Tuzla's young amputees endure a long struggle

Bill Leeson, co-director of War Child, found his visit to the general hospital in Tuzla very gruelling. He was visiting children and young people, injured during the Bosnian war, who were being fitted with artificial limbs.

"I found seeing the children being fitted terribly embarrassing. I saw this strange pink stump and tried not to avert my eyes with shock," Mr Leeson said. Virtually all of the injuries involved the amputation of legs, feet and legs below the knee.

War Child, in collaboration with the Fund for Refugees in Slovenia, donated pounds 102,000 of prosthetics to the hospital which were delivered in September. In its first donation it has assisted 700 amputees. A further pounds 50,000 is needed for more prosthetic sections, especially joints, but also to provide much-needed training to the medical staff at the hospital.

Dr Sooria Kumaran, Consultant in Rehabilitation Medicine at the Roehampton Rehabilitation Centre, Queen Mary's Hospital, London, finds that children and young people adapt far quicker to amputations and prosthetics than adults.

"Children are highly resilient, are eager to learn quickly and do so easily," he maintains.

But it is a lengthy process. "A total assessment of the child is necessary, including paediatricians and psychologists. The psychological aspects are very important, especially counselling for both the parents and the child," he says.

Explosions can cause more than one injury, which might take longer to heal than a planned surgical amputation. Whereas Dr Kumaran would expect to fit a child with a prosthetic about three to four weeks after an amputation, a bomb blast might cause the skin on the stump to be more sensitive and skin grafts might be necessary.

After fitting the artifical limb, the child is seen daily by both a physiotherapist and the prosthetic specialist, who adjusts the new limb as the child learns to walk again. This involves exercises to strengthen the muscles in the stump; instruction on how to remove or fit the limb, and how to get up after falling over. Depending on the child's needs this can take about three to four weeks. Then the cosmetic covering is put on the leg.

Children soon get depressed by their lack of mobility and pick up bad movement habits with substitutes like wheelchairs and crutches. "They have to unlearn these poor habits once they are fitted with a limb and this can take up much time and lead to resistance. It is vital that they learn the proper way of walking and moving with a new limb quickly," said Dr Kumaran. The muscles on the stump waste away rapidly if they are not used, but children can build up and strengthen weakened muscles much faster than adults.

The Tuzla children are not likely to be receiving such a rigorous programme as that of Roehampton but the hospital staff are doing their best, says Mr Leeson. "As I left I felt, 'My God, I'm lucky I've got all my limbs', but as always I am uplifted by the people's fighting spirit, they simply carry on."