At a crossroad in Haiti

Where the need to help meets the need for hope, a N.H. firm found a cause and a child took one big step

By Stephen Smith
Globe Staff / June 27, 2010

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PORT-AU-PRINCE, Haiti — Her expression, fixed in a brittle half-smile, betrayed little of what roiled inside.

Reginette Cinelien, barely across the threshold of adolescence, had seen her sister die, head smashed by a shower of rocks. Her father had vanished, presumed to be an anonymous victim of the earthquake.

And Reginette? Like hundreds of other Haitians, she bore the indelible brand of Jan. 12, the day the earth convulsed. Doctors had amputated her left leg below the knee to save her from a ravenous infection.

Now, on a cloudy March morning, a man crouched before her, his left knee dug into the dirt like a suitor. He had trav eled from a place she’d never heard of — New Hampshire — to the teeming soccer field where she’d lived since the quake, some nights squeezed onto a single cot with her mother and surviving sister.

The man, Chris Phillips, wanted Reginette to walk again. As he explained his plan to build her a new leg, his words translated into Creole, he searched the 13-year-old’s face.

Nothing. Just that half-smile.

Phillips and two colleagues from a small New England prosthetics company flew to Haiti sustained by hope and little else, yet confident that they could repair some of what the earthquake had wrought. They were strangers in a stricken land; their resolve would be sorely tested.

In the United States, amputees routinely get new limbs. In Haiti, where the disabled expect to find rejection instead of help, that was never the case before the quake. And now, the battered and broken live in tents, easy prey for infection and despair, tottering on crutches across rubble and fetid streets. Here, a new leg doesn’t make a person whole.

“Ask her if she’s ever seen it snow,’’ Phillips said to the translator, making an awkward attempt at a connection.

Phillips, hands sheathed in blue gloves, was making a cast of Reginette’s leg. He rubbed his hands together, crumpling flecks of plaster into a powdery snow, eager to coax a laugh, a twinkle — anything from the wounded girl with dull eyes. Her head remained bowed.

“Boy!’’ Phillips said, shoulders slumping. “Tough crowd.’’

But Reginette — once the outgoing lieutenant of the household, the enforcer when her mother was out scraping together coins by selling spaghetti on the street — was busy inside, thinking.

With a new leg, I could cook and clean again, she remembers thinking. Maybe even jump rope. I could walk to school without crutches. But doubts nagged. What would the leg look like?

A few hours after the man from New Hampshire left, Reginette perched on a wobbly cot. “I want to know,’’ she said, her voice no more than a whisper, “when I come out of here, where am I going to live?’’

Rosemaine Cius awakened that Tuesday in January in the sheet-metal cottage she shared with her daughters, Reginette, 9-year-old Manouchka, and Francesca, almost 5. It was humble, not much more than two beds, four chairs. There was no running water. What they needed they scoured from the street, the grand bazaar of the Haitian economy where barter is the currency of the realm.

The girls’ father did not live with them, but that morning, he swung by to leave money as he headed to his construction job.

In the afternoon, the mother shepherded the girls home from school along Delmas 33, a two-lane street frenetic with jousting cars and jitneys.

Francesca, a kinetic blur, bounded ahead.

And then: “We felt dizzy, the street was wavy, we fell down,’’ Reginette remembers.

She tumbled onto her stomach. Above her loomed a 6-foot-high, 2-foot-thick wall of fieldstone. She looked up. Cracks gashed the wall. There was no escape.

Manouchka died instantly. Rocks half-buried Reginette, and their mother suffered a head injury. Francesca, a few feet ahead, escaped unscathed.

“I lost my Manouchka!’’ their mother wailed. “I lost my Manouchka!’’

Minutes passed. Finally, a stranger lugged the stones off Reginette. In those panicked moments, survivors faced terrible choices, foremost among them: Tend to the dead or tend to the living?

“Let’s go to the hospital,’’ Reginette’s mother said.

Reginette, leg mangled, leaned on her mother as she hobbled to a hospital. It was a short but excruciating walk. At the hospital, bedlam reigned. All they could offer was a bandage. Her leg wasn’t even cleaned.

Six days later, after treatments at a succession of clinics failed, mother and daughter arrived at a hospital near the fallen presidential palace. Reginette needs an operation, they were told.

The doctors are going to clean my leg, she thought, so they can save it.

But they cut it off. “Infection, Pain,’’ they scrawled in explanation on a scrap of paper.

Sadness more than anger engulfed Reginette when she woke up. Why me? she wondered.

Still, she had survived.

The day after the earthquake, Rosemaine had gone looking for Manouchka’s body. It was gone.

The TV pictures from 1,700 miles away riveted Dennis Acton, and awakened something.

At 43, he was restless. He had survived testicular cancer and outlasted the technology boom and bust. He wound up as the IT trouble-shooter at the New Hampshire prosthetics firm run by his wife’s family, New England Brace Co.

He and Karen, his wife, longed to start a family, but years passed, and medical problems made it difficult.

What could he do? Acton had asked her beseechingly. Maybe go somewhere distant — India, perhaps — to provide limbs to the destitute.

“I had a pretty boring existence,’’ Acton said. “I wanted to go out there and do something more than just be an IT guy.’’

One evening not long after the earthquake, he stood in his basement, firing up the wood furnace. He’d fallen away from his Catholic upbringing, but on that night, he sensed a calling.

“I heard a loud voice in my head say, ‘Go to Haiti, you’re needed in Haiti.’ ’’

He poked around the Internet, stumbling upon a technology company from New Hampshire specializing in disaster response. The firm was sending workers to Haiti, and Acton offered to tag along and count amputees.

He returned six days later, emotionally wrenched — but with a mission. His priority, he decided, shouldn’t be counting amputees. It should be fixing them — and he knew the people who could help. In fact, he worked with them.

New England Brace was started six decades ago by Karen’s grandfather, an amputee. It is a company with a proud history and loyal employees, New England through and through, right down to the Cape-style headquarters that opened last year in Manchester.

The firm had never done anything remotely like this but quickly bought into Dennis Acton’s vision. Now, its specialists would be working in a country where they knew neither language nor geography nor who, nor how many, needed help.

Early reports suggested that as many as 100,000 Haitians underwent amputations. A representative of Handicap International, a French humanitarian group working with the Haitian government, called that a “crazy number.’’

Relying on surveys of hospitals and clinics, the group estimated that 1,500 amputees needed prosthetic legs or arms. Handicap International, as well as a leading maker of prosthetic devices, Hanger Inc., would soon open limb-building workshops in Haiti.

We’re here to help, too, the New Hampshire team gamely announced at an early March meeting of rehabilitation specialists, in a Port-au-Prince classroom so torrid the walls were moist.

As the meeting wound down, a young doctor from Los Angeles bounded up to them. “We’ve actually been looking for people like you,’’ Dr. Allen Chen exclaimed. He was working at a field hospital established by Cambridge’s Harvard Humanitarian Initiative on a dusty plateau 25 miles due east. “We can rock and roll tomorrow.’’

The next morning, Chris Phillips and another limb builder, self-styled “prosthetic commandos,’’ headed for the field hospital in Fond Parisien.

As Phillips toured the camp, an orderly assemblage of tents where patients were served three meals a day and medical workers used iPhones to track patients, he proved an immediate sensation — and a curiosity.

“Look, look!’’ children sang out. They pointed and poked at his left leg, which is made of titanium and carbon fiber, with the don’t-camouflage-anything design common in the United States. A crowd swarmed.

“I’ve grown up with a prosthesis. I’ve gotten the best possible care you can get,’’ said Phillips, who was born with a leg not fully developed. “If I could give back one-tenth of that, that would be terrific.’’

While Phillips and his colleague evaluated eight amputees in Fond Parisien, Acton’s phone rang back in Port-au-Prince, where he was attending meetings. It was his wife. A medical student had read about the fledgling efforts of New England Brace and called, describing a gritty tent camp with a number of neglected amputees. “It was something that moved my wife enough to call and say, ‘Hey, you’ve got to go to this place, these people really need help.’ ’’

It was Reginette’s camp.

Actually, it was less a camp than a small, improvised city, of 125 tents and 1,200 people. Reginette and her family lived under a blue plastic tarp not much larger than a two-car garage, with a dozen cots shared by 20. It was reserved for the hobbled, the ill, and their families.

On dry nights, Reginette’s mother slept on a swatch of cardboard on the ground. On rainy nights, rivulets of water sluiced into the tent and she clambered onto Reginette’s cot. Outside, the soccer field turned gooey, treacherous for someone on crutches.

Reginette parted the tent flaps to watch other children, like a little boy who tugged at a plastic milk jug fashioned into a car. Sometimes, she braided her hair. There was plenty of time to ponder life without a leg.

“Don’t think so much about losing your leg,’’ her mother told her. And, yet, who could blame a 13-year-old — especially in Haiti — for fixating on it? Much of the Haitian economy pivots on getting around, peddling what goods or services you have. Those who aren’t mobile often become outcasts.

“They always say, if you have two feet, you cannot do much of anything in Haiti,’’ said Dr. Jean Fefnay Belfort, the camp’s chief physician. “What about the person with one foot?’’

On the day the men from New Hampshire arrived, Phillips’s prosthesis was covered by slacks. When he lifted his pant leg, intent on showing her how well the leg works, Reginette was frightened by its mechanical sheen. She’d never seen anything like it. But, she thought to herself, he can walk — even earn a living.

With a lilting “Oui,’’ she agreed to his offer to make her a new leg, peering intently as he measured her right leg and what remained of the left. Using an indelible pencil, he traced the contours of the left leg onto a sock he’d pulled up over the knee. Then, he dampened rolls of plaster of Paris and wrapped them around the sock. The markings from the sock transferred to the plaster cast, creating an anatomical road map for the leg builders.

“Tres bien! Merci!’’ Phillips called out to Reginette when he was done.

Dennis Acton, stout frame sagging, stood at the edge of the tent. Here and at Fond Parisien, they had promised new legs for a factory worker, an electrician, a tailor, and seven other Haitians.

“I’m worried we’re getting in over our heads,’’ he said, eyes unfocused, distant. “Coming down here and seeing so many people injured, I want to help everybody.’’

Five nights later in Manchester, N.H., the basement workshop at New England Brace was abuzz. Eight prosthetic legs — long legs and short legs, legs with cosmetic coverings and legs with naked metal — lined the floor.

Like his colleagues that night, Acton, just back from Haiti, was there on his own time. They were harvesting spare parts — screws, plates, metal pylons — from legs that had been donated, many by relatives of amputees who had died. It was a way to lower the cost of building limbs for the Haitians.

“We’re basically cannibalizing them,’’ Acton said.

They had hoped to use the feet, too, but the ones they had were white. They would have to buy new, dark-toned feet, an expense they could ill afford.

The sour economy and the move to the new headquarters had rocked the company, resulting in a financial loss last year. Tension was palpable. Some on the Haiti team thought Acton was pushing too hard, and other employees questioned the wisdom of continuing to shoulder the project.

A foundation established to collect donations had raised only a few thousand dollars by late March. Acton and his wife had dipped into their vacation account to pay for his travel to Haiti, and now they were using credit cards. On one trip, Karen called Dennis to say they had $5.11 in their checking account. Travel to the island was exacting a toll, with team members sleeping in airports and cramming trips into weekends to limit days away from work.

Still, there they were, building limbs.

The Haitian amputees would get traditional mechanical limbs seen rarely today in the United States, where legs with microprocessors are increasingly popular because they deliver a more natural gait. But the microprocessors are expensive and finicky, susceptible to water damage and reliant on batteries — in short, ill suited to life in a tent camp.

The team used the casts from Haiti to make plaster models of the patients’ legs. They had to hope the measurements were spot on, that the patients’ legs had not swollen or shrunk too much. There would be no chance for second fittings, a standard offering with US patients. Phillips took particular interest in Reginette’s mold, refining the replica toward a more perfect match.

The crucial component of a prosthesis is the socket that attaches to what remains of the leg. New England Brace ordered slabs of plastic the color of milk chocolate to make sockets that would come close to matching the Haitians’ skin.

It is baked in an infrared oven at 400 degrees. The molten plastic for Reginette’s socket was removed and draped over the plaster model of her leg. Once it cooled, Phillips used a clacking pneumatic chisel to separate the socket from the replica.

But it was too thin and would have to be remade. They were returning to Haiti in a few days, and the company’s regular work had to get done. Phillips worried: Would they be able to keep their promise to Reginette?

“Thirteen years old,’’ he said. “She should be out there, hanging out with other kids and doing stuff.’’

Reginette awakened before dawn, rousted by anticipation. It was the day she’d been told the leg builders would return. 9 o’clock. 10 o’clock. 11 o’clock. Where were they?

At 1 p.m. they arrived, their tattered truck bobbing and weaving on the cratered road leading to the camp. “I’ve got the exquisite bag full of legs here,’’ Phillips declared, hoisting a white plastic garbage bag.

Just to be safe, Phillips had carried Reginette’s prosthesis inside the plane’s cabin. There was a foot, too, that matched the tawny color of the socket, Reginette’s name inscribed on the bottom.

“Big day today!’’ Acton said to Reginette, who wore a moss-green sundress. She gazed up at him with that half-smile.

A murmuring throng, as many as 75, clustered around. Phillips, sweat beading, introduced Reginette to her new leg and to the four-step regimen soon to be part of her daily life. First, a long sock goes on. Next, a liner made of rigid foam called Pelite. Then, a nylon stocking. Finally, the socket.

If the socket didn’t fit perfectly, Reginette could suffer skin irritation. The last thing they wanted was to leave her with a leg she wouldn’t wear. It was loose and painful at first, so they added a pad inside.

“Ask her if she knows any dance moves,’’ Phillips said to a translator, whose request was met with a head-shaking no.

Then he attached the rest of the leg, and Reginette took her first halting steps, supported by crutches. She scrunched her face in determination but otherwise revealed little.

The truth was, she felt embarrassed by the crowd. And the leg was heavy, not like her own. But she would make it work. She had to.

After the hourlong fitting, Reginette sat holding the leg tightly, her hands caressing it. Children approached her, peering at the socket. Reginette asked Phillips if she could jump rope with the leg. Yes, he told her. Would it come flying off, she wanted to know. No, he assured her.

As Reginette tried out the leg, her mother’s face shifted like the tropical sky, one moment clear and hopeful, the next cloudy and bereft. “All my family, everybody has two legs, everybody’s normal,’’ Rosemaine said later, wiping away tears. “I never thought this would happen to me with my daughter.’’

The next day, after Reginette’s first exercise session, Rosemaine twice tapped the 6-inch metal pylon connecting foot to socket.

“Will this part be covered, the steel part?’’ she asked, hoping for a more natural look.

Phillips absorbed her words.

“There’s a lot of work to be done here,’’ he said quietly to the mother, masking his disappointment at her preoccupation with the leg’s appearance. “But we’ll make it look nice, or we’ll help her make it look nice.’’

In the next few weeks, Reginette reported at 8 every morning and 5 every afternoon to exercise in a courtyard next to the camp, still using crutches. Each day, she walked a bit farther, threading her way around a lopsided mound of debris, under ropes strewn with clothes, past tents. On those first days, Reginette did not venture beyond the courtyard, embarrassed to be seen.

Yet something had shifted inside. She began looking up. Her conversations became animated. The half-smile thawed.

There are certain universals: If music thumps on a Saturday afternoon, in Haiti or anywhere, teenagers will flock.

One day in May, Reginette primped her hair, affixing costume jewelry festooned with three stars. She slid into sandals, a gift from the New Hampshire leg makers.

And she pulled on long blue surgical scrubs, also a gift. “So that people don’t tease me.’’

Her destination was a party at a sprawling tent camp more than a mile away. Reginette walked there without crutches, favoring her right leg and struggling to stay upright on the uneven, rock-strewn road.

Once she arrived, she sat and watched as people danced, boys played soccer. When a woman blocking her view wouldn’t move, Reginette — displaying equal parts resolve and mischief — tossed a pebble at the woman’s shoulder. She moved.

The next day, Reginette spotted Dennis Acton at the camp. What’s his name? she asked a translator. I want to thank him. The translator relayed Reginette’s words. Tears welled in Acton’s eyes.

He was physically and emotionally spent. The company had burned through $40,000, the foundation had raised barely $16,000, and some acquaintances viewed his efforts as quixotic, even if he had succeeded in getting limbs for a dozen Haitians. But in the time it took to draw Reginette into a hug, Acton found a measure of redemption.

For Reginette, with every passing day, the leg from New Hampshire felt more like her own. But what will happen in a few years when she outgrows the leg or it wears out, Reginette’s mother wondered. Who will build a new one?

Rosemaine has no job, no money. In fact, when a nun gave the mother cash to buy Reginette shoes, she instead paid off a debt she owed for food.

And they have no home to return to. It was crushed in January by bigger houses as they fell.

Some people from Miami erected a tall new tent for Reginette and others with injuries at the camp. But rain still breaches it. One evening, Reginette went to bed with the leg tucked next to her. During the night, the prosthesis fell to the ground and got soaked. The next day, she could not wear the leg.

Tomorrow, maybe.

Stephen Smith can be reached at top stories on Twitter

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