We will soon be presenting mirror box therapy to the physical therapists as well as other hospital staff so that patients can continue to be treated long after we have gone. There is a problem in the region of worsening conditions after donations or money runs out so we have been brainstorming how the mirror box therapy can continue after the mirrors that we have brought have all been given out. This could involve utilizing sensory referral - massaging the residual limb, watching someone else's limb be massaged and massaging the ipsilateral face for upper limb amputees.
Another factor that must be considered is evolving materials for best use in Haiti. For example, many of the wheel chairs sent to Haiti patients can't use because the tires aren't strong enough for the roads here. The best tires for the wheelchairs are tires for rough terrain like those on a mountain bike. We believe that by utilizing the durable, shatterproof acrylic mirror sheets rather than glass, our materials are well suited for the environmental challenges of the region.
We've learned that after the earthquake the clinic was extremely busy and people were working 12 hour days to make enough prosthetic limbs. This clinic was the busiest and biggest physical therapy and rehabilitation clinic after the quake: 27-30 patients/ day were fitted with prosthetics and treated in the period of time after the earthquake.
There appears to be a high incidence of phantom sensations in Haiti. This may be due to the nature of the amputation (many of the patients' limbs were in great pain before the amputation due to being caught under fallen rubble and during the operation as anesthetics weren't available). We have had no problems in describing what a phantom sensation is to the amputee community here: every patient thus far has immediately known what we are talking about. The patients have been very willing to try the therapy and are incredibly relieved— overjoyed to feel pain alleviation in their phantom. Many patients continue to tell us they will show all their friends with phantom sensations and phantom pain the therapy. This is probably one of the best ways to spread word of the therapy beyond our clinic.
A new phenomenon we have noticed is that when many patients are in front of the mirror and feeling their phantoms move for the first time, they report they “feel their veins pulsing.” We've never heard this description used in the States—we are researching if this expression means something different in Haitian Creole than the direct translation.