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Afya's Rehab Trip to Haiti A Success!

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Dear Afya Supporter,

"What you lose in the fire, you will find in the ashes"
              Creole Proverb

I just returned from a week in Haiti. With the extraordinary financial support of the Joint Distribution Committee, we sent a team of Occupational and Physical Therapists to coincide with the arrival two containers of rehabilitation supplies. These teams and containers were aimed at maximizing function for those who were disabled by the earthquake. We also initiated a program to train Haitians as Rehabilitation Technicians.

Deb Tupe, my colleague from Columbia University, led one rehab team at Gheskio, while I led the second team at the Bernard Mevs Hospital, both in Port au Prince.

At Bernard Mevs (BM), there is a unique opportunity for
Afya trained Haitian rehab techs work with amputee patient
substantial capacity building. Drs. Marlon and Jerry Bitar, twin brothers and highly gifted surgeons, volunteer their expertise and perform surgeries for the underserved population that is cared for by this hospital.  The need for rehab is clear: the surgeons perform complicated operations and patients require rehab to sustain the benefits from these surgeries.

Our team was greeted with a newly painted room with a scrubbed-clean floor.  Patients were welcomed into an immaculate and structurally sound room. The sensitivity to the trauma that each victim experienced demonstrates the notion that each life, each Haitian life, matters - a reality that thousands of people, either homeless or living in tents, don't fully believe. Our team repeatedly verbalized "You matter, your health matters, your life matters, and this is why we are here."

We saw patients recovering in tents; many with little hope
Close patient relations was the norm for the Afya staff
or joy, because they were unclear as to how they could deal with their disabilities, now and in the future. Our team walked into the rehab room and within two hours; the room was filled with people, many with amputations. Recognizing the need for translators, we found several fantastic men who, we discovered, were accustomed to translating at high level meetings, and were not emotionally prepared for the conversations between our team and the patients.

The stories we all gathered are powerful...

During one conversation, a woman who had lost both her arm and leg on one side described, in tragic detail, the circumstances of her injury: her home collapsed and the debris immediately amputated most of her arm and part of her leg. She was then pulled out from the rubble to have neighbors saw off the rest of her arm in the street, while conscious and screaming at the top of her lungs in pain. The choked-up translator said "Oh - this is enough - I can't do this." But it all had to be talked about; avoiding the stories that each of these people carry in their heart leaves no room for them to heal. They each needed to tell their story: a personal tale of survival, a return to life.

This courageous woman spoke of her belief that she is the only person who looks like this in Haiti - she had no idea
Patients who hadn't walked since the earthquake found  new resolve
that thousands of others have had multiple amputations. She told us that her husband left her after her amputations; and she expressed her terror of being stared at on the streets. Upon discharge, she will live with her mother, where their temporary home (tent) will rest on top of the remnants of her crumbled house holding the memory of her personal trauma. This woman is beyond courageous; prior to our visit, she needed her mother to dress her and perform all of her Activities of Daily Living (ADLs). During her week with us in rehab, she transformed from a woman who felt like "half of a whole" to a woman restoring herself to wholeness. She quickly learned how to put on and take off her bra with one hand, could do her laundry, independently transferred herself onto/off a commode, and Joel Neff, a member of our team, creatively constructed a cutting board for her so that she could cut food with one hand. We took photos of other people with amputations to show her that people with recently acquired disabilities are not hiding - they are in the markets, getting on the tap tap (public open bus) and are integrated into Haitian daily life.

She saw, through our eyes, that people with disabilities do not have to sequester themselves. We left her "a whole woman" with a tent, a wheelchair,  a forearm crutch for ambulation, a tub bench to sit on to help keep her amputated leg extended, and a tub seat on which she could balance bowls and pots while preparing food. Joel even made her a long-handled sponge so that she can bathe with the use of one hand. As we said good-bye, she said proudly "Thank you. I can do things now that I thought I would never be able to do, ever."

A 58 year-old "seemingly" frail man described being a bookkeeper prior to the earthquake. I asked him what that meant and he responded "I sell French textbooks from France; I keep the books until I sell them." (Hence a bookkeeper.) When the earthquake occurred, his shop crumbled on top of him and he was crushed by concrete
There is an estimated 6000 amputees in Haiti due to the earthquake, including this 13 year old girl
and trapped for five days, after which they found him with a severely fractured femur. They moved him to a park where he laid for three more days, until someone found him and brought him to a hospital. Now, recovering at Bernard Mevs, he said sadly that he hadn't stood on his legs since the earthquake - he was afraid of his own body, and felt that he needed to rest more. He tearfully spoke of his responsibility to take care of his daughters, and expressed his fear that he will never again be able to maintain this role and meet this responsibility.  

We grabbed a walker and asked him to come to a standing position. His eyes widened like this was a moment of madness. We calmly reassured him and told him that he will never get better if he stays in bed believing that he will be sick for the rest of his life. With reassurance and fortitude, he was instructed: "Please get up." And he did. By the end of the week, he independently walked all over the hospital (even outside!) with a walker, sat and talked to other patients in their tents, bathed himself, and became whole again. His beautiful smile, energy and self-confidence returned to him quickly. He left the hospital with a walker, a wheelchair (for longer distance travel), a commode and a sense of self that had been nowhere to be seen. When we said our goodbyes, he said "I will keep you in my prayers every day."

A 13 year-old orphan was found after her school collapsed. An unrelated parent was screaming, but instead of her child responding, this 13 year-old girl called out for help and was rescued. She spoke about wanting to save her leg, but days after the earthquake, she required an above-knee amputation. When we met her, she could barely stand, didn't know how to wrap her stump and had little hope for her life ahead. Within one week, she was standing, doing math problems at a desk (she loves school), was walking all over the hospital (outside on rocks with her walker), and talked to us about growing up to become a nurse. Joy, real joy had returned to her heart.

She had been on two outings from the hospital, and told us about people staring at her and asking lots of questions about her amputated leg.  She didn't like this and said that it's easier to stay away or to stay in a car. To address this discomfort, we decided to role play.  I asked her for her name tag (we all wore name tags) and put it on my shirt in order to play her, and asked Sarah Schuyler, a team member, to play a stranger that she might meet who would hound her with questions. This astute and wise young lady studied our conversation carefully. With the help of a translator, we gave her words to respond to situations that made her uncomfortable.  At the end of the role play she smiled - she got it!  At any time during the day, one could walk by her and hear her quietly singing to herself "Don't worry, every little thing is gonna be alright." Clearly, this was not her song at the beginning of the week, but by the end, it was hers.

Our team members, Laura, Nandita, Sarah and Joel, were extraordinarily dedicated. On our final day, we loaded up a prison van (literally!) that was lent to us to move rehab equipment that had been delivered to another hospital. We
Many surgeries were done hastily, leaving patients with badly needed revisions
were to assign and distribute these supplies to each of the patients we were working with at BM. We tumbled out of the prison van, along with thousands of pounds of supplies that had been packed on a container from NY.  The expression on the faces of those we were helping was both unforgettable and priceless. For these amazing Haitians with untold strength, this team presented the idea of acceptance, a new world of possibilities, positive approaches to heartbreaking challenges, and the supplies needed to live.  

We left Bernard Mevs with its first trained team of Rehabilitation Technicians who, with our training, are now able to treat amputees - with heart, compassion and wisdom. They have learned how to evaluate what people need to walk, how to transfer, how to teach therapeutic exercises, and how to wrap stumps and massage scars. We leave this team with a solid set of beginning skills and enough supplies to create positive change. They will help people become whole again.

We are grateful to the JDC for helping us make this vision a reality. They have supported the launch of this expanding rehabilitation initiative. Also, a heartfelt thanks to Ecoworks International, for their unfailing support and amazing ability to make things happen.

Haitians need our advocacy and support to be able to pick up the shattered pieces of their lives, and to live. In order to provide this help, we need rehabilitation products, tarps (as many as possible), hangers for people to keep their clothing dry and off the ground, shoes and much more. Please check our website [] for ongoing needs and wishes.  We also have a continued need for financial funding to support our ability to assess needs and deliver the much-needed medical and rehab supplies.

At the end of April, our team hopes to return to Haiti to continue this capacity building effort. We plan to continue to provide care at Bernard Mevs Hospital, will further train the Rehabilitation Technicians, and plan to bring the team to the tented communities where many amputees are living without equipment or access to restorative care. In the meantime, a member of our team will continue to connect, online, with the trained rehab techs to maintain competency and solve/resolve new concerns about patient issues. We will start our own version of tele-medicine, with the goal of restoring purpose and function to any patient. We know that everyone's life deserves to be lived, whole.

At the end of the week, one of our translators turned to our team and said "I don't think I've ever seen anything like this - your team thinks about the future for my people and encourages others to do the same - you bring people hope and the skills and supplies they need to get up and believe they can live again."

What you lose in the fire, you will find in the ashes..........

The people we met and the patients we treated will remain in my heart and thoughts for the rest of my life.  These people are the heroes of this tragedy; these survivors learn and respond faster than anyone I have ever seen (clinically); and they are grateful for the simplest acts of kindness and concern. I am proud to say that we have just gotten started here!


Danielle Butin, MPH, OTR
Founder and Executive Director


About The Afya Foundation of America
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The Afya Foundtion of America
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