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In Haiti, Many Amputees Have No Place to Go

Ruth Fremson/The New York Times

“She said I have to go home,” Mr. François, 26, said. “I don’t want to leave until I can walk. I am weak. I have no place to go.”

A doctor, sensing some confusion, intervened. “We’re not telling him he has to go home,” the doctor, Rose Antoine, 33, a native of Haiti who now lives in Pennsylvania, explained. “We’re only telling him that this is an acute ward and we need the bed. We’re trying to find a step-down unit where he can go to.”

Nearly two weeks after the 7.0-magnitude earthquake that devastated Port-au-Prince, the immediate health crisis, which involved treating the injuries of people who were crushed by collapsing buildings and amputating damaged limbs, has begun to settle into a new phase.

This one is perhaps even more daunting: caring for thousands of post-operation trauma patients who are ready to leave the hospitals, but lack homes or families to go to. Many will require prosthetic limbs, frequent wound cleanings, bandage changes and months of rehabilitation.

As officials warn of possible outbreaks of infectious diseases from unsanitary conditions in hundreds of makeshift camps of people made homeless by the earthquake, they are also wondering where to send patients who have been treated for their injuries but require follow-up care.

“It’s very hard to send people home when they don’t have a house,” said Dr. Surena Claude, who is coordinating a commission appointed by President René Préval to respond to the health emergency. “This situation is causing so many problems, because the hospitals are full, and if this continues we will have no room.”

Early reports that there might be as many as 200,000 people who required amputations appear to have been exaggerated. At the University Hospital, Port-au-Prince’s largest hospital, which received the brunt of the casualties after the quake, surgeons have performed about 225 amputations, mostly in the first few days. Doctors Without Borders estimated that its doctors had performed 125 amputations in 12 centers across the country. Hundreds more have been done in other clinics and hospitals elsewhere; the total is more likely to have been a few thousand.

Still, this is a country that, even before the earthquake created so much devastation, could barely cope with the healthy. There will be thousands more who will need rehabilitation for a range of injuries, from broken hips and femurs to neurological disorders from head injuries.

Health officials are still in the earliest stages of determining how to deal with post-operative patients, even as new patients are coming to the hospitals with secondary infections as well as the usual array of emergencies.

Dr. Mirta Roses, director of the World Health Organization’s Pan-American region, said Sunday that all of the country’s remaining 48 hospitals were at full capacity, including 11 in Port-au-Prince. That does not include the many clinics that aid groups have created.

Health officials are dealing with another problem. With aftershocks still rattling the city, including another on Sunday, many people are afraid to be inside the hospitals but are also unwilling to leave the grounds, where they can get food and water and have access to care.

“Even their relatives want to be with them in the hospitals,” Dr. Roses said. She added that a solution would involve creating centers for ambulatory and post-operative care and persuading patients and their families to move there.

Even in the best of circumstances, it can take four to six months for a person who has had a traumatic amputation to function again, Dr. Steven R. Flanagan, medical director of the Rusk Institute of Rehabilitation Medicine at N.Y.U. Langone Medical Center, said in a telephone interview. The Rusk Institute has a team in Haiti.

“What they really need to worry about in Haiti is infectious complication, so if you have an amputation of a leg or arm, that wound is subject to infection,” Dr. Flanagan said. “And clearly they don’t have all the medicines they need down there.”

Dr. Claude, of the presidential commission, said the government was well aware of the situation.

“Unfortunately, a solution is not yet found,” he said. Even when one is found, he said, logistics in this rubble-choked country will continue to be a problem.

The hope is that access to medicines and care will be eased greatly when the government carries out plans to build giant tent cities across Port-au-Prince and the vicinity, but that could take weeks.

At University Hospital, which is next to a nursing school that collapsed, killing about 50 students, Mr. François was relieved to learn that he did not have to leave immediately. He said he did not know if his relatives died in the earthquake, and that they did not know that he survived.

Outside the tent, a giant post-operative ward has been created in a grove of mango and oak trees, with low-slung tarps strung over patients’ beds. The ward, known as “the forest,” is filled with many patients who did not want to be inside the hospital. The doctors do not know how many patients are there, because they have been too busy to count.

In the United States, many of these patients would already be home, receiving outpatient care, said Dr. Michael Marin, chairman of surgery at Mount Sinai Hospital in New York, who is volunteering here with the International Medical Corps, the group coordinating relief efforts at the hospital.

Here, many of the patients cannot return home. “The only place they have to go is the forest,” Dr. Marin said.
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