Prosthetic & Orthotic Services in Post-Earthquake Haiti

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The 7.0 magnitude earthquake which struck Haiti on January 12 of 2010 created the challenge of providing prosthetic and orthotic care to a severely marginalized population that was already lacking in adequate services.

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<ul><li> 1. </li> <li> 2. Prosthetic &amp; Orthotic Services in Post-Earthquake Haiti Dave Ritchie, Amanda Barizo Nathaniel Wheeler, Edward Phinney </li> <li> 3. <ul><li>Overview </li></ul><ul><li><ul><li>Haiti, Jan. 12 earthquake, immediate effects, P&amp;O response </li></ul></li></ul><ul><li>Current P&amp;O practices </li></ul><ul><li><ul><li>Survey, fabrication trends, training programs </li></ul></li></ul><ul><li>Challenges, Issues and Outlook </li></ul><ul><li><ul><li>Sustainability, standardization, ISPO Code of Conduct, volunteering </li></ul></li></ul><ul><li>Acknowledgements/Q&amp;A </li></ul>P&amp;O Services in Post-Earthquake Haiti </li> <li> 4. The Republic of Haiti Rpublique d'Hati Repiblik Ayiti </li> <li> 5. Pre-Earthquake P&amp;O: Needs Assessment <ul><li>800,000 disabled (GoH, 1983) </li></ul><ul><li>Total disabled people in need of P&amp;O services: 50,000 </li></ul><ul><li>(WHO 0.5% of ~10 million pop.) </li></ul><ul><li>Number of trained personnel needed: </li></ul><ul><li>67 (Cat I/II), 300 (Cat III) </li></ul><ul><li>(WHO/ISPO, Guidelines for Training Personnel in Developing Countries in P&amp;O services) </li></ul></li> <li> 6. Pre-Earthquake P&amp;O Services <ul><li>Healing Hands for Haiti, PaP </li></ul><ul><li>St. Vincents Hospital, PaP </li></ul><ul><li>Advantage Program, Les Cayes </li></ul><ul><li>Center for Eucharistic Heart, Cap Haitien </li></ul>(Eitel, 2010) </li> <li> 7. The Earthquake </li> <li> 8. </li> <li> 9. </li> <li> 10. P&amp;O Post-Earthquake <ul><li>2000-4000 amputations (HI), 4000-6000 amputees (GoH) </li></ul><ul><li>Number of those requiring orthotic services is unknown </li></ul></li> <li> 11. The P&amp;O Response <ul><li>Donations </li></ul><ul><li>Parachute Services </li></ul><ul><li>Patient-transport Programs </li></ul><ul><li>Rotational Short-term Projects </li></ul><ul><li>Long-term Projects </li></ul></li> <li> 12. I. Donations <ul><li>Monetary </li></ul><ul><li>Componentry </li></ul><ul><li>New or used </li></ul><ul><li>prostheses </li></ul><ul><li>Fabrication materials </li></ul><ul><li>Equipment </li></ul></li> <li> 13. II. Parachute Services <ul><li>Neglect in-country services and capacity building of Haitians. </li></ul><ul><li>Often leave problems in their wake </li></ul><ul><li>(Kistenberg, 2010) </li></ul></li> <li> 14. III. Patient-transport Programs <ul><li>Highly discouraged by ISPO </li></ul><ul><li><ul><li>Componentry may not be appropriate for the patients home country </li></ul></li></ul><ul><li><ul><li>Traveling to a foreign country can be disorienting for the patient </li></ul></li></ul><ul><li><ul><li>Upon return, patient may be left with a sense of abandonment </li></ul></li></ul><ul><li><ul><li>(Kistenberg, 2010) </li></ul></li></ul></li> <li> 15. IV. Rotational Short-term Missions <ul><li>Rotational short-term missions </li></ul><ul><li><ul><li>Length of stay and objectives of the P&amp;O clinic should be considered </li></ul></li></ul></li> <li> 16. V. Long-term Projects <ul><li>Adhere to international standards </li></ul><ul><li>Implement training programs </li></ul><ul><li>Offer integration programs and psychosocial support </li></ul></li> <li> 17. Current P&amp;O Practices Current P&amp;O Practices </li> <li> 18. Post-Earthquake P&amp;O Services </li> <li> 19. <ul><li>Healing Hands for Haiti with Handicap International </li></ul><ul><li>Hanger Prosthetics Clinic </li></ul><ul><li>Hopital Albert Schweitzer </li></ul><ul><li>Mission of Hope </li></ul><ul><li>Hopital Sacre Coeur </li></ul><ul><li>BRAC Brace and Limb Center </li></ul><ul><li>Haiti Hospital Appeal </li></ul></li> <li> 20. Can you give a brief description of your facility? </li> <li> 21. What are the most common injuries and pathologies you have treated? </li> <li> 22. Fabrication Trends Of your P&amp;O clients, what is the percentage of those injured by the January earthquake? </li> <li> 23. What fabrication methods are most commonly practiced at your facility (i.e. Lamination, Polypro sockets, donated parts, ICRC kits)? </li> <li> 24. ICRC <ul><li>Cheap </li></ul><ul><li>Requires few additional materials </li></ul><ul><li>Accepted by international standards </li></ul><ul><li>Durable &amp; Comfortable </li></ul><ul><li>Ease of learning &amp; repair </li></ul><ul><li>Recyclable </li></ul></li> <li> 25. Approximately how many patients have you fitted for a device? </li> <li> 26. Training Is there a training program currently implemented at your facility? </li> <li> 27. Proposal of Education in Prosthetics and Orthotics for Haiti </li> <li> 28. </li> <li> 29. </li> <li> 30. </li> <li> 31. Challenges Challenges, Issues &amp; Outlook </li> <li> 32. Further Needs <ul><li>Overwhelming enthusiasm for providing LE prosthetic devices, but orthotic care is far more needed. </li></ul><ul><li><ul><li>Pediatric orthotics </li></ul></li></ul><ul><li><ul><li>Traumatic and chronic disease orthotic devices </li></ul></li></ul><ul><li>Upper extremity prosthetics </li></ul><ul><li>(Ingersoll, 2010) </li></ul></li> <li> 33. <ul><li>Sustainability </li></ul><ul><li><ul><li>Education, materials </li></ul></li></ul><ul><li>Coordination </li></ul><ul><li><ul><li>Geographical </li></ul></li></ul><ul><li><ul><li>Technical </li></ul></li></ul><ul><li><ul><li>Governmental </li></ul></li></ul><ul><li>Information gaps (pre-quake, new injuries) </li></ul><ul><li>Ethical considerations of P&amp;O groups </li></ul><ul><li><ul><li>Publicity, previous experience in undeveloped nations, cultural sensitivity </li></ul></li></ul><ul><li><ul><li>(Stanfield, 2010) </li></ul></li></ul>Challenges </li> <li> 34. <ul><li>ISPO Code of Conduct for Humanitarian </li></ul><ul><li>Organizations </li></ul>ISPO Code of Conduct for Humanitarian Organizations </li> <li> 35. The sheer quantity of humanitarian assistance efforts in Haiti is heartwarming and inspiring. But it is also alarmingly inconsistent, with examples ranging from well thought out and appropriate relief work to the infamous charitable group that allegedly kidnapped the children. Rob Kistenberg, president of US ISPO, recently put out an appeal to all those prosthetic, orthotic, and mobility organizations offering assistance in Haiti to study and endorse the US ISPO Code of Conduct. Jon Batzdorff, CPO, Chair of the International Outreach Committee of US-ISPO. </li> <li> 36. <ul><li>Avoid discrimination on the basis of race, religion, nationality or political party. </li></ul><ul><li>Assistance shall not require any political or religious endorsements or behavior in order to receive benefits </li></ul><ul><li>Respect the local customs and culture </li></ul>Code of ConductforProsthetic and OrthoticNongovernmental Humanitarian and Development Assistance </li> <li> 37. <ul><li>Encourage and support local capacity for providing P&amp;O services. </li></ul><ul><li>5. Avoid creating dependency of the local community on the NGO for future follow up, adjustments, replacements. </li></ul><ul><li>Materials should be used which can be found or acquired locally. </li></ul>Code of ConductforProsthetic and OrthoticNongovernmental Humanitarian and Development Assistance </li> <li> 38. <ul><li>7. Avoid overlapping of services </li></ul><ul><li>8. Coordinate efforts, planning, and delivering of services with the local community </li></ul><ul><li>Consider long-term development goals, not simply emergency immediate needs. </li></ul><ul><li>(Batzdorf, 2010) </li></ul>Code of ConductforProsthetic and OrthoticNongovernmental Humanitarian and Development Assistance </li> <li> 39. <ul><li>What Can You Do To Help? </li></ul></li> <li> 40. <ul><li>Research the Organization </li></ul><ul><li>Security </li></ul><ul><li>Residents </li></ul><ul><li>- Immunization Shots </li></ul><ul><li>Travel Insurance </li></ul><ul><li>- Registration with Embassy </li></ul>Volunteer Considerations </li> <li> 41. Donations <ul><li>Prosthetic &amp; Orthotic Component Clearinghouse (P.O.C.C) </li></ul><ul><li>MedShare International c/o P.O.C.C. 3240 Clifton Springs Road Decatur, GA 30034 </li></ul><ul><li>Monetary Donations </li></ul></li> <li> 42. <ul><li>For more information, please visit our website </li></ul><ul><li>http://haitipando.info.nu </li></ul></li> <li> 43. Acknowledgements Dan Blocka &amp; Gord Ruder Al Ingersoll Healing Hands for Haiti Shaun Cleaver Albert Schweitzer Hospital Katherine Mackenzie, Diana Cherry Mission o f Hope Monir Uzzaman BRAC Brace &amp; Limb Center Ann Culloo, CRUDEM &amp; Hospital Sacre Coeur Vern Hostetler, Hanger Klinik Reninca Hill, Haiti Hospital Appeal </li> <li> 44. <ul><li>The international community has shown overwhelming enthusiasm for providing prosthetic devices, but orthotic care is far more needed. </li></ul><ul><li>Geographical and technical coordination is a constant problem. </li></ul><ul><li>Thomas Calvot, HI's disability and emergency advisor </li></ul>References Batzdorff, J. (2010) Code of Conduct for Humanitarian Organizations. Retrieved from November 30, 2010 from US-ISPO website: http://www.usispo.org/code.asp CDA Collaborative Learning Projects (2010) A Brief Background to Conflict in Haiti. Retrieved November 30, 2010 from CDA website: http:// ww. cda inc.com/ cda www/.../rpp_haiti_ brief _ background _20100203_Pdf_1_1.pdf Eitel, S. (2010) Haiti Mission Report. Retrieved November 30, 2010 from One Response web site: http://oneresponse.info/Disasters/Haiti/disabilities/publicdocuments/Eitel%20Haiti%20Feb-Mar%202010%20Report%20-final%20draft.doc Groupe de Travail Inclusion, Readaptation et Situation de Handicap (2010) Liste des Services Orthopediques , Appareillage et Readaptation Haiti. International Committee of the Red Cross (2010) Polypropylene Technology. Retrieved from the ICRC website: http://www.icrc.org/eng/assets/files/other/icrc_002_0913.pdf International Committee of the Red Cross (2010) Prosthetics and Orthotics Manufacturing Guidlines. Retrieved from the ICRC web-site: http://www.icrc.org/eng/resources/documents/publication/p0868.htm Rencoret, N., Stoddard, A., Haver, K,. Taylor, G., Harvey, P., (2010) Haiti Earthquake Response Context Analysis. Retrieved November 30 (2010) from ALNAP website: http://www.alnap.org/pool/files/haiti-context-analysis-final.pdf Rogers, J., Kistenberg, R.,Ingersoll, A,. (2010) Creating a Unified O&amp;P Response to the Haitian Tragedy. Retrieved November 30, 2010 from American Academy of Orthotists &amp; Prosthetists website: http://www.oandp.org/about/press/ Kistenberg, R. (2010) Prosthetics and Rehabilitation Services for People with Amputations in Haiti Message from the Chair of US-ISPO. Retrieved November 30, 2010 from US-ISPO website: http://www.usispo.org/message_haiti.asp Stanfield, M. (2010) Haiti: The International Response. Retrieved from oandp.com website: http://www.oandp.com/articles/2010-05_02.asp University of Don Bosco (2010) Proposal of Education in Prosthetics and Orthotics in Haiti. Retrieved November 30, 2010 from Physical Rehabilitation Programs in Haiti Forum website: http://groups.google.com/group/haitiprp/browse_thread/thread/32ac1844d61883f1?hl=en# World Health Organization (2005) Guidelines for Training Personnel in Developing Countries for Prosthetics &amp; Orthotic Services. Retrieved November 30, 2010 from World Health Organization website: http://whqlibdoc.who.int/publications/2005/9241592672.pdf </li> <li> 45. Questions? </li> </ul>

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