LES CAYES, Haiti (AP) — The home of clothing merchant Felix Pierre Genel collapsed before he could flee outside as a powerful earthquake shook southwestern Haiti. He was dug out of the rubble that same day with a broken arm and was among the somewhat fortunate ones who promptly received medical care at a local hospital. But even so, he could not escape amputation, a common consequence of the calamity.

Doctors at first told the 36-year-old they would try to save his right arm. He had surgery to place rods in to stabilise the broken bone. Then came an infection and a second operation.

“Instead of dying, I took the decision of letting them cut off my arm,” Genel said from his bed at the Les Cayes’ general hospital, his right arm bandaged where doctors amputated it above the elbow. “From where I’m coming from, inside the mouth of death, it’s best that they cut the arm off.”

Broken bones that cause open wounds are frequent injuries in devastating earthquakes like the one that battered the Caribbean nation on August 14. That combination causes a particularly high risk of infection, and even more so when, as in Haiti, access to health care is limited or people delay seeking medical attention in favour of natural remedies.

“The risk of infections goes up the longer you wait to get care, and some of that is related to access to health care, not all of it,” said Dr Christopher Colwell, chief of emergency medicine at Zuckerberg San Francisco General Hospital.

“If there are fractures or broken bones that are associated with those open wounds, those infections can be devastating and can result in the need for amputation, or, in some cases, even threat to life, over the next days and weeks,” he added.

The magnitude 7.2 quake, centred under the country’s southwest peninsula, killed at least 2,207 and injured 12,268 people. About 130,000 homes were damaged or destroyed. Hospitals, schools, offices and churches were also affected.

Health care facilities were already at a critical point before the temblor because of the pandemic. Many of the injured had to wait under the blistering heat, even on an airport tarmac, for care. One hospital was so overwhelmed that it placed patients in patios, corridors, verandas and hallways.

The ability to get medical attention also was complicated by a tropical storm that trailed the earthquake and the two-day closure of a major hospital in the capital of Port-au-Prince to protest the kidnapping of two doctors, including one of the country’s few orthopaedic surgeons.

Colwell, who was not in Haiti, said natural remedies can have varying degrees of success, but some not only are unhelpful, they are harmful and can even introduce bacteria that lead to infected tissues.

In the weeks after a massive earthquake struck Haiti in 2010, hospitals only admitted patients in the most serious conditions. Some with simple fractures that did not expose the bone through the skin left without seeing a doctor, only to return later with complications and serious infections.

The nongovernmental organisation Humanity and Inclusion concluded that as a result of the complications, “amputations represented an exceptionally large proportion of the surgical operations” and added, “Some amputations performed under extremely difficult circumstances required corrective surgery.”

The organisation estimated the number of amputations at between 2,000 and 4,000, with at least 1,000 people requiring a lower limb prosthesis.

Far fewer people were injured this time compared to 2010, when at least 300,000 Haitians were hurt and the government asserted that a similar number of people died.

The group now has a team in Haiti assisting health care personnel and assessing patients’ needs. They can examine scars and stumps, teach patients exercises and work on joints to avoid muscle stiffness. They also help psychological support efforts.

“People can be traumatised, and they can be very sad, depressed, but also some of them, they’re kind of in denial, and they believe extremely strongly that their life is going to be the same, which can be true, but same but different.” rehab specialist Virginie Duclos said.

Governments too have sent aid to southwestern Haiti, including the US military, whose USS Arlington arrived with a surgical team.

The NGO Samaritan’s Purse also opened an emergency field hospital in Les Cayes a week after the temblor.

“When we opened, we saw many people who were seeking care for the first time — and that was already a week after the earthquake — with broken bones and with wounds,” said Melanie Wubs, medical director for the field hospital.

She said others “had been hastily patched up right after the earthquake but now required more further care, whether that is surgery or debridement of wounds”.

Wubs said her team has only performed one amputation so far.

A couple of beds from Genel’s, Robenson Perjuste lay with his eyes closed Wednesday, the left leg bandaged where doctors amputated it well above his knee. His older brother, Ricardo Lavaud, fanned him with a small square of cardboard.

Lavaud, an agronomy student, was not at the apartment he rents in Les Cayes when the earthquake struck. But Perjuste, on vacation from school, had been staying with him. Lavaud rushed home and found his 15-year-old brother buried in rubble, a heavy concrete beam crushing his leg.

Passersby helped Lavaud lift the beam enough to pull Robenson out. Doctors told Lavaud that the leg was too damaged to save. He believes his brother was the first quake victim to undergo surgery at the local general hospital.

Nurses help change the bandages on Robenson’s leg every two days, but no one has spoken to the brothers about physical therapy that should follow or the possibility of fitting Robenson with a prosthetic.

“My brother believes in the spirits,” Lavaud, 22, said. “Whatever happened to him, he believes in the will of God and this is the path that God destined for his life.”