Points of View
Haitian Amputees — Lessons Learned from Sierra Leone
N Engl J Med 2010; 362:e42March 18, 2010
- Article
More than a month after the recent earthquake, the Haitian government reported that 6000 to 8000 people had lost limbs or digits, but they did not address the bigger question: What's the plan for these amputees?1
Nearly a decade ago, Sierra Leone emerged from war and faced the problem of providing health care to the many civilians who had undergone amputations. In my view, Sierra Leone's history with amputees teaches three lessons: amputees and their dependents have the right to free, lifelong health care, government cannot afford to bear this immediate responsibility, and medical facilities are central to coordinating comprehensive care needs.
Sierra Leone's Lomé Peace Accord enabled legislation to form the Truth and Reconciliation Commission (TRC) in 2000.2 Four years later, the TRC recommended that war reparations include free, lifelong health care for amputees and their dependents and that a national implementing body manage reparations through the Special Fund for War Victims.3
I spent a year during medical school in Sierra Leone, beginning in 2006. After listening to the pleas of sick amputees and witnessing social inaction, I joined forces with a local doctor, Bailor Barrie. We cofounded an organization in rural Kono District to deliver free medical services to amputees and their dependents.4
In 2009, the Sierra Leone government made its first contribution, $246,000, to the Special Fund for War Victims, and the United Nations Peacebuilding Fund gave $3 million. Even so, the Special Fund was about $10 million short of the $13 million to $14 million needed to reach all eligible individuals.5
Over the past 10 years, government and nongovernmental organizations have collaborated to deliver health care to amputees. They have provided free emergency care, prosthetics, physiotherapy, and mental health care — not the free primary, secondary, and tertiary care recommended by the TRC. Today, even these free collaborative services are diminishing as the primary financiers — nongovernmental organizations — move on to other conflicts that have come along and claimed greater international attention.
The government cannot afford to shoulder these responsibilities, so some health care organizations have been transitioning services such as mental health and physiotherapy to our clinic. As we fill the gap in health care delivery, we have become, by default, the coordinating center for amputees in Kono District.
Sierra Leone's peace accord helped to create a health care plan for the amputees; without a war and an ensuing accord, what will happen to Haiti's amputees? There will be no TRC or governmental body for immediate implementation of a plan. However, the global community has already responded with so much heart that I believe we can work with government to develop a coordinated approach to comprehensive health care for amputees.
J. Daniel Kelly, M.D.
Baylor College of Medicine, Houston, TXDr. Kelly reports receiving no compensation from the organization he cofounded in Sierra Leone.
No other potential conflict of interest relevant to this article was reported.
This article (10.1056/NEJMpv1002391) was published on March 3, 2010, at NEJM.org.
- References
References
1
Sontag D. Countless lost limbs alter life in Haiti's ruins. New York Times. February 22, 2010.
2
Parliament of Sierra Leone. The Truth and Reconciliation Commission Act 2000. 2000. (Accessed March 2, 2010, at http://web.archive.org/web/20051230045239/www.sierra-leone.org/trcact2000.html.)
3
TRC Steering Committee. Witness to truth: report of the Sierra Leone Truth & Reconciliation Commission. Vol. 2. Accra, Ghana: GPL Press, 2004: 248-59, 266-70. (Accessed March 2, 2010, at http://www.sierra-leone.org/TRCDocuments.html.)
4
Global Action Foundation. Wellbody, a Sierra Leone non-governmental organization. (Accessed March 2, 2010, at http://www.goact.org.)
5
Integrated Regional Information Networks (IRIN). Sierra Leone: lack of aid funds for amputees, rape survivors, war widows. February 23, 2009. (Accessed March 2, 2010, at http://www.unhcr.org/refworld/docid/49a660d01a.html.)
- Citing Articles (1)
Citing Articles
1
A. James P. Clover, Sahan Rannan-Eliya, Waseem Saeed, Richard Buxton, Sanjib Majumder, Shehan P. Hettiaratchy, Barbara Jemec. (2011) Experience of an Orthoplastic Limb Salvage Team after the Haiti Earthquake: Analysis of Caseload and Early Outcomes. Plastic and Reconstructive Surgery 127:6, 2373-2380
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