FOND PARISIEN, Haiti — In this land of amputees, hope is a metal crutch.
You see them reflecting the sun by day and car headlights by night, as people hoist themselves along roads, thankful to be vertical. Gleaming Vs of aluminum poke out from rice bags and plastic jugs on tap-tap roofs. They lie in truck beds among bundles of cane and wood strips.
What you don't see are artificial limbs.
Nearly two months have passed since a catastrophic earthquake killed an estimated 230,000 people and made amputees of some 4,000 survivors. Those victims are discovering that a rehabilitative process that under less dire circumstances would have begun almost immediately after surgery has barely started for them. And some are discovering that process might never start at all.
Mackendy Francois uses his crutches to catapult himself down a dirt path in a refugee camp near the border of the Dominican Republic, which is home to over 250 patients, most of them amputees. Nearby, Mona Isma watches from a wheelchair.
Of the two, Francois, 22, is the lucky one because his below-the-knee amputation makes him a likely candidate for a prosthetic leg.
"I'm making myself strong for a prosthesis to get my job at the T-shirt factory back again," he said.
But Isma, 38, had a different view: "I know it is bad for my future that my amputation is high."
In this world of earthquake injuries, hierarchies form quickly. A crushed limb is enviable because the limb is still intact. A below-the-knee amputation is preferable to a mid-thigh one because of the knee's ability to control a prosthesis. What was shame over a partial leg amputation only a month ago has turned into the promise of an artificial limb, if the leg cut isn't too high.
"At least I have one leg. Some people lost both," said Isma, placing herself in the hierarchy.
The fate of people like Francois and Isma may rest in the hands of Handicap International, a French-based charity charged by the UN with bringing nonprofit agencies from around the world together to help people with limb injuries. By mid February, about 250 doctors, rehabilitation technicians and organizers connected to Handicap International fanned out across Haiti looking for amputees and treating them.
They check for infections and hand out crutches and walkers. They teach strengthening exercises and give pep talks. Temporary prosthetics, which just became available on a small scale in Port-au-Prince at the end of February, look like plastic cups connected to a metal pole with a rubber stopper for a foot.
"I hope to get one soon," said Francois.
• • •
On. Jan. 12, Francois was stitching necklines at the Palm Apparel T-shirt factory in Carrefour, the earthquake's epicenter, when the walls buckled. More than 300 people died in the factory, and hundreds were critically injured.
Twelve hours later, Francois' brother used a hacksaw to cut his left leg off at mid-shin to free him from the factory rubble. The brother then tied newly stitched T-shirts around the wound to stem the bleeding, and drove Francois to an overflowing hospital in Port-au-Prince. A few days later, he was trucked to the public hospital in Jimani, a border town in the Dominican Republic.
When Francois arrived at the Jimani hospital, Isma lay on a mattress on the floor in a hallway, her right leg amputated at mid-thigh. Drifting in and out of consciousness, she described herself to visitors as "ugly" and said she didn't want to live.
In Haiti, where life is even a struggle for the healthy, it is all but impossible for amputees who are ostracized and often shut out of schools and jobs.
"To have a chance at life, I think I must leave Haiti," said Isma.
She was at home in Petionville when the earthquake hit, and a wall fell on her. At the Jimani hospital, doctors planned to amputate both legs to save her life. But Mike Wnek, an Auburndale developer volunteering in Haiti, arranged for her to get strong antibiotics that saved her remaining leg. Wnek also got her a wheelchair.
Weeks later, when government officials in the Dominican Republic ordered Haitians who were no longer in critical condition back to hospitals and camps in Haiti, Isma and Francois were bused to the Fond Parisien refugee camp. The camp had sprouted up on the grounds of Love a Child Orphanage founded by Riverview couple Bobby and Sherry Burnett.
In the week after the earthquake, the orphanage was overwhelmed with hundreds of injured people and only a lone licensed practical nurse to treat them. But by late February, it had become a full-fledged medical compound called the Love a Child Disaster Relief Center run by the Harvard Humanitarian Initiative and staffed by surgeons, primary care doctors and emergency room doctors from all over the United States. Handicap International staff visit regularly.
"In those early days right after the earthquake, I'd see people and know they were going to die," said Sherry Burnett. "Now, I see the same people getting around on crutches, waiting for prosthetics and doing fine."
• • •
Situated on a shady ridge east of Port-au-Prince, this amputee center has potable water, flushing toilets, electric lights and nightly soccer games for the families of the injured. There is even ice in the fruit punch.
Tim Budorick, an orthopedic surgeon from Virginia Beach, Va., operated on Francois here two weeks ago to clean up his stump and prepare him for a prosthetic.
"If someone loses a leg or part of a leg," said the surgeon, "you need to move quickly to walking before neurological adaptive behaviors and balance are lost, and that's what we're trying to do here."
On this Friday afternoon in late February, primary care physician Marye Lois McCroskey from Maryville, Tenn., walks around the camp showing patients how to wrap stumps to prepare them for fittings. Many ask when they'll get limbs.
"That's a good question, but we don't know yet," the doctor tells them. "There's a huge need to be filled."
Francois pauses under a cluster of trees where amputees sit on mattresses, doing leg exercises. He nods and smiles.
"We try to encourage and motivate each other to get to the next step," he said.
If Francois gets a prosthesis in the next few months, he plans to return to Carrefour, where the Palm Apparel factory was and where supervisors are taking applications for future work.
"You can bet we'll be waiting for him to give him a job," said Palm Apparel factory owner Alain Villard.
In the shade of a mango tree, Isma lifts her intact leg up and down to strengthen it — even though she is not a likely candidate for a prosthesis.
"If I can just get on crutches ..."
Times staff writer John Barry contributed to this report. Meg Laughlin can be reached at mlaughlin@ sptimes.com.