Amputees face bleak future

US ship saves lives, Haiti not ready for amputees

* Hospital ship Comfort treating hundreds of Haitians
* Most cases of amputation due to infected wounds
* Total amputees could be in the tens of thousands
* Haiti has almost no provisions for amputee care
* Comfort's patient-load higher than in war


PORT-AU-PRINCE, Jan 27 (Reuters) - Doctors on the U.S. Navy's hospital ship Comfort are fighting gangrenous infections in broken limbs as they try to save the lives, if not the arms and legs, of Haiti's earthquake victims.
"Originally we were seeing primarily a lot of orthopedic injuries now we're starting to see those injuries and wounds are infected," Commander Mark Marino, head of nursing on the USNS Comfort, said on a tour of the ship as it was anchored off the coast of Port-au-Prince.
Asked how many of the 500 people treated so far on the ship have needed amputations, Marino replied simply "lots."
The total number of amputees due to the earthquake could stretch into the tens of thousands, said Dr Ronald Waldman of the U.S. Agency for International Development.
Their care will burden the country's medical system for decades.
The magnitude 7.0 quake hit late afternoon on Jan. 12 and wounds left untreated that long frequently develop fatal infections unless the limb is taken off.
Already in Port-au-Prince, one-legged people on crutches are a frequent sight, part of what a Haitian doctor said was a generation of amputees, many of them young, who will need expensive care that was unavailable to most even before the quake hit the Western Hemisphere's poorest country.
The Comfort's doctors count as a miracle a young man badly infected with gangrene they thought surely would die. Taking off his arm and leg saved his life.
"We can fix femur fractures," Marino said, if the patient arrives soon after the injury. Now, weeks after the quake, patients are sick with infection.
"The majority of the amputations we have had to do have been either extremities that had gotten infected and they were no longer salvageable or they came in traumatically amputated and we were just treating the wound and closing it up," he said.
Lieutenant Bashon Mann, public affairs officer for the ship, said the Comfort, and its 200 doctors and nurses, will be here as long as the Haitian government says it is needed. They were told to prepare for at least a six-month trip.
Operating rooms on the 1,000-bed ship run around the clock to treat orthopedic injuries, head wounds and even one shark bite. But the 890-foot-long (271-metre) floating hospital is stretched to the limit.
People on the ship who have served during wars, Marino said, "liken this to war on steroids because the volume is so great."
The ship was designed to treat young soldiers and sailors with war wounds, not masses of civilians, many with amputated limbs or broken legs, who cannot safely climb to the ship's 400 top bunks.
The goal is to have a place to move about 100 recovering patients off the ship and into a hospital on land each day so more patients can be moved to the Comfort. So far, only 60 to 70 have been moved ashore.
But Port-au-Prince hospitals are stretched beyond their limit as well. They have set up tent facilities on their grounds, due both to damaged buildings and Haitians' fear of being inside if one of the many daily aftershocks is violent.
One lucky patient on the Comfort, tiny Gabrielle Estalink, 12, was able to keep her leg despite a deep gash suffered when a mirror fell on her.
Port-au-Prince was a challenging place to live before the quake, now to navigate its uneven, hilly and often unpaved streets on one leg will make life even more difficult.
Dr Lafontaine St. Louis, whose clinic before the quake made prosthetic limbs and provided physical therapy, said ideally many amputees should already be getting treatment with electronic devices and therapy to keep their muscles strong.
"The future for people with both legs was already quite grim. What can be done for them?" he asked in an interview on a Port-au-Prince street corner. He is trying to find a place to reopen his damaged clinic, but the costs, and the lack of skilled medical care in this field, are daunting impediments.
St. Louis said he knew of only three other doctors in his specialty in Haiti, one of whom was 80 years old, and four to six physical therapists.
The many children who have lost limbs will need a new prosthesis every two to three years as they grow, he said, as well as physical rehabilitation.
One organization, Physicians for Peace, has started an international collection of used prosthetic devices.