Humanitarian outreach begins with one person, or a small group that wants to donate time, money or services. They then recognize that having the necessary components is key to success of their mission.
These people — and all O&P practitioners — should begin a personal search to find the means help others.
Understanding limb banks
Limb banks throughout the developed world exist to help amputees in developing countries become functioning members of their societies. These efforts require the collaboration of many people and organizations who have an interest in advancing the O&P profession.
The United States has a surplus of orthotic and prosthetic components, as well as the ability to provide them. Many practitioners, like Rob Kistenberg, MPH, CP, FAAOP, chair of the U.S. National Member Society of the International Society of Prosthetics and Orthotics (US-ISPO) and clinical director for Sonrie Ministries, have identified this situation and set out to help others internationally.
|The Barr Foundation, which has traveled in support of missions in 17 countries, assists practitioners in getting the items needed in developing nations.|
|Image reprinted with permission of the Barr Foundation.|
“Every clinic in the United States probably has a closet somewhere that has lots of old components,” he said. “It goes against our nature just to throw them away.”
A surplus of usable components develops for many reasons. In some cases, prostheses are used only for a short time before patients die, or get high-tech prostheses. Despite being like-new, these prosthetic components cannot be resold or redistributed in the United States.
“It is a waste to see these components end up in a landfill,” Jon Batzdorff, CPO, founder and president of PROSTHETIKA and clinical director at Sierra Orthopedic Lab in Santa Rosa, Calif., said.
MedShare International is a nonprofit organization that collects surplus medical supplies and equipment — that would otherwise be disposed of — from the U.S. health care system, including hospitals, manufacturers and distributors. The donated supplies are then shipped in 40-foot cargo containers to hospitals in the developing world.
In 2007 MedShare shipped 78 containers to 30 countries, with contents valued at an estimated $13 million.
A.B. Short, cofounder and chief executive officer, modeled MedShare from a concept put into practice by the Atlanta Food Bank. The idea is simple: identify excess supply and devise a process to distribute it to people who need it. In MedShare’s case, the excess comes in the form of medical supplies.
“Over the years we have built up a great network of hospitals here in Atlanta,” Wills Moore, director of operations for MedShare said. “Also, about two-thirds of our donations come directly from manufacturers.”
In those cases, he said, the product often is cosmetically defective — the packaging is damaged but the product inside is in tact. Manufacturers receive a tax write off for these donations.
With the help of the Internet, MedShare’s staff members communicate with hospitals in need, as well as third parties who can raise money to cover the cost of filling and shipping the container to that hospital. This funding typically covers both internal costs and shipping costs.
Over the years, MedShare has shipped to 73 countries. Last year, 60% of its shipments went to Africa, approximately 30% to the Caribbean and Central America, and the balance to South America, Asia and Eastern Europe. According to Moore, the organization has no political agenda or geographic limitations.
In September 2007 Jack Richmond was elected president of the Barr Foundation, which provides limbs for amputees with no other source of funding. Donations often come from manufacturers with a surplus of component parts. These are paired with practitioners completing mission trips to countries in need of prosthetic services.
The Foundation, which has traveled in support of missions in 17 countries, assists practitioners in getting items they need. If any components are not available in the warehouse, the Foundation often works with buyers to locate the items at reasonable prices.
“It is not just collecting used prostheses and breaking them down,” he said. “The larger part is helping [practitioners] pull together all the supplies that they need.”
|Donations to the Barr Foundation often come from manufacturers with a surplus of component parts. These are paired with practitioners completing mission trips to countries in need of prosthetic services.|
|Image reprinted with permission of the Barr Foundation.|
In July 2007, the stars aligned for Kistenberg: The Barr Foundation, in an effort to streamline its operations after Tony Barr’s death earlier that year, offered a large amount of prosthetic components being stored in the organization’s warehouse; MedShare expressed an interest in international prosthetics and orthotics; and several individuals called on US-ISPO to find a good use for these components.
The Prosthetic and Orthotic Componentry Clearinghouse (POCC) began as a collaboration of several organizations, with US-ISPO serving as the umbrella to consolidate the various outreach efforts. POCC’s foundation is a critical mass of components, Kistenberg explained, organized and accessible to organizations or individuals.
MedShare provided a portion of its 48,500 square-foot warehouse in Decatur, Ga., for O&P component donations. Into this space went the initial donation from the Barr Foundation, as well as a significant donation of components and plastics from Southern Prosthetic Supply (SPS).
Alongside US-ISPO, the Barr Foundation and MedShare, additional manpower has come from students in the MSPO Program at Georgia Tech School, where Kistenberg is prosthetics coordinator, and from the doctor of physical therapy students at Emory University.
In just 1 year, POCC, in conjunction with other organizations, has sent shipments to Mexico, Honduras, Belize and Nigeria, with plans for distributing to schools in Vietnam and Cambodia.
Moore noted possibilities to partner more closely in the future. For example, MedShare has begun working on a potential container shipment of medical equipment and supplies to Basra, Iraq; POCC, too, is in talks to fill a significant shipment of O&P supplies to Iraq.
“If timing worked out, then there would be the chance to include the prosthetic and orthotic items on the container shipment,” Moore said. “We are still in the pilot stages, but I think it is working well.”
Sorting through help
Manufacturers often donate components that have not been sold at the time they debut a newer model. Another common donation comes from the pile of returned components. These components are not sold in the United States because of liability issues. Amputees in developing countries, on the other hand, are appreciative for these devices, Kistenberg told O&P Business News.
Not all assistance is helpful, however. Kistenberg has witnessed situations where medical equipment, including O&P components and wheelchairs, were shipped to a country where the recipients were not trained to use them, or were not equipped to sustain their use.
“It ends up being a big junk closet,” he said. “I think there is even apprehension in some places because they don’t want to receive stuff that they cannot use.”
Creating a new wave
Providing prosthetic devices and other components for people is one feat; ensuring their new limbs continue to function properly is another. The Barr Foundation works to foster missions that are sustainable, Richmond said, because that helps to build the O&P profession in that country.
Manufacturers also benefit from donating supplies because the components used create the manufacturers’ next market, said Richmond, an area sales manager for Fillauer Companies in Chattanooga, Tenn.
“By spreading this prosthetic technology worldwide, it is a win-win-win situation for everybody,” he said. “There will be a profession established in these countries through the mission work that is being done.”
|The Prosthetic and Orthotic Componentry Clearinghouse began as a collaboration of several organizations, including US-ISPO, the Barr Foundation and MedShare International, among other organizations.|
|Image reprinted with permission of Rob Kistenberg, MPH, CP, FAAOP.|
For this reason, Batzdorff created an outlet for these up-and-coming practitioners to receive proper training. PROSTHETIKA is a nonprofit that provides continuing education to prosthetists and technicians in developing countries who have no access to formal educational programs.
Batzdorff and his team work with a dual purpose: fitting patients in developing countries side-by-side with local technicians and prosthetists, giving them the benefit of advanced training. This training improves the prosthetic care they can offer to their patients, as well as their ability to deal with more difficult cases.
When appropriate, PROSTHETIKA uses components donated from limb banks. Recently, the organization completed a project in Mexico using components donated from POCC. The process ran smoothly, Batzdorff told O&P Business News.
There is no doubt that amputees in developing countries benefit from donated O&P services and devices. Kistenberg asserts that any developing nation is in need of expansion of their O&P capacity.
Having prosthetic components merely is one element of the issue. Another aspect to consider is the capacity of the region to produce prostheses using those components, Kistenberg pointed out.
“We aim to assist with elevating the capacity of the practitioners in the developing countries by partnering with existing clinics and nongovernmental organizations,” he said. “If I took a container of prosthetic feet and pylons and adaptors and plastic, and dropped it in the middle of a country, that doesn’t mean the people will be able to make legs.”
On the other hand, although people in a number of countries have enough training to provide O&P devices, they may not have the necessary materials to make the prostheses.
Another concern is that many components originally designed for use in the United States — whether new or slightly used — may not be appropriate for the climate and lifestyle of developing countries.
Batzdorff said he is careful to choose components that can be maintained locally, which typically means avoiding hydraulics, electronics or any devices that require calibration.
“In general, the simpler, the more low-tech, the better, unless there are capabilities available for these adjustments,” he said.
Providing the dream
Recently, PROSTHETIKA’s mission team was able to lighten the load for a young woman using a heavy transfemoral prosthesis with a wooden exoskeletal knee. The team replaced it with a lightweight endoskeletal knee joint and reduced the prosthesis’s weight by half.
“That alone was so exciting to the patient,” Batzdorff told O&P Business News.
The need for donated prostheses is never ending. An important and surprising point is that outreach serves to increase this need, Richmond said.
In developing nations where prosthetic care is not readily available, amputees are seen as outcasts because of their misfortune. People in those countries do not consider a productive life for amputees. Humanitarian O&P outreach, however, shows these people that they have options. The more people who receive prosthetic devices, the more others in these countries become aware that prosthetic devices are available.
“It is a dream for them that can come true,” Richmond said.
— Stephanie Z. Pavlou
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