Coralie Brutus, a 7-year-old with red hair ribbons, is not making the knees of her artificial legs bend the way she’s supposed to. It’s easier to walk stiff-legged with a crutch when running errands for her mother.
She deposits the clamshell container from lunch in a trash can. She checks on her baby brother. She leaves the cavernous gym at Handicap International’s rehab center and reappears in a few minutes balancing a 7-Up bottle on her head.
“She’s at the age that if she’s going to improve, it’s best to challenge her,” whispers Gillian Fergusson, a Scottish physiotherapist, as she watches the girl. “It’s better than letting her walk with a crutch for three years — and then trying to take it away.”
So when it’s Coralie’s turn with the Haitian therapist-in-training working under Fergusson’s supervision, the first thing he does is take away the crutch.
Hand in hand, the two weave their way through the equipment, the girl dutifully bending her artificial knees. Each step makes a soft click.
Coralie Brutus’s disability has nothing to do with the earthquake that struck Haiti on Jan. 12, 2010, producing thousands of amputees almost overnight. Nevertheless, she’s a beneficiary of the relief effort.
The earthquake poured attention, money and expertise into Haiti. Nearly three years later, thousands of quake victims have gotten prosthetic limbs, orthotic devices and rehabilitation services that were once rare here. So have hundreds of people whose disabilities are sometimes worse and once were even less likely to get attention. They include children with cerebral palsy and spina bifida, adults with stroke and spinal cord injuries, and people with birth defects such as Coralie.
The earthquake is also advancing the country’s disability rights movement. The destruction of 300,000 buildings is providing an opportunity for the ones built to replace them to be handicap-accessible. Hundreds of Haitians are learning new jobs as makers of prosthetics and as rehabilitation assistants.
The catastrophe may also have raised consciousness in a place where disabled people used to be called “kokobes” — good-for-nothings in Creole.
“The perception of people with disabilities changed a lot after the earthquake. Everybody realized they can become disabled at any time,” said Claire Perrin Houdon, a manager at Handicap International. The charity, headquartered in Lyon, France, has provided more prosthetic limbs and rehabilitation to earthquake amputees than any other organization here.
About 223,000 people were killed and 300,000 injured by the disaster. Of those, about 4,000 had amputations. But, points out Gerald Oriol Jr., the country’s 32-year-old secretary of state for the integration of people with disabilities, “before the earthquake there were already 800,000 disabled people in Haiti. We cannot forget them.”
One of them was Coralie.
She arrived at the center in May 2011, moving like a seal on two hands and deformed feet at the end of kneeless legs. That might well have been her lifelong form of locomotion. But when the Handicap International people saw her, they said there was an alternative.
After months of thought, her mother agreed to surgery that made her daughter in effect a double above-the-knee amputee.
The family was displaced by the earthquake and lived in a camp in a neighborhood called Cavadeux. Her mother brought her faithfully for therapy. Fergusson, 31, remembers the first time the girl stood on her artificial legs.
“She had this surprised look on her face. She was the same height as the other children. She wasn’t using her hands. It was so lovely.”
Thirty-eight people work at Handicap International’s rehab center, which is on a teeming thoroughfare called Avenue John Brown. The building had been an unfinished supermarket, its concrete pad and large footprint perfect for a rehab gym.
The center today has 3,000 “beneficiaries” — the term it prefers — on the books. About 650 have lower-limb prostheses and 210 have upper-limb ones. There are 105 children. The staff custom-builds artificial limbs and assistive devices, trains the clients to walk, carry things, climb onto buses, cook, scrub clothes and care for themselves.
These days, however, there are often empty chairs in the indoor-and-outdoor waiting room.
Many earthquake amputees have been effectively discharged from care, seen only if they have problems. Those still coming in regularly are people whose rehabilitation has been delayed or complicated.
On the day of Coralie’s session, Judette Jusme, 30, was practicing between the parallel bars. Pinned beneath earthquake wreckage for a day, she lost her right leg above the knee and, months later, her right arm below the elbow. Last year, she developed tuberculosis and was hospitalized for six months.
She once supported seven members of her family with her salary as a lab technician. She doesn’t work now. She is tall and parts her hair in the middle, over a patch of scarred scalp. She has chronic headaches, and sometimes when she lies down “I can still hear the hammers they were using to dig,” she says after her session, eyes filling with tears. “Sometimes I wonder why I am alive.”
For many of Handicap International’s clients — especially the younger ones — things have gone better.
A few times a week, members of the staff, usually with a therapist-in-training, make home visits. They assess the household environment and watch the client move in it. They’re on the lookout for obstacles to autonomy and privacy that can be fixed.
The team reached Sebastien Lamothe, 10, the last client on a recent day, in mid-afternoon. The boy was home from school and taking a nap. He lives with his uncle’s family — nine people in three rooms.
Sebastien has large eyes, a broad face and Chiclet-white front teeth. His mother and grandmother died in the earthquake; his father isn’t in the picture. He is an only child, although now his household features many cousins.
The boy emerged from an inner room and came to the breezeway on the side of the house. He had lost his right leg above the knee. One of the therapists felt the stump. The bone was growing and coming closer to the skin, which might soon cause pain when Sebastien wears his artificial leg. He will probably need a surgical “revision” at some point.
Sebastien put the prosthesis on. It’s a complicated process that involves wrapping the stump of the leg and then inserting padding into the device’s molded socket and out the bottom of it. He did it faster than the three adults the team had visited earlier in the day.
As the team put Sebastien through his paces — climbing over a low wall, walking to the privy, standing straight to have his hips measured — his uncle, who sells lottery tickets, described how things were going.
The boy doesn’t have to cross busy streets to get to school. He is the only child in his school who is missing a limb. No, he doesn’t feel isolated. He plays with his classmates and cousins. He likes soccer. He can kick but can’t run. He doesn’t talk about his mother much. A counselor used to visit him at home but doesn’t anymore because he has adjusted well. He wants to be a pastor when he grows up.
“He is a happy boy,” his uncle said.
The prospects aren’t quite so good for 51-year-old Henry Ovinel.
He escaped injury when the house he shared with his brother in Village de Dieu collapsed. Fleeing with the crowd, he stepped in a foot-size hole in the pavement and was trampled. He lay in the street for an hour before his brother, who worked at an icemaking plant, rescued him and took him to the hospital.
Ovinel had a compound fracture of his left lower leg — bone sticking through skin. Normally, such an injury wouldn’t require amputation but would need surgery, antibiotics and meticulous nursing care.
“I suffered a lot for several days. The only option was to cut. That’s how they saved the leg,” he said without irony, sitting on a concrete wall in the squatters camp in Champs de Mars. He’s lived in a shanty there since the earthquake but is about to move into a rent-subsidized apartment out of town.
A year after the earthquake, he was fitted with an artificial leg. It hurt too much for him to use and he gave it back after a few weeks. When he had a follow-up appointment two months later, the organization that provided the limb was gone. He says now he’d be open to trying a prosthesis again or even getting surgery to make his stump more compatible.
Ovinel is a “street worker”— a private-duty sweeper, a carrier of loads, a runner of errands. Or he was. He hasn’t worked since his injury. He spends his time sitting with friends at one of the shaded entrances to the downtown park. His brother supports him.
“In cleaning streets, you need to walk with a broom. The kind of work I was doing is not fit for people with one leg,” he says.
He would like to find a job in which he can sit. Perhaps in sales. He can barely read but is good at arithmetic, he says. He’s not terribly optimistic, given his age.
“I wasn’t doing that good with two legs,” he says. “And now I have one.”