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Limb loss a grim, growing global crisis

In an instant, the earthquake that rattled Haiti on Jan. 12 created as many as 6,000 amputees, people who lost limbs either from direct injury or the complications and infections that followed.

Aid experts said this ranks among the largest-ever loss of limbs in a single natural disaster, and propelled Haiti to the epicenter of an existing global amputation crisis.

"We've seen many amputees, but nowhere near the magnitude of this," said Ivan R. Sabel, chairman of Hanger Orthopedic Group, which launched the Haitian Amputee Coalition to respond to the problem.

The earthquake galvanized the international prosthetics community, prompting promises of limbs, supplies and staff to help rebuild bodies devastated by the temblor and its aftermath.

Already some two dozen prosthetics groups are setting up shop, and plans are in place to distribute rehabilitation services across the country, including Hanger's site at the Hopital Albert Schweitzer in Deschapelles, 60 miles outside Port-au-Prince, where msnbc.com is tracking the stories of amputees as they rebuild their lives.

But even as attention is riveted on those who've lost limbs in Haiti, experts warn that the tragedy there highlights a grim reality: the number of amputees worldwide is rising -- and fast.


War, violence, disaster and disease are fueling limb loss estimated at between .5 percent and .8 percent of global populations, according to the World Health Organization and the International Society for Prosthetics and Orthotics.

More precise figures are difficult to get, mostly because amputation receives little attention or resources in countries where survival is constantly in jeopardy. But the problem remains very real in every country, said Robert S. Kistenberg, who heads the U.S. chapter of the ISPO.

Still, some places have more than their share. In Angola, 1 in every 334 people has lost a limb, mostly to landmines left behind by a bloody civil war, according to the International Committee of the Red Cross. Ongoing conflict in Afghanistan means 1 in every 631 people is an amputee; in Iraq, the figure is 1 in 987.

The WHO estimates that in Africa, Asia and Latin America combined, as many as 30 million people require prosthetic limbs, braces and other such devices for daily living, up from 24 million people in 2006.

In the United States, where 185,000 people suffer amputation each year, the prevalence of limb loss keeps climbing. Today, there are more than 1.6 million U.S. amputees, according to a 2008 analysis in the Archives of Physical Medicine and Rehabilitation.

And the number is expected to more than double, rising to 3.6 million people by 2050 according to researcher Ellen J. MacKenzie of Johns Hopkins Bloomberg School of Public Health.

"We knew the incidence was high. But even we were surprised to see how large the numbers became," she said of her bleak estimate.

Even that number is probably conservative because researchers didn't allow for rising rates of disease. Amputations caused by vascular disease, usually related to diabetes, account for 54 percent of cases of limb loss in the U.S. Traumatic amputation – limb loss caused by car crashes, workplace accidents, natural disasters and war – accounts for 45 percent of loss.

"Every 30 seconds, someone loses a limb because of diabetes," said Dr. David Armstrong, a professor of surgery and director of the Southern Arizona Limb Salvage Alliance at the University of Arizona. "It's like a tsunami crashing in on us."

The disease robs people of the perception of pain in their lower extremities, allowing even minor ulcers and cuts to fester into limb-threatening infections.

Regardless of the cause, the loss of a limb is a traumatic, life-altering event, noted Dr. James Gosney, a Norfolk, Va., member of the International Society of Physical and Rehabilitation medicine and the International Rehabilitation Forum who is building a prosthetics lab in northern Honduras.

Without prostheses, amputees may only get worse, suffering further physical and psychological problems as they become increasingly isolated. At the same time, their families bear a heavy social and financial burden for their care. Although wheelchairs are often available, they're often not a good long-term option as they can be impractical given the rugged terrain and harsh climate of developing nations.

"You have a population of already marginalized people who are further marginalized," he said.

Sustaining the world's attention -- and support -- is vital for amputees not just in Haiti, but around the globe, said Armstrong, the Arizona surgeon.

"That's what's happening in Haiti. What we have done is identified a dire situation," he said. "The real story is that this is happening every single day, all the time."