On a Mission to Give Spiderman Orthoses in South America

In September, I was recruited to help out with a local charity’s
orthopedic mission to El Salvador. The Greater Philadelphia chapter of Healing
the Children has been sending a team of orthopedic surgeons, podiatrists,
anesthetists and nurses to El Salvador to perform various orthopedic pediatric
surgeries for the last 17 years and counting. Then there is always the lone
team orthotist who takes care of the children who aren’t candidates for

Shriner’s Hospital for Children in Philadelphia donated new or
gently used AFOs, KAFOs and the like ahead of time, where they would be
retrofitted to the kids in El Salvador.

  “Sonrisa” means
“smile” in Spanish.
  Images: Derek Fondren and Jocelyn

As a CPO at Independence Prosthetics – Orthotics in Newark, Del., this
would be my first time participating in this mission, and I wasn’t exactly
sure what to expect. Mark Holowka, the former director of O&P at
Shriner’s hospital pf Philadelphia and a three-time veteran of this
mission, had briefed me on what he had done on these trips before but he did
mention every year is different.

Soon I would find out for myself that 2011 would be the most intense
yet. It was the first time Healing the Children (HTC) went right into the heart
of San Salvador, the nation’s capital, where we set up shop at Hospital
Militar Central, the local military hospital.

Team HTC

I was lucky enough to have Derek Fondren, a student going through the
O&P technician’s program at Joliet Junior College, as my sidekick to
tackle the sheer volume of patients we were inundated with as Team HTC
Orthotics. Because we were so close to the city center and the mission was
hosted by the military hospital, the location was much more accessible to
families than in years past and also advertised more heavily. As a result, we
saw children nonstop throughout the 5-day workweek, pulling 12-hour days the
first 4 days and capping it off with a grueling 16-hour day the last day to
finish up some bilateral KAFOs.

We were situated in the maintenance department of the hospital, so all
we had on hand was an industrial bench grinder. It ended up being the perfect
location to hide our O&P subdivision as we also had access to a vice and
drill press, and when all our speedy rivets ran out on the fourth day, we were
given copper rivets by our new military friends. Rivets and moleskin were
nowhere to be found in any hardware stores or pharmacies in this country. One
of the back rooms even had a couple of old sewing machines that we put to good
use when we had to do strap repairs.

Leave the propane home

Our technicians at Independence P&O had helped me pack for the trip,
but I ended up leaving the torch and propane tank back home after checking
TSA’s website and confirming that non-flammable liquids were not allowed
in checked baggage. Instead, I filled an entire suitcase with various O&P
tools and materials, most notably a heat gun, cast saw, hot glue gun,
rechargeable Dremel, drill, Velcro straps, moleskin and rivets. There was a
rumor we would have access to a Troutman so I brought some attachments, but the
rumor proved to be false.

  AFOs were provided to this little patient courtesy of Cascade DAFO.
  AFOs were provided to this little
patient courtesy of Cascade DAFO.
  Wong was happy to work with the non-criers.
  Wong was happy to work with the

The moleskin I had thrown in as an afterthought, and in actual practice
became of great use because we weren’t always able to perfectly smooth
down some rough edges. In hindsight, a plug-in Dremel would have been more
efficient; because it was taking up the slack from the missing Troutman, the
rechargeable battery was constantly dying from overuse.

Do the best you can

The motto for this intensive week was inspired by a quote from Theodore
Roosevelt: “Do the best you can, with what you have, where you are.”
Sure, we didn’t have everything we needed in the most ideal O&P clinic
situation, but families were willing to wait all day just to see us, or come
back and wait another day. No one really complained, and we were happy to work
for smiles, hugs, home-made snowflake and the occasional local treat as a gift.

We saw children who had cerebral palsy, spina bifida, clubfoot and those
who had previous surgeries to correct various deformities and needed lower
extremity orthoses to help weakness, paralysis, or deformities like equinus
contractures. Some children came in with old orthoses and were retrofit with
newer ones. Others only needed minor adjustments as they had no access to
follow-up care, for example, heating and flaring AFOs around the malleoli to
prevent recurrence of blistering and other skin breakdown.

Spiderman needs KAFOs

With our very limited supplies and materials, we had to make four KAFOs
in addition to a variety of devices for about 60 to 70 patients. We saw
children who needed AFOs, SMOs, shoe lifts for leg length discrepancies, foot
orthoses, and twister cables. There was even a Dennis Brown bar that was passed
from an older patient to a toddler in need. “Hombre Araña”
(“Spiderman” in Spanish) needed bilateral KAFOs, which is a huge
project no matter where you are, and had us working hard that final day. Even
making just one of them back in the United States, with a full lab at your
disposal is considered a rush job if you want it done in 1 week.

  Hombre Araña approves of these superhero bilateral KAFOs.
  Hombre Araña approves of
these superhero bilateral KAFOs.
  Materials for this shoe lift were MacGyvered from a Scooby Doo sandal.
  Materials for this shoe lift were
MacGyvered from a Scooby Doo sandal.

It seemed like the number of children and families that kept coming by
would never end. It was very rewarding work but also extremely draining,
physically, mentally and emotionally. Most days we wouldn’t eat lunch
until 2 pm or 3 pm because subconsciously it was hard to take time off for
lunch breaks or even bathroom breaks when you had a whole room of families that
had been waiting for you since early in the morning. Fortunately, the local
Rotary Club (Cuscatlan-San Salvador) took care of us and provided lunch for us
each day. They practically forced us to stop working so we wouldn’t pass
out. They also provided translators but in the few moments between translator
shifts, my 3 years of very rusty high school Spanish came in handy and I
learned new phrases like “plantillas” (insoles) and Hombre

By the end of the week, the boxes of donated orthoses from
Shriner’s had dwindled to a small ragtag pile of random parts and pieces,
and we had sent home many happy children and parents who were walking better
and smiling more. Exhausted and ready to go home ourselves, we had our fill of
hugs, smiles, El Salvadorian candy and papusas and fried chicken. It was a very
memorable week, and I was happy to donate my time and efforts to make a
difference for so many children.

My biggest thanks go to my right-hand man and technician, Derek, my
employers at Independence Prosthetics & Orthotics, the local Rotary Club,
Shriner’s Hospital of Philadelphia, and the Healing the Children
organization. — by Jocelyn Wong, MSPO, CPO

For more information:



For more information:

Jocelyn S.Wong, MSPO, CPO, is from Independence
Prosthetic-Orthotics Inc.

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