Child Amputees in Developing Countries Face Great Challenges

Oct. 2010

NOGALES, Ariz. – When he was 2, Rodrigo’s parents chose to amputate his lower right leg just above his ankle. Because of a birth defect, Rodrigo was born missing a bone and most of his foot.

Each month since his amputation for the last 8 years, 10-year-old Rodrigo Cortez of Nogales, Sonora crosses the border into the U.S. with his family on a 1-day humanitarian medical visa to receive free prosthetic care at the St. Andrew’s Children’s Clinic in Nogales, Ariz.

Like clockwork every first Thursday of every month except July, St. Andrew’s Church transforms into a hustling and bustling medical clinic. The 35-year-old makeshift clinic acts as a lifeline to those it serves. It provides free, specialized medical care to children living in Mexico who can’t afford or can’t access the crucial medical care they need at home.

During his visit to the clinic on Nov. 4, Rodrigo had a mold taken of his lower right leg for a new prosthesis. “Next month we’ll do a practice fitting, and if that looks good then we’ll finish it the following month,” his prosthetist Dr. James Druwe said. He should be able to wear it home in January.

A thin, tall and quiet young man, Rodrigo sat patiently in a chair in a small and crowded side room just behind the main worship hall of the church, as Mallory Lemmons, a resident with Hanger Prosthetics and Orthotics in Tucson, Ariz., took the mold of his leg.

Mallory first wrapped Rodrigo’s leg in plastic wrap, slid a tight, white sock just above his knee, and inserted a long rubber tube to the end of the sock. She marked the bones in his leg with a pencil on the outside of the sock, which will transfer onto the inside of the mold. She then submerged a ball of rolled up plaster into a bucket of water, and began to wrap it around his leg.

The plaster dried within a matter of about 5 minutes, after which Mallory sawed through the first layer with an electric saw, just above the rubber tube, and just deep enough so she could finish cutting through the mold with scissors. Using the rubber tube as leverage, she tugged the mold off of his leg.

Rodrigo is fortunate to receive the care he does, and in fact St. Andrew’s Children’s Clinic helps in it’s own small corner of the globe to fill a critical void in prosthetic care for child amputees. Without prosthetic care, amputees can experience a diminished quality of life, increased discrimination, and limited mobility. Prosthetic care often allows amputees to integrate and become fully functioning members of society.

Amputations among children in developing countries generally originate from birth defects, as in Rodrigo’s case, or from traumas. Lemmons said that most of the juvenile humanitarian cases she saw from developing countries while attending the University of Texas Southwestern Orthopedics and Prosthetics School in Dallas, Texas came from birth defects, many of which result from malnutrition. “Mothers aren’t getting the nutrients they need during pregnancy,” Lemmons said.

According to the World Health Organization, mineral deficiencies contribute greatly to birth defects, particularly iron deficiencies. The 2004 Bulletin of the World Health Organization estimated that birth defects in developing countries could be reduced by one-third simply by fortifying wheat flour with iron and folic acid.

Amputations from traumas in developing countries can often occur as a result of natural disasters, particularly from earthquakes. Project Medishare estimates that 6,000 – 8,000 people suffered amputations as a result of the Magnitude 7 earthquake in Haiti on Jan. 12, 2010. One thousand of them were children. Lack of building codes in poor, developing countries like Haiti leave the population much more vulnerable to severe injuries, including limb loss, during natural disasters due to falling rubble.

Yet traumas in developing countries can also occur in war zones from weapons, especially from landmines. According to UNICEF, children in at least 68 countries face the threat of death or limb loss from landmines. They estimate the presence of 37 million landmines on the African continent, and 10 million in Angola alone. As a result, Angola has 70,000 amputees, 8,000 of which are children.

UNICEF says that children are especially vulnerable to landmines. Signs to warn them of their presence are useless if they are illiterate or too young to read. Also, children often mistake landmines for toys; their curiosity often leads them to pick up the weapons. At that point, it’s too late. Their lives change forever.

Aside from accessing the necessary surgical and prosthetic care they need, one of the greatest challenges for child amputees in developing countries, whether from birth defects or from trauma, remains the burden they bear of social stigmas and discrimination.

“Children with visible disabilities experience social disadvantages as a result of prejudicial attitudes,” said s.e. Smith, contributing founder of Feminists With Disabilities.  This can include diminished access to education, either because it’s not accessible due to mobility issues, or because people believe they aren’t worth educating, Smith said.

“They also face unwanted negative attention from both adults and other children, and experience bullying and depression at much higher rates than non-disabled children,” Smith said.

This is where clinics like St. Andrew’s can make a difference in providing the resources child amputees need to integrate into society more easily. The care they receive leaves them less vulnerable to ostracism, and gets them closer to living the life they would otherwise live without an amputation.

“We improve quality of life one hundred percent. Because they may not be walking, they may not be running, they may not be playing with their friends without the prosthesis,” Druwe said of the clinic.

Yet, while the monthly care provided at St. Andrew’s is a blessing for those who receive it, it’s still not equal to the care patients in developed countries receive. “The tough part about doing a clinic like St. Andrews is that we only go down once a month. That’s better than what most people get in developing countries, but if they’re out in the middle of nowhere, the follow-up care can be very challenging. But it is extremely important, especially with a new prosthesis,” Druwe said.

Doctors need to regularly check the skin on the stumps of newly amputated limbs. Also, new prosthesis need adjustments so they fit comfortably and correctly. This is especially important for children, who need a new prosthesis approximately every year as they outgrow them. Druwe said he likes to see patients once a month at a bare minimum, but prefers to see patients on a weekly or biweekly basis during this stage, an option not available to most children in developing countries.

Yet for children like Rodrigo who have no other option, the monthly care he receives at St. Andrew’s Children’s clinic makes all the difference in the world, and he will keep coming to the clinic until he turns 18. After that, he must find care on his own through one of the many nonprofits, or non-governmental organizations that provide prosthetic care in Mexico, such as Limbs For Life, the World Rehabilitation Fund, or the Barr Foundation.

In the meantime, Rodrigo gets to run and play with his friends, something for which his mother, Consueula Ceniceros told translator Luz Villalba, she is very grateful for. Were it not for St. Andrew’s Children’s Clinic, “He would probably be on crutches because we wouldn’t have the means to have this done for him,” Ceniceros said.