How Venezuela’s earthquake amputees adapt to life without limbs

Experts say recovery for earthquake survivors will likely be a lifelong endeavour, given the physical and mental toll of the June 24 tragedy.

A line of prosthetic limbs on display in the Ortoprotecnica clinic in Caracas, Venezuela [Catherine Ellis/Al Jazeera] A line of prosthetic limbs on display in the Ortoprotecnica clinic in Caracas, Venezuela [Catherine Ellis/Al Jazeera]

Ricardo Contreras’s new leg rests on a wooden countertop.

More than four months after twin earthquakes struck Venezuela, the 24-year-old is still recovering from his injuries.

When he was trapped beneath the rubble on the night of June 24, he waited hours to be rescued. His left leg had been pinned beneath a fallen door frame, limiting its blood circulation. It had to be amputated.

“One of the biggest achievements is that we survived,” Ricardo said, glancing towards his 16-year-old brother, Andres Contreras. “At first, when I found out Andres was well, I didn’t care about my leg too much. I would have chosen a thousand times over for Andres to be OK.”

But now Ricardo is adapting to his new reality.

He and his brother are still undergoing physiotherapy for their injuries. On a scorching afternoon, he sits in a small workshop in the hills of northwestern Caracas, waiting to do rehabilitation exercises to prepare for his new prosthetic leg.

“Now it’s about regaining a little of the independence I had before the earthquake, because that’s what limits me most," Ricardo said.

But recovery is only part of the challenge he is facing. His parents died in the collapse.

Resources and aid have also grown scarcer, particularly as global attention faded and international donations dried up.

As of September, the United Nations Children's Fund (UNICEF) said it had secured only $29.5m of the $65.7m needed to continue its earthquake support in Venezuela, a shortfall of 55 percent.

Separately, that same month, the International Red Cross said its Venezuela response effort was only 39.8 percent funded.

Not only are survivors like Contreras left to grapple with loss of limbs and family members, but they now face the prospect of lifelong health costs — with dwindling support.

Brothers Andres and Ricardo Contreras survived the earthquakes on June 24, each sustaining serious injuries [Catherine Ellis/Al Jazeera] Brothers Andres and Ricardo Contreras survived the earthquakes on June 24, each sustaining serious injuries [Catherine Ellis/Al Jazeera]

From rescue to recovery

More than 6,500 people have been confirmed dead as a result of the earthquakes, according to government authorities.

At least 226,696 people have received hospital treatment for injuries. The government says it has compiled a census of amputees, but no details have been made public.

At Ortoprotecnica, a Caracas workshop that makes prosthetic limbs, director Bianca Damaso is helping survivors like Ricardo through the next stages of recovery.

For those who have lost limbs, it typically takes two to three months of physiotherapy, rehabilitation and preparation to be ready for a prosthesis — sometimes longer depending on how their wounds heal and any pre-existing health conditions.

“It’s a very individual process where you have to support each person from where they are, because some are very anxious to have the prosthesis already, but their skin hasn’t even healed yet,” Damaso explained.

She said there are more than 100 types of knees to choose from, as well as more than 200 skin shades.

But the process does not end with the first fitting. Children may need five or six replacement prostheses as they grow, while adults might require ongoing adjustments and repairs.

Then there are the psychological hurdles. Many earthquake survivors wonder about practical realities like whether they will walk again, whether they will need a wheelchair or whether they will be able to urinate independently.

Many, in Damaso's experience, also question whether they will find a partner who will love them.

"Right now, the challenges for them are going to be more than just physical. They’re mental battles," Damaso said.

There is one rule she is adamant about in her workshop: “We tell them that the only thing that’s forbidden here is saying, ‘I can’t.’”

Bianca Damaso holds up a cast as she discusses how prosthetics are made and fitted [Catherine Ellis/Al Jazeera]

Karina Bechara, who lost both her legs in the earthquakes, is hoping to stand on her new feet by December 1. For now, she relies on a wheelchair.

“That motivates me every morning to get up and say, 'One day less to go.' It's painful, yes, but we're getting closer to the goal,” Bechara told Al Jazeera.

Before the earthquake, Bechara ran her own business and had an active life, training regularly with high-intensity CrossFit workouts. Her children saw her as an independent mother who did not depend on anyone.

“Now I am the opposite, a mum who needs their help, a dependent mum,” Bechara said.

After the earthquakes struck, Bechara was stuck in the rubble for 23 hours, immobilised by a piece of heavy furniture that crushed her legs.

She describes her recovery as an “emotional rollercoaster”. She said she allows herself to cry on the harder days but tries to keep looking ahead.

“Because if I don’t see the future for myself, no one else will.”

Karina Bechara, a mother and CrossFit enthusiast, is hoping to learn to walk again in the coming months [Catherine Ellis/Al Jazeera] Karina Bechara, a mother and CrossFit enthusiast, is hoping to learn to walk again in the coming months [Catherine Ellis/Al Jazeera]

More than just limbs

But readjusting to routines can be difficult for those who have sustained life-altering injuries — not to mention other losses.

So far, Ricardo is optimistic about his daily activities. He has resumed work at his family's truck parts business, as well as his university studies. A new semester of classes has started, and he uses crutches to get around.

“I was really quite nervous. I was even worried about where the classes will be because we have three floors and also the distances are long,” Ricardo said.

But his concerns quickly melted away. The professors even moved his lessons to ground-floor classrooms to make the courses more accessible.

“It was actually great going back," Ricardo explained. "My classmates have always been there, helping me.”

The most difficult adjustment, however, has been grappling with the loss of loved ones.

“If my leg hurts, I take a pill, but with that, there’s nothing I can do. There’s no cure, there’s no remedy, there’s nothing,” Ricardo told Al Jazeera.

His mum and dad both died from suffocation during the earthquakes while the family was waiting to be rescued. Their building was one of dozens in the state of La Guaira to collapse.

“I fell in the bathroom hugging my mother, and Andres fell near my father. She was telling me she was fine, but I saw that her head was covered with concrete, with a wall on top, and dust,” Ricardo said.

Before the earthquakes, he remembers his mother cooking, singing and spoiling the family dog, who also died in the destruction. He credits his father with teaching him and Andres the value of work and the importance of being strong.

Ricardo Contreras, right, and Andres, left, pose with their family before the fatal earthquake [Courtesy of the Contreras family]

The brothers often look through photographs of their parents on their phones. One shows their family home, overlooking the sea. Another has them by the pool.

“As time goes on, the crying is the same, but the reason is different. Instead of crying so much from sadness, it's more like remembering the good times,” Ricardo said.

Following his parents' death, Ricardo has taken on additional responsibilities beyond school and work.

He is now Andres's legal guardian, and he is hoping the pair can soon find a home of their own through a government housing programme for earthquake victims.

His university has also offered him a full scholarship to finish his studies, to help relieve the financial burden.

Money, however, is still expected to be tight. The average salary for a private-sector worker in Venezuela is not much more than $200 a month.

“Of course, I'm worried about my financial situation,” Ricardo said, explaining the family business has slowed since the earthquakes.

“Sometimes it's hard to cover all the expenses, given everything that's happened, but we find a way. I think that's what Venezuelans do: We’re always finding a way to make things work.”

Ricardo Contreras lifts weights to help with his physical recovery as he is fitted with a prosthesis [Catherine Ellis/Al Jazeera] Ricardo Contreras lifts weights to help with his physical recovery as he is fitted with a prosthesis [Catherine Ellis/Al Jazeera]

The cost of recovery

The Juan Pablo Dos Santos Foundation, a Venezuelan nonprofit, is among the groups helping earthquake amputees. Its founder and namesake, Dos Santos, lost his legs in a car accident in 2019.

He remembers realising the scale of June's tragedy when, at the first hospital he visited, he encountered a ward with 12 children. All of them had either lost limbs or were facing amputation.

“It's very difficult for everyone in general but especially for children, who suddenly lost so much. They lost family members, their homes, their schools, their abilities, and on top of that, they're missing a part of their body,” he told Al Jazeera.

One of his priorities was to show them what their lives could look like after amputation, telling them of his own achievements as an athlete and model.

But alongside the physical and psychological challenges, he knew they would face another obstacle: the cost of prosthetics.

Juan Pablo Dos Santos visits Karina Bechara as she receives medical care [Courtesy of the Juan Pablo Dos Santos Foundation]

“A prosthesis for a below-knee amputation, which is a transtibial prosthesis, can cost between $3,000 and $5,000," Dos Santos said. "And a prosthesis for an above-knee amputation can cost between $7,000 and $12,000."

The price tag for artificial limbs with electronic components — that react to the body's muscles — can stretch even higher, into the tens of thousands of dollars.

Even before the earthquake, the foundation had a waiting list of hundreds of people who needed a prosthetic limb but could not afford one.

After the seismic disaster, some 200 people were added to its database, Dos Santos said.

He explained that the foundation focuses on functional prostheses rather than the most expensive technology, partly because patients also need to be able to afford adjustments, repairs and replacements.

For many families, the cost is simply beyond reach.

The foundation is now planning to set up a specialist orthotics and prosthetics centre in Venezuela, which it says is essential to provide ongoing support for amputees.

A display in the Ortoprotecnica clinic in Caracas shows different prosthetic attachments and skin shades [Catherine Ellis/Al Jazeera] A display in the Ortoprotecnica clinic in Caracas shows different prosthetic attachments and skin shades [Catherine Ellis/Al Jazeera]

Navigating the healthcare system

Medical professionals also see continued care as fundamental to recovery.

“For patients who suffered serious injuries or amputations, being saved and discharged from hospital is only the beginning. The recovery can be long, and that’s where we encounter many limitations,” Ana Rosario, the president of the Caracas Nurses Association, told Al Jazeera.

She said the earthquake compounded problems in Venezuela’s health system, which was weakened by years of economic crisis.

There are often too few nurses for the number of patients. Hospitals sometimes relied on supplies donated by citizens and organisations to help meet their needs.

“Although healthcare is technically free, patients may still have to pay for medicines, medical supplies, tests, transport and rehabilitation,” Rosario said. “And these are costs that can continue for months.”

For families who cannot afford them, the consequences can be serious.

“We see it every day: Families ask for help through social media, look for donations, go into debt, or simply have to wait,” she said. “When a test, medication or procedure is delayed, recovery can also be delayed, and new complications can arise.”

For survivors like Ricardo, private donations through organisations such as the Juan Pablo Dos Santos Foundation are helping pay for prosthetic limbs and rehabilitation.

“A few days ago, I saw my leg being made, and that got me really excited,” Ricardo said.

Though Ricardo is his guardian, Andres explained they help care for one another as they each recover from their injuries.

“Just getting out of the wheelchair was already a big step," Andres said of his brother. "He’s getting better every day. Honestly, it makes me so happy that he’ll be able to walk again."

The brothers attend physiotherapy sessions together, with Andres encouraging his older brother as he learns to walk again.

“My brother makes me feel like a world champion,” Ricardo said, laughing as his younger brother breaks into a smile.

专家表示，鉴于6月24日地震造成的身体和精神创伤，地震幸存者的康复很可能是一项终身事业。

委内瑞拉加拉加斯Ortoprotecnica诊所展出的一排假肢。[凯瑟琳·埃利斯/半岛电视台]

里卡多·孔特雷拉斯的新假肢放在木质台面上。

委内瑞拉发生双重地震四个多月后，这位24岁的年轻人仍在从伤痛中恢复。

6月24日晚，他被困在废墟下，等待救援数小时后才获救。他的左腿被倒塌的门框压住，血液循环受阻，最终不得不截肢。

“最大的成就之一就是我们活了下来，”里卡多说着，瞥了一眼他16岁的弟弟安德烈斯·孔特雷拉斯。“一开始，当我得知安德烈斯没事的时候，我并不太在意自己的腿。我宁愿安德烈斯平安无事一千次。”

但现在里卡多正在适应新的现实。

他和他的兄弟仍在接受伤后康复治疗。在一个炎热的下午，他坐在加拉加斯西北部山区的一间小作坊里，等待进行康复锻炼，为安装新的假肢做准备。

“现在我希望能重新获得地震前的一些独立性，因为独立性是我最大的限制，”里卡多说。

但康复只是他面临的挑战的一部分。他的父母在那场坍塌事故中丧生。

资源和援助也变得越来越稀缺，尤其是在全球关注度下降和国际捐款枯竭的情况下。

截至9月，联合国儿童基金会（UNICEF）表示，为继续向委内瑞拉提供地震援助，所需的6570万美元中，仅筹集到2950万美元，缺口达55%。

另外，同月，国际红十字会表示，其对委内瑞拉的救援工作仅获得了 39.8% 的资金。

像孔特雷拉斯这样的幸存者不仅要面对失去肢体和家人的痛苦，现在还要面对终身医疗费用的困境——而支持却在不断减少。

安德烈斯·孔特雷拉斯和里卡多·孔特雷拉斯兄弟在6月24日的地震中幸存，但两人均身负重伤。[凯瑟琳·埃利斯/半岛电视台]

从救援到康复

据政府部门消息，地震已造成超过6500人死亡。

至少有226,696人因伤接受了住院治疗。政府表示已完成截肢者普查，但尚未公布具体细节。

在加拉加斯一家名为 Ortoprotecnica 的假肢制造作坊，负责人 Bianca Damaso 正在帮助像 Ricardo 这样的幸存者度过康复的下一个阶段。

对于失去肢体的人来说，通常需要两到三个月的理疗、康复和准备才能安装假肢——有时时间会更长，具体取决于伤口愈合情况和任何既有的健康状况。

“这是一个非常个性化的过程，你必须根据每个人的实际情况给予支持，因为有些人非常渴望尽快拥有假肢，但他们的皮肤甚至还没有愈合，”达马索解释说。

她说，膝关节有 100 多种类型可供选择，肤色也有 200 多种。

但整个过程并非在第一次试戴后就结束了。儿童在成长过程中可能需要五到六副替换假肢，而成年人则可能需要持续的调整和维修。

此外，还有心理上的障碍。许多地震幸存者会担心一些实际问题，例如他们是否还能再次行走，是否需要轮椅，或者是否能够独立排尿。

根据达马索的经验，许多人也会质疑自己是否能找到一个爱自己的伴侣。

“目前，他们面临的挑战不仅仅是身体上的，更是精神上的挑战，”达马索说道。

在她的工作室里，她坚持一条规则：“我们告诉他们，这里唯一禁止的事情就是说‘我做不到’。”

比安卡·达马索举起一个石膏模型，讲解假肢的制作和安装过程。[凯瑟琳·埃利斯/半岛电视台]

在地震中失去双腿的卡琳娜·贝查拉希望能在12月1日之前重新站起来。目前，她只能依靠轮椅出行。

“这激励着我每天早上起床，告诉自己‘离目标又近了一天’。这很痛苦，是的，但我们离目标越来越近了，”贝查拉告诉半岛电视台。

地震前，贝查拉经营着自己的生意，生活充实而积极，经常进行高强度的 CrossFit 训练。她的孩子们视她为一位独立自主的母亲，不依赖任何人。

“现在我正好相反，我成了需要他们帮助的妈妈，一个依赖他们的妈妈，”贝查拉说。

地震发生后，贝查拉被困在废墟中 23 个小时，一件沉重的家具压住了她的双腿，使她动弹不得。

她形容自己的康复过程就像“过山车”一样。她说，在难熬的日子里，她会允许自己哭泣，但也会努力向前看。

“因为如果连我自己都看不到自己的未来，别人又怎么能看到呢？”

卡琳娜·贝查拉是一位母亲，也是一位 CrossFit 爱好者，她希望在接下来的几个月里重新学会走路。[凯瑟琳·埃利斯/半岛电视台]

不仅仅是四肢

但对于那些遭受改变人生的伤病的人来说，重新适应日常生活可能很困难——更不用说其他损失了。

目前，里卡多对自己的日常生活持乐观态度。他已经恢复了在家族卡车配件公司的工作，同时也继续着大学的学业。新学期已经开始，他现在需要拄拐杖出行。

“我当时真的很紧张。我甚至担心上课地点，因为我们有三层楼，而且楼层之间的距离也很远，”里卡多说。

但他的担忧很快就烟消云散了。为了让学生更容易上课，教授们甚至把他的课搬到了底楼的教室。

“回去感觉真好，”里卡多解释说。“我的同学们一直都在，帮助我。”

然而，最难适应的还是失去亲人的痛苦。

“如果我的腿疼，我就吃药，但除此之外，我什么也做不了。没有治愈方法，没有补救措施，什么都没有，”里卡多告诉半岛电视台。

地震发生时，他的父母因窒息而亡，当时全家正在等待救援。他们居住的房屋是拉瓜伊拉州数十栋倒塌房屋之一。

“我抱着妈妈在浴室里摔倒了，安德烈斯摔倒在我爸爸旁边。她告诉我她没事，但我看到她的头被混凝土盖住，上面还有墙和灰尘，”里卡多说。

地震前，他记得母亲做饭、唱歌，还疼爱家里的狗，可惜那条狗也在地震中丧生。他感谢父亲教会他和安德烈斯工作的价值和坚强的重要性。

里卡多·孔特雷拉斯（右）和安德烈斯（左）在致命地震前与家人合影。[孔特雷拉斯家族供图]

兄弟俩经常翻看手机里父母的照片。一张照片是他们家，可以俯瞰大海。另一张照片是他们在泳池边。

“随着时间的推移，哭泣的次数虽然一样，但原因却不同了。不再是因为悲伤而哭泣，而是为了回忆美好的时光，”里卡多说。

父母去世后，里卡多除了上学和工作之外，还承担了更多的责任。

他现在是安德烈斯的法定监护人，他希望两人能够通过政府为地震灾民提供的住房计划，尽快找到属于自己的家。

为了减轻他的经济负担，他的大学也向他提供了全额奖学金，帮助他完成学业。

然而，资金状况预计仍然会很紧张。委内瑞拉私营部门员工的平均月薪略高于200美元。

“我当然担心我的财务状况，”里卡多说道，并解释说自地震以来，家族企业的业务已经放缓。

“考虑到发生的一切，有时很难支付所有费用，但我们总能找到办法。我认为这就是委内瑞拉人的作风：我们总能找到办法让事情运转起来。”

里卡多·孔特雷拉斯正在举重以帮助他进行身体康复，他正在安装假肢。[凯瑟琳·埃利斯/半岛电视台]

恢复成本

委内瑞拉非营利组织胡安·巴勃罗·多斯·桑托斯基金会是帮助地震截肢者的组织之一。该基金会的创始人兼同名人物多斯·桑托斯在2019年的一场车祸中失去了双腿。

他记得，当他走进第一家医院时，看到一个病房里有12个孩子，他才意识到琼的悲剧有多么严重。这些孩子要么失去了肢体，要么面临截肢。

“这对每个人来说都非常艰难，但对孩子们来说尤其如此，他们突然失去了那么多。他们失去了家人、家园、学校、能力，而且雪上加霜的是，他们还失去了身体的一部分，”他告诉半岛电视台。

他的首要任务之一是向他们展示截肢后的生活会是什么样子，并讲述他自己作为运动员和模特所取得的成就。

但除了生理和心理上的挑战之外，他知道他们还将面临另一个障碍：假肢的费用。

胡安·巴勃罗·多斯桑托斯探望卡琳娜·贝查拉接受医疗护理 [由胡安·巴勃罗·多斯桑托斯基金会提供]

“膝下截肢假肢，也就是胫骨假肢，价格在3000美元到5000美元之间，”多斯桑托斯说。“而膝上截肢假肢的价格在7000美元到12000美元之间。”

带有电子元件（能够对人体肌肉做出反应）的人造肢体的价格可能更高，达到数万美元。

甚至在地震发生之前，该基金会就已经有数百名需要假肢但又买不起的人在等待名单上。

多斯桑托斯说，地震灾害发生后，该数据库新增了约 200 人。

他解释说，该基金会专注于功能性假肢，而不是最昂贵的技术，部分原因是患者还需要能够负担得起调整、修理和更换的费用。

对许多家庭来说，这笔费用根本无法承受。

该基金会目前正计划在委内瑞拉建立一个专门的矫形器和假肢中心，并表示这对于为截肢者提供持续支持至关重要。

加拉加斯 Ortoprotecnica 诊所的展柜展示了不同的假肢连接件和肤色。[凯瑟琳·埃利斯/半岛电视台] 加拉加斯 Ortoprotecnica 诊所的展柜展示了不同的假肢连接件和肤色。[凯瑟琳·埃利斯/半岛电视台]

如何驾驭医疗保健系统

医疗专业人员也认为持续护理对康复至关重要。

“对于遭受重伤或截肢的患者来说，获救出院仅仅是开始。康复过程可能很漫长，而这正是我们面临诸多限制的地方，”加拉加斯护士协会主席安娜·罗萨里奥告诉半岛电视台。

她说，地震加剧了委内瑞拉医疗系统的问题，而该系统已经因多年的经济危机而变得脆弱不堪。

医院常常面临护士人手不足的问题，无法满足患者的需求。有时，医院需要依靠市民和组织捐赠的物资来勉强维持运转。

罗萨里奥说：“虽然医疗保健在理论上是免费的，但患者可能仍然需要支付药品、医疗用品、检查、交通和康复费用。而且这些费用可能会持续数月之久。”

对于负担不起这些费用的家庭来说，后果可能很严重。

“我们每天都能看到这样的情况：家庭通过社交媒体寻求帮助、寻找捐款、负债累累，或者只能等待，”她说。“当检查、药物或手术被延误时，康复也会被延误，并且可能出现新的并发症。”

对于像里卡多这样的幸存者来说，通过胡安·巴勃罗·多斯·桑托斯基金会等组织的私人捐款正在帮助支付假肢和康复费用。

“几天前，我看到了我的假肢正在制作中，这让我非常兴奋，”里卡多说。

虽然里卡多是他的监护人，但安德烈斯解释说，他们在各自伤愈期间互相照顾。

“能离开轮椅就已经是一大进步了，”安德烈斯谈到他的弟弟时说。“他每天都在好转。说实话，他能再次行走让我非常高兴。”

兄弟俩一起参加理疗课程，安德烈斯鼓励哥哥重新学习走路。

“我弟弟让我感觉自己像个世界冠军，”里卡多笑着说，他的弟弟也露出了笑容。