Non-government organizations have warned that an estimated 3,000 people who lost their limbs after Haiti's January 12 earthquake would face a tough time returning to normal life.

Doctors now operating on Haitians with the most severe injuries are now trying their best to save their patients' limbs, with amputation only selected as the last-ditch option.

The doctors are using techniques that ensure amputees are given appropriate secondary operations and after-care.

However, several sources said that during days after the quake, which was claimed officially to have killed 200,000 people, too many amputation operations were performed inappropriately by inexperienced doctors.

"The procedure was carried out by general practitioners, emergency room teams and inexperienced volunteers," Al Ingersoll, a U.S. prosthetist, told Xinhua last week.

With hundreds of people waiting for emergency treatment for infected, open and severe wounds that general practitioners might have seen only once in a lifetime, surgeons resorted to the simplest option: a guillotine amputation that cut the limb off above the wound and left the cut open.

"Often people have to cut off a limb in order to pull a victim out of the rubble," said Herbert Rader, a trained surgeon who has been in Haiti's capital for 10 days working at a Salvation Army clinic, as part of a group that came to treat those injured in the quake. "Part of them would be trapped and rescuers just cut it off. Aftershocks were frightening everyone and they wanted to get out," he said.

Amputations should only be performed when wounds that have already been treated cannot or will not heal and patients are showing signs of entering toxic shock, intensive care nurse Christian Vansever, told Xinhua in a post surgery ward in Port-au-Prince's Isaie Jeanty Hospital, where each bed was filled with a person with recently bound wounds.

"There could be a high level of local infection, if the wound has been open for two or three weeks it can be very difficult to close," he said.

As the body tries to reabsorb material from such wounds the patient may experience high temperatures, high blood pressure, a burst of secondary infections and even kidney failure, he explained.

Some patients, who have been living in insanitary conditions in temporary shelters with open fractures waited until they were suffering from such symptoms before seeking help. When that happens, losing a limb is the only option, he said.

"It is very difficult for amputees to reestablish their life and suicide is a concern," said Mike Stewart, country officer for non- government organization Hope for Haiti. Even in wealthy nations with considerable support, amputees have to struggle for life.

In Haiti, the poorest nation in the Americas, people could well struggle to find basics like prosthetics and wheelchairs, let alone psychological help, Stewart said.

The biggest problem may be the shock, Valerie Darnaudet, a French occupational who flew into Haiti 10 days after the quake, told Xinhua in an interview on Tuesday.

"Everything here was so sudden. People are normally prepared, because amputation usually comes after an illness," said Darnaudet, a volunteer at Handicap International, a non-government organization that has committed to working in Haiti to supply aftercare, prosthetic limbs and psychological support to amputees.

Darnaudet explained that she wanted to get those who have lost a limb moving as soon as possible, to reduce any feelings of helplessness and to help physical adaptation to the new situation.

Starting in March, the organization will supply 300 to 500 temporary limbs to recent amputees, which must be swapped for a permanent limb in three to six months.

That means patients must immediately get mobile to develop their muscles and balance, she said. "If they have lost a leg below the knee, and the muscles or knee joint is no good then we can't put on a good prosthesis," she said.

Another Handicap International official said that a sudden amputation can severely damage a person's sense of identity, men feeling that they are somehow less male and women less female.

However, the organization's experience in China, Pakistan and 58 other nations where it has worked showed that adults return to work and children to school and play, when they get appropriate prosthetics, physiological and psychological care.

Darnaudet reports that the patients she saw are showing more signs of happiness and adaptation despite extreme circumstances like sleeping in the streets when their homes were destroyed.

"People are seeming more calm and we are seeing even some patients singing" as they wait for treatment. The tough conditions have also created a sense of community among the people who are living together, she said.

(Xinhua News Agency February 3, 2010)