British physiotherapist David Young in Haiti with survivors of the earthquake. Picture courtesy CBM
British physiotherapist David Young in Haiti with survivors of the earthquake. Picture courtesy CBM

Physical therapists rehabilitate and rebuild in disaster zones

Victims of the recent natural disasters in Haiti and Chile are gaining mobility and independence as a result of the continuing work of physical therapists. In Haiti, physical therapists from around the world have been supporting local health services to rehabilitate people.

Shaun Cleaver, a Canadian physiotherapist who has worked as a volunteer in Haiti for three years, says that an already weak health infrastructure in the country was all but destroyed by the earthquake.

“The initial destruction from the earthquake caused significant trauma, but the impacts of this trauma were more severe because of the lack of healthcare," he says. "The results were that thousands of people with fractures were left with more severe disability than would have been the case with solid emergency care.”

When the earthquake struck on 12th January, there was very little physiotherapy involvement, partly because the profession was weak. “A month after the event, however, the importance of physiotherapy was recognised and the profession’s involvement in the response has been solid and growing. This has resulted in greater integration of physiotherapy in the healthcare and development sectors.”

Shaun Cleaver had temporarily returned to Canada at the time of the earthquake, but when he returned 19 days after the disaster, he took up position as Coordinator of Rehabilitation Services Development at the Hôpital Albert Schweitzer (HAS), north of the capital, Port-au-Prince.

“With few options for care in Port-au-Prince, casualties streamed in from the capital to access services from our almost exclusively local staff. Most had endured a two-hour trip in the back of a pickup truck. HAS is one of the few facilities in Haiti to have a rehabilitation service, having been developed through the Rehabilitation Technician Training Program, an initiative begun in 2009 to train technicians to work together with David Charles, a Haitian physiotherapist trained in the Dominican Republic. The influx of people was difficult for David and the staff to keep up with so my immediate involvement was to seek out foreign volunteers who could be quickly mobilised and help with management issues. My role evolved to include participation in a working group to establish an emergency rehabilitation response for Haiti and to support an initiative that is now providing prosthetics.”

Shaun has since received a Golden Apple Award from Health Volunteers Overseas, to recognise his contribution to international programmes (www.hvousa.org).

Partly because of delays in treatment, there will be many thousands of newly disabled people in Haiti. Physical therapists from all over the world have been flying in to help. David Young, a physiotherapist from Poole in England, was given three weeks unpaid leave to go to Port au Prince with disabilities charity CBM (www.cbmuk.org.uk). Arriving four weeks after the earthquake hit, there were many people requiring rehabilitation following initial surgery.

“'The majority of cases were orthopaedic trauma - a lot of people with upper and lower limb amputations, some with spinal cord injuries and lots with head injuries and strokes,” he said. David worked with other volunteers and local Haitian medical staff, across three hospitals and in community clinics. Many people had been immobile for weeks following the earthquake.

“The wards were nearly always set up in the tents provided by the various aid agencies working there,” he said.

American physical therapist June Hanks, Associate Professor at the Department of Physical Therapy, University of Tennessee at Chattanooga, is also Director of the Advantage Programme (www.advantagehaiti.com), which has been providing rehabilitation and prosthetic services in Haiti since 2001. She was in Haiti during the earthquake. Days afterwards, she wrote: “There is so much to do… instructing patients and family members how to manage amputated limbs, walk with a walker or crutches, exercise so people are ready for a prosthesis when the surgical wound heals.”

“There are many crush injuries resulting in broken bones along with open wounds and nerve injuries. Unfortunately, many people have wounds that are difficult to heal and they must go to surgery several times for cleaning and revisions. Rehabilitation services are clearly a part of this process and I feel privileged to be here to help.”

“The hospital where I have been working for the past several days, Hopital Lumiere in Bonne Fin, is basically a mobile hospital unit in a building instead of tents. I worked in this hospital for several years and am sad that the hospital has degraded so severely. Many are hoping to revive the orthopedic service here, but are not yet sure what is best in the long term.”

In Chile, where a major earthquake hit on 27th February, physical therapists have been dealing with the effects of trauma, but also the effects of homelessness. With cold conditions in much of the zone affected by the earthquake and subsequent tsunami, many people living in tents are affected by respiratory problems. Oscar Urrejola, General Secretary of the Colegio de Kinesiologos de Chile, said: “Around 20-30 physical therapists have been sent to the disaster zone. We are in communication with the Ministry of Health here, and have told them that the problem isn’t just trauma but respiratory. They do understand, and have responded by sending physical therapists out there.”

What can be done to ensure an appropriate physical therapy response in disaster zones? See the article "Disaster management" www.wcpt.org/node/33714.

Further information about how physical therapists can help in Haiti is available on the WCPT website at www.wcpt.org/node/32997.