By Zach Harvey, CPO from Creative Technology, Bulow OPS Partner Clinic

When I started getting interested in prosthetics and orthotics and decided to go to school to become a certified prosthetist orthotist, one of my goals was to do work in the developing world.  I kept reading about the unmet need and how much impact could be made getting people independently mobile and able to support their families, simply by providing them the appropriate prosthesis or orthosis.  It was several years into my career before I got the opportunity to travel with a group called Physicians for Peace, based out of Norfolk, VA.  The  Walking Free Program through Physicians for Peace was started by a physical therapist named David Lawerence.  I was able to take paid time off work (at the time Hanger Orthopedics) a couple weeks per year so I could volunteer.  The trips started in the Dominican Republic and later Guatemala.  I learned a lot from David and always felt really good about the experiences.  The program in the Dominican Republic was well-established and I learned quickly that education of the existing staff was more important than seeing how many patients our team could make devices for during our short time there.  I also learned the importance of sustainability – that was the end goal and often came down to economic factors.  We would bring suitcases of donated used prosthetic and orthotic parts with us, and since there were at least a few trips per year, this became a way of sustaining their program.  However, the team knew that education would last longer than the parts we brought along, so we always took time to present PowerPoints and had translated handouts for the local providers.  This was tough when there were patients lined up outside the door who had come from miles away with hopes of being treated by our US team, but we knew that it was the better long-term solution. 

The program in Guatemala was grass roots.  My friend and fellow prosthetist, Ben Blecha, CP, and I formed a core team of ourselves, a physical therapist, and a physiatrist.  Our first trips were fact-find missions during which we traveled around the country meeting with hospital directors, other rehabilitation professionals, the ministry of health, and even the first lady, an advocate for people with disabilities.  Making the work we did sustainable was one of the biggest challenges because there were so many socioeconomic and political challenges we ran into.  One example was a wonderful lab that had been set up by the Spanish Red Cross in the children’s hospital that had existed for years but was underutilized.  We thought that we had found the perfect match and that we could come in and educate and bring patients in, but we lacked local buy in from the administration.  More patients would mean a need to hire more employees and existing employees would have to work more, and the administration did not support this.  Another example was that a local private business viewed our non-profit as competition for his paying customers.  After several subsequent trips, we realized that our program had not been as successful as we had hoped for and that our core team lost motivation.  

It was almost ten years later when I got the opportunity to return to Guatemala with my new co-worker, Eric Neufeld and my boss, Matt Bulow.  My employer, Bulow OPS, allowed me two weeks paid time off within a year to volunteer.  Eric and his friend, David Krupa, had started the Range of Motion Program (ROMP) prior to working for Bulow OPS and it was a great opportunity for me to get to help out again.  I was familiar with the routine of negotiating tax fees on our suitcases packed with prosthetic components, so that part was not a shock.  What was shocking was how well this program was doing.  “How did they do it?” I kept asking myself.  The facility was located in the middle of nowhere, yet we saw around 60 patients that first week, many with above knee amputations and several complex upper extremity and hip disarticulation patients.  Granted, we had a lot of student volunteers, but the local staff was also very well educated and proficient at fabrication.  We worked some really long hot days, but seeing the rewarding results made it all worth it.  I was able to contribute a little of my experience and suggested that we would have educational breakout sessions.  These were a big success.  We identified a few things we could improve on and it wasn’t long before Matt wanted to get down there again.  My mission was to build a vertical alignment jig out of local materials and to educate local staff on laminating with carbon fiber using local materials.  Our second trip was as fun as the first, but we didn’t have as many patients.  A suitcase full of laminating supplies got stolen at the airport and we had to resort to using local materials.  I felt like Walter White from the TV series Breaking Bad, dressed up in a lab coat with safety goggles, mixing up unlabeled resin and promoter, trying to find the correct ratio so that I could teach proper lamination technique.  I built a vertical alignment jig from parts I found around the lab; in the US we would just buy the complete jig.  This is a device used to duplicate the alignment from one socket to a newly made socket.  I used some serious MacGyver tactics, and with the help of the rest of our team, left that trip with a mission accomplished.   

If you are a healthcare professional reading this, I would encourage you to get involved with volunteer work.  It’s a great way to meet new colleagues and it is very gratifying.  Bring with you a suitcase of used parts, an open mind, educational material (translated to the native language), some personal gifts like candy and tools, and an expectation that you’ll be working really hard.  If you can, take some time at the end and make it a vacation.  I personally can’t wait until my next trip.  If you are a person who wears a prosthesis or orthosis and you have some old parts collecting dust, sort through it and find a place to donate it.  Somebody is sitting around waiting for your donation to arrive so that they can become more mobile.  If you are interested in learning more about ROMP and want some inspiration, check out this video: