Principal Investigator:
V.S. Ramachandran MD, PhD

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Bringing Mirror Box Therapy to Port-au-Prince, Haiti

Elizabeth Seckel

The day following the devastating earthquake in Haiti, the queue for amputations was more than 1,000 patients long. Surgeons therefore had to resort to “guillotine-style amputations,” which increases the prevalence of phantom limb pain – the perception of pain relating to a limb that is no longer part of the body. There are an estimated 7,000 amputees due to the Haitian earthquake that have yet to have treatment. In mirror box therapy, developed by Dr.V.S. Ramachandran at the UCSD Center for Brain and Cognition, a mirror is placed vertically on a table so that the mirror reflection of the patient's intact limb is `superimposed' on the felt position of the phantom (see Figure 1).

Figure 1. Demonstration of mirror box therapy for phantom limb pain developed by Dr. V.S. Ramachandran at UCSD.
Double blind studies have shown the mirror box to be effective in reducing phantom pain in 89% of phantom pain patients (Ramachandran and Rogers-Ramachandran. 1996; Ramachandran et al 1995). Psychophysical studies in normal subjects strongly support the notion that the mirror effect works by using vision of the intact or good limb to replace or drive proprioception in the affected limb (Altschuler and Ramachandran, 2007). The mirror box is an excellent low cost, low tech option for eliminating once thought of as intractable pain. Mirror box therapy in Haiti is incredibly important as pain medicine is not readily available. Having experienced chronic myofascial pain throughout my life, helping eliminate chronic pain in others holds special meaning to me.

As part of my 2011 Clinton Global Initiative – University commitment, I, Elizabeth Seckel, traveled to the Albert Schweitzer Hospital in Deschapelles, Haiti armed with 200 mirror boxes. I decided to utilize acrylic mirror sheets for the mirror boxes which are similar to typical mirrors but have a plastic rather than glass backing, making it lighter, less expensive and more durable.

Haiti has an incredibly complex history with foreigners (“blancs”) to say the least yet I've never felt so welcomed. Locals came up to me freely and took me on tours of their schools, to the markets underneath tarps and past labyrinths of vendors. There is beautiful art everywhere one goes. Asking someone in Haiti what their art is would be comparable to asking someone what their favorite color is back in the States: everyone has one. On the same day, I would walk through the open corridors of the Albert Schweitzer Hospital with dozens of patient beds crowded together (those with tuberculosis and other infectious diseases abreast those without), past the malnutrition ward, and relief tents housing the overflow of cholera patients. These conditions furthered my commitment to help others through medicine. Being in the minority here has taught me to view the world from a different perspective, as well as deepened my knowledge and appreciation of sustainable philanthropy. Further information about the trip can be found at

Looking Ahead: Dominican Republic, July 2012

As part of my 2012 Clinton Global Initiative – University commitment, I have pledged to expand mirror box therapy to several new areas, including the Dominican Republic, Nicaragua and Mexico.

Altschuler, E., Ramachandran, V.S. (2007). A simple method to stand outside oneself. Perception, 36, 632-634.
Ramachandran, V.S., Rogers-Ramachandran D, 1996 ``Synaesthesia in phantom limbs induced with mirrors'' Proceedings of the Royal Society of London, Series B 263, 377 – 386.
Ramachandran, V.S., Rogers-Ramachandran D, Cobb S, 1995 ``Touching the phantom limb'' Nature (377), 489 – 490.

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