Three Months at Klinik Hanger

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By Anna Avakian, CPO

A first-person retrospective by Anna Avakian, CPO

It's amazing how a simple task like tightening a foot bolt can bring a flood of memories rushing back. That's just what happened today as I was replacing a foot for a patient who will soon return to Sierra Leone. Because of the rugged conditions in his home country, my patient was being fit with the same type of foot we provided during my three-and-a-half months working at the Hanger Ivan R. Sabel Foundation Clinic in Deschapelles, Haiti.

Anna Avakian (center) poses with staff and volunteers at the Hanger Clinic in Haiti. Photographs courtesy of Hanger Prosthetics & Orthotics.

Since my return home to the United States, many people have asked about my experiences providing prosthetic care in Haiti just a few months after a 7.0-magnitude earthquake ravaged the country on January 12, 2010. From May to August I was immersed in the aftermath of one country's nightmare. Claiming more than 300,000 lives and severely injuring thousands more, it seemed there was not a person in Haiti who was spared life-changing physical or emotional scars. But in addition to the challenges that follow any tragedy, what also emerged were a series of inspirational moments, smiles, and triumphs.

In May, as I prepared to trade the comforts of my own little world in Washington DC for the uncertainty of a new home in a developing country, I was motivated and impassioned by thoughts of the lives I would soon help in Haiti. So many lives were forever changed in such a short time. I cannot begin to imagine what living through that would be like, nor can I imagine surviving such a horror, only to be told hours, days, or weeks later that my injuries would result in amputation. I was anxious to join the team that was already making such a big difference in the lives of those dealing with limb loss in Haiti.

A Typical Day in Deschapelles

Avakian embraces Modeline, who had bilateral amputations as a result of an infection when she was five years old.

A typical day for me at the Hanger Clinic in Haiti started around 6 a.m. with the sun streaming through the windows and the sounds of roosters crowing. My fellow volunteer practitioners and I often joked that these roosters either had a broken internal clock or were actually European roosters because they literally began crowing in the wee hours of the night-I'm talking midnight! Additional jokes abounded whenever we were served chicken, although to my knowledge, no Haitian roosters were harmed in the feeding of our team. Thankfully, after about a week or so, I didn't hear the roosters' incessant crows until my alarm clock woke me in the morning.

Some mornings we'd get up even earlier to hike up the nearby hills and catch the sunrise. Frequently, we'd see Haitians up there as well, praying and singing as the sun rose. This was a lovely reminder that although the hills may resemble the Blue Ridge Mountains, we were in a different culture, a different country, a different world.

"Catching" the Water

This rare, flushing toilet is one of the most-photographed "features" by practitioners at the Hanger Clinic.

Another reminder of how different it is to live in Haiti is that we had running water only three times a day: 6 a.m., noon, and 6 p.m. We would often have to rush back from our sunrise hike to catch the water. Even though the water was only one temperature-cold-it always seemed refreshing when it was running. If we missed the running water, the alternative was a "bucket shower;" that is, scooping large cupfuls of water from a previously filled bucket.

The lack of running water led to some ingenuity when it came to the toilets. One of my fellow practitioners constructed a rig using a marine hand pump to get the water from the large bucket to the toilet tank so it could flush. This engineering feat may well be the rotating practitioners' most photographed object.

After a cold shower, we would sit down together for breakfast at our residence on the grounds of Hôpital Albert Schweitzer (HAS). This hospital, located approximately 60 miles northwest of Port-au-Prince in Deschapelles, has been in existence for 54 years, occupying the grounds of an old fruit plantation. The earthquake did not affect the HAS buildings, so it made for a wonderful location to set up a clinic.

Klinik Hanger

After breakfast, we walked about 100 meters from Kay Hanger (the Hanger house) down a dirt road to the Klinik Hanger (Hanger Clinic) where we met Joel, Tcho, Alix, and Cira, our four Haitian technicians. These guys are amazingly talented! They've been learning on the job since the clinic opened and can now independently fabricate prostheses with little assistance or instruction. Our staff also included translators Rony and Evnir, and a wonderfully joyous woman named Roslyn who is the intake coordinator. I'd be remiss if I didn't mention Jill Caporiccio, a nurse from Boston who volunteered to serve a one-year stint as the patient care coordinator at the clinic.

Each day in Haiti brought something different. Two days a week, vans loaded with patients who were ready to be fit or needed adjustments arrived from Port-au-Prince. At the same time, other patients who had stayed on campus for a while were being discharged. They'd be packed up, and then we'd say our goodbyes as they bravely faced their new lives with their prostheses.

Traveling Care

On Wednesdays, a team of us would get in a minivan for a two-and-a-half-hour journey to Port-au-Prince. We'd usually leave before 7 a.m. and return to Deschapelles sometimes as late as 9 p.m. In Port-au-Prince, we would set up a temporary clinic at an orphanage where we would see new patients and mostly take casts. The clinic was in the chapel on the orphanage grounds, and patients would be lined up on the wooden benches that functioned as pews. At times, there could be as many as four patients at once being cast and measured by practitioners. Although it was especially hot and inhabited by a higher than average number of mosquitoes, somehow it always seemed special to be doing our work in the chapel.

We held several similar clinics at the General Hospital across town, and sometimes our team would be split between locations. The General Hospital is just behind the National Palace. I don't know if you've seen the heartbreaking photo that was in Time magazine of the white and green hospital grounds where a bulldozer is moving a pile of bodies-that image was taken of the General Hospital. Of course, the bodies are now gone, but the cracks up the sides of the building serve as reminders of the lives that have been torn apart. I can't imagine how anyone who lived through the earthquake and its aftermath will ever be able to forget that day.

On many Saturdays, some of us would go to a clinic in Cange, a small, remote village in the Central Plateau of Haiti, while others worked at the Klinik Hanger in Deschapelles. Our work days were long and hard, but it was satisfying to see the dramatic and immediate impact we had on our patients' lives.


Modeline walks with her new prostheses.

So many of our patients' stories broke my heart, and as I look back, several of them stick out in my mind.

One of those patients is a woman named Modeline. When she was five years old, Modeline had some sort of infection (family members said they didn't know what it had been) that resulted in a Syme's amputation on one side, a transtibial amputation on the other, and multiple partial finger amputations on both upper extremities. As if life in rural Haiti wasn't difficult enough, this woman received no prosthetic care until we arrived-16 years after her amputations!

This sweet, kind, resilient woman found out about our operation and shuffled into the clinic the same way she'd been shuffling for 16 years-on her knees. The HAS surgical staff performed tendon releases on her, and we began prosthetic care about six weeks later. Despite the surgical intervention, we still had to flex the socket on her transtibial side approximately 45 degrees to accommodate her contracture. That's when one of the physical therapists volunteering at the clinic had Modeline begin some major stretching and serial casted her for about two weeks.

I rarely allow my emotions to show at work, but the first time I saw Modeline stand and then take a few steps, I got misty-eyed. Modeline continued to progress and get stronger, and we continued to realign her prosthesis throughout her stay. This wonderful woman who shuffled in on her knees walked out of our clinic sporting a skirt and an amazing smile!


Naomi (in yellow) plays with four-year-old Georgeline and ten-year-old Odelia.

Another patient who stands out in my mind is Naomi, a beautiful, shy, reserved 12-year-old unilateral transfemoral amputee, who arrived in one of the vanloads of new patients. After some time with a patient translator, the horrifying truth was revealed-Naomi's entire family had been killed in the earthquake, and she was left alone in the world to face life as a new above-knee amputee. My heart sank. I cannot fathom the physical and emotional pain that this brave little girl has endured. And what strength and determination she must possess to get into a van full of people she didn't know and go to a town where she'd never been, all for the promise of a prosthesis. Wow.

Naomi blossomed at L'Escale, the housing facility where our out-of-area patients stay while they receive prosthetic care and physical therapy. In this unique setup, patients at all stages of the fitting process are placed together. The resulting dynamic resembles an informal support group. Within the first few days after fitting, Naomi started walking quite well with her prosthesis and even began to look up at people instead of looking down timidly. We got to see her laugh, smile, and recover some of the childlike joy that had been hidden at first.

Naomi was great with the younger kids, like a precocious four-year-old named Georgeline and a spunky ten-year-old named Odelia. They laughed, did each other's hair, colored with crayons, played a version of patty cake, and walked around visiting everyone in the clinic. During the occasional slower times at the clinic, I'd join in on a game of patty cake or a game where you get in a circle and sing and one person at a time walks around the circle and then you all hold hands and rotate the circle until the next verse. The children definitely brightened up the clinic with their laughter, games, and innate optimism! It seemed that everywhere you looked at Klinik Hanger, tragedy was turning into triumph.

I feel immensely honored to have had this experience in Haiti. Our work would not have been nearly as effective if it hadn't been for the selfless efforts of so many incredible people. The prevailing hope of the Haitian people inspired me every day. Haiti and the Klinik Hanger will forever have a piece of my heart. Mwen p'ap bliye ou! I won't forget you!

Anna Avakian, CPO, served as the lead prosthetist at the Hanger Clinic in Deschapelles, Haiti, for three-and-a-half months in 2010. At the time of this writing, she was a practitioner at the Hanger Prosthetics & Orthotics patient care facility in northeast Washington DC.