Amputees need crutches, wheelchairs, prostheses

As fresh aftershocks shake his bed, 16-year-old Hamid instinctively tries to rise to rush outdoors. Then he realises he cannot do so. Both his feet have been amputated and swathes of white bandages wrap his lower legs. “I am helpless. When a new earthquake comes, I will die here and perhaps that would be for the better. I often wonder if life is worth living as a cripple who can do nothing,” Hamid said from his bed at the district hospital in Mansehra, gateway to some of Pakistan’s most picturesque mountain valleys in the North West Frontier Province (NWFP). “I need a wheelchair, crutches, anything to help me get off this bed. My father tries to lift me, but he is an old man and cannot manage,” Hamid added. No wheelchairs, crutches or physiotherapy are available in the area and doctors warn of a soaring demand for the prostheses needed to grant amputees a degree of normality in their daily lives. Hamid is not alone in his plight. Dozens, possibly hundreds, brought to the hospital over the past 10 days have lost limbs. A team of 14 doctors and 10 nurses have been working overtime in the hospital’s operating theatre, where thousands from the scattered villages and towns of Mansehra district have been brought. The team can no longer keep track of the numbers. “I have treated hundreds of people. Carried out at least 100 surgeries almost single-handedly and I must have amputated the limbs of at least 30 people, maybe more. It was the only way to save their lives,” said Dr Tariq Hussain, one of the volunteer doctors helping local practitioners cope with the flood of quake victims. Other doctors report similar caseloads. Patients who have lost hands, feet or limbs are scattered two to a bed throughout the hospital. Many have been discharged and carried home by relatives along steep mountain paths. At the hospital gates, where military officers struggle to control the hordes trying to enter, Abdul Aziz, 44, carries his 10-year-old daughter Fareesa. “We have come from the village of Domel,” he said. “It is nearly 30 kilometres from here. I hitched a ride on a jeep early this morning after walking down to the main road. My daughter needs treatment desperately.” Fareesa has a fractured arm and blood seeps from her bandages. An ominous odour, familiar now to most in the area, suggests gangrene has set in. “We came two days ago as well. But we had to go back home. There was no space for her,” Aziz said. Fresh landslides created by new tremors had once more made his remote village inaccessible, he explained. “My nephew helped me carry her down from the mountains.” Doctors involved in relief work suggest tens of thousands, possibly more, will be disabled by the quake. Dr Hassan Shah, an orthopaedic surgeon from Karachi who reached Mansehra a week ago, said: “Lots of people suffered compound fractures, with open wounds as well as broken limbs. Because treatment was delayed, in some cases for over a week, gangrene has set in. The only way to save lives is to cut off limbs.” Mansehra, a small city of about 130,000 people with a history dating back centuries, is located 150 km northwest of the capital Islamabad. The small hospital based at the city has received patients from many kilometres away. Mansehra district, with a highly scattered population of at least 1.15 million, has some of the most inaccessible mountain villages in the country. Rain and aftershocks have caused fresh landslides that have prevented aid reaching some areas after the initial tremor on 8 October. This will inevitably mean more amputations as medical teams eventually reach people with infected wounds. Whereas the city of Mansehra was not badly damaged by the quake – cracks in buildings are the main evidence of the calamity – it has become a hub for relief work. People seeking medical help have converged on it from the surrounding districts of Battagram, Kohistan and Shangla, and some families from the worst-affected areas have moved in with relatives who live in the city. At the besieged district headquarters hospital, now supported by field hospitals in locations further north, hundreds of patients arrive daily. Meanwhile, those who have lost limbs or suffered severe spinal injuries have been left to ponder their futures. “Of course I need to continue with my life and my studies. But at the moment I’m just not sure what the future will bring,” said Hamid. Waleed, 14, has had his left leg amputated at the knee and several toes on his right foot removed also. “Well, at least I’m alive. My only dream in life was to become a Test cricketer. I used to bowl really quick and was the best player in my home town of Battal. Now that dream is over.” In the months ahead, thousands of crutches, wheelchairs, prostheses and other aids will be needed by the likes of Hamid and Waleed. They will also need extensive physiotherapy to regain mobility and the ability to manage day-to-day life. “Basically, the fitting for a prosthesis takes place after about six weeks when the wounds are healed,” says Dr Shah. But he adds: “We should have stocks in all sizes available before then, as well as experts to fit them, train people and make adjustments on the spot. The numbers needing such aids are too large to shift to a large city hospital.” Doctors insist such aids would be of immense benefit at the hospital right now, granting many patients at least some independence and helping to free beds needed by the most critically ill. Many adjustments will need to me made during post-quake reconstruction. Schools and workplaces will need to provide access for the many disabled survivors and jobs created for those physically unable to return to their former livelihoods. In devastated northern Pakistan it is not just the physical landscape that has been altered forever. Human life in this region will never be quite the same again.