Short-term survival is one thing – a question of proper life-support and surgical care.
To get going again – and keep going – is another matter. The F-16 rockets and cluster bombs are just one feature of the war of oppression; structural poverty and being without basic rights to water and land is another presentation of the North’s war on the South.
The life-savers in the mine fields of Cambodia and North Iraq asked us what to do with the mine accident Survivors. “We helped them survive, but they are stuck in chronic pain which pain-killers cannot relieve. What can we do?” In 2001 we studied the quality-of-life of severely injured mine accident survivors, and found that 2/3 suffered from chronic pain problems. The pain was so severe that they could not work and provide their families. Amputees could not wear their prosthesis.
This is important: The level of pain did not relate to the quality of primary trauma care and surgery. But it did correlate with poverty, meaning that poverty itself acts as a chronic trauma; meaning that the traumatic amputation not only takes the limb – but the entire family.
Cow as pain-killer
Based on this understanding we hypothesized: If chronic pain is the price you pay when hardships are chronic, poverty relief should give pain relief. In 2001 we initiated an intervention inside the mine fields: The survivor families came together in self help groups and were given micro-credit support: “Here’s a cow, give us a calf back in three years’ time”.
The intervention is now under evaluation; preliminary results indicate that cows, sheep, and bee cubes – and the collective support of the local community – are efficient pain-killers in patients with post-injury chronic pain syndromes.
Early temporary walking aids for amputees
Devastating pain: In the study of land mine amputees (n = 34, PEKER) we found rates of phantom pain at 68%. Ten amputees said the phantom pain was stable, seventeen said it was increasing. The rate of amputation stump pain were 43% in Cambodia, 76% in Northern Iraq. Nineteen amputees said the stump pain was stable, eight said it was still increasing more than one year after the accident. There was no correlation between amputation stump quality and levels of chronic pain. However, self-rated loss of post-injury income did correlate with rates of phantom limb pain (p< .05).
Relief organizations provide nice polypropylene prosthesis for the amputees at professional centers.
But definitive prosthesis fitting takes place 4 – 6 months after the injury. In the meantime amputees have to sit waiting in their villages. If they at all can afford to take a two week travel to the city.
Hypothesis: That is not a professional strategy. To encourage coping we should get the amputees going immediately after injury and surgery.
At TCF’s remote rural “laboratory” workshop in Sompouv Lun we are breaking new ground. Tuber ischii bearing temporary walking aids are made from local materials (sewage tubes and local metals). The prosthesis is fitted immediately after surgery to get the patient up and going – encouraging a body image of two legs, not one. Three weeks after surgery we see the amputee back on his tractor.
The early temporary prosthesis study started in 2006 in cooperation with the Ministry of Social Affairs in Phnom Penh. The study is conducted as a semi-cross over clinical trial with pain and function as main outcome variables. Results from the Sompouv Lun study are pending.