTTP partnership is with Health Volunteers Overseas (HVO). HVO is based in Washington, DC, and its mission is to create opportunities for health professionals from high-income countries to build health and human resources in low-income countries. (Whoa – that’s a mouthful.) Now, what does this all really mean? At the most basic level, HVO programs are rooted in teaching. Professional volunteers from the United States and Canada travel to international sites to collaborate with locals to train health care workers. In this way, HVO’s work should serve to strengthen health care systems at their local program sites. All RTTP teachers are HVO volunteers with previous experience in Haiti.

HVO has a strong physical therapy component, currently with programs in Bhutan, India, Nicaragua, Peru, St. Lucia, Suriname and Vietnam. According to Denise, “Working with HVO provides us with a wealth of international expertise and important contacts.” Denise is in regular contact with the Program Directors from the other sites, enabling exchanges regarding experiences and lessons learned.

HVO is sponsored by the American Physical Therapy Association (APTA) and has a reputation among physical therapists as offering a very organized volunteer experiences. The RTTP is proud to have HVO as part of our team and excited about the opportunities this provides.

We are also lucky to have friends like Denise and Shaun on our side.

Read an Article from the Pittsburgh Post-Gazette about Denise English and her work with the RTTP.