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Hanger RFD: Helping Colombia’s Poor and Desperate
By Jeff Fredrick, MS, CO, BOCP
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Common street scene—kids like this find a familiar corner to call home for the night in most undeveloped cities worldwide. |
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We motor into the refugee camp near Barranquilla,
Colombia, laden with $40,000 in medical and rehabilitation supplies
and two local medical students who have volunteered to help.
During our six months' absence, the World Health Organization
(WHO) built a school in the camp. It is typical "third world":
cement, wrought iron, no carpet or air conditioning. However, it
adds an aura of stability and permanence to the makeshift
construction of the one-room hovels squeezed into its shadow. It is
more than a building: it is a monument to the future--testimony
that there are people on the outside who believe there will be a
future.
The leaders of the refugee camp take us to a large, open
structure that will someday serve as a lunch room--if the luxury of
regular meals ever becomes a reality. The lunchroom-without-lunches
is empty, except for a small class of children whose desks are
bunched into a corner.
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Uninvited visitors to our clinic in the refugee camp. |
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There is something new in the camp: two local
policemen are stationed at the school. It was the only way a
teacher would agree to work at the new building, Amelia, clinic
coordinator, tells us.
One of the policemen, quite a large man, has somehow squeezed
himself into one of the small desks. He is surrounded by children
and scarcely notices us as he grades papers and encourages little
heads with soft pats. It is obvious the children adore him.
The other guard watches everything we do with suspicion. Only
after we offer his family the services of an American doctor does a
smile appear.
So much for America's stereotypical perceptions of Colombia and
its perpetual aura of violence. Horrors are ever-present, but they
represent only a small corner of the snapshot. Colombia is full of
people exactly like us, maybe even better. Perhaps the difference
is revealed by a subtle form of conflict: the hearts and compassion
of Colombians are just tested more often--no doubt, every day.
Sickness Plagues the Camp
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Policeman-teacher at the WHO school where our clinic is held. |
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There is much sickness in the camp, we are told.
Within hours of the first clinic, it is apparent there is more
sickness in the camps this trip. My old nemesis, scabies, is
ravaging small children and I hate the prospect of catching scabies
even though I never have--yet! Can you imagine what it is like to
be a small infant and have a complete body infestation of these
dreadful, microscopic, itch-producing insects--endured in
unrelenting heat? What a horrible way to be introduced to the human
condition!
As the clinic progresses, I'm told, "You're not going to like
this . . . that little girl over there is not eating. She is so
malnourished; Dr. Kohler can't find enough muscle to inject
Rocephin." The child also has pneumonia--a potential byproduct of
cerebral palsy is chronic aspiration.
Across the room, a 15-year-old girl hasn't spoken a word since
she was physically abused by her father.
Providing O&P Care
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Debbie Plescia, CPO, and a friend with a new arm. |
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Debbie Plescia, CPO, is handling the orthotics and
prosthetics for the team. Some patients are late because they must
walk long distances. Others appear out of nowhere and hit the
schedule like a bowling ball. Plescia never flinches, taking them
as they come with a smile. Her only comments on the last day
pertain to how overwhelming the job is. Despite this she's
committed to returning as part of the solution.
Fittings are complicated by the prospect of a two- to
three-month interruption in follow-up. Continuity of short-term
rehabilitation scenarios and long-term objectives of the program
necessitate networking among local talent. Marta Rojas of
Laboratorio Ortopédico in Barranquilla volunteers her time and
facility. Her two nephews accompany her as technicians. They
constantly smile and jump at the opportunity to make any
adjustments (which necessitate a ride across town to their
laboratory) and thank us for the opportunity to help the poor.
Mr. Wulfran Palmer is fitted with a right BK prosthesis. His
distal tibia protrudes two centimeters from the conjoined muscle
and vascular bundle. It is a probable site of abrasion. In the US,
the prosthetic evaluation would recommend an immediate revision.
Not so here in Colombia. Surgery is simply not an option--yet.
Our new associates from Laboratorio Ortopédico eagerly
accept Mr. Palmer as their patient, and a follow-up appointment is
set.
Hanger RFD USAID Grant Concept
Hanger Rehabilitation for Development (Hanger RFD) submitted a
grant concept paper to the US Agency for International Development
(USAID) in May 2003. Most funding focuses on development, at least
in USAID's manual. It is a good philosophy. Don't just give a
person a fish; teach him how to fish, as the old saying goes.
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Typical patients present at each clinic. |
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The Hanger Orthopedic Group's humanitarian or NGO
(nongovernmental organization) division was founded with this in
mind. The project for which the grant paper was submitted is unique
in its scope. In countries like Colombia, a prosthesis or orthosis
can mean the difference in a whole family's survival. Competition
for resources on the street is a mean physical hustle. However,
O&P rehabilitation won't be attempted in a clinical vacuum.
Medical care and physical and occupational therapy are included in
Hanger RFD's philosophy of O&P intervention. But the concept
doesn't end there. During its 36-monthinitial funding period, 18
full medical/rehabilitation clinics are scheduled in the camps.
Twenty local candidates will travel to the US for basic O&P
technical training. Half will be former guerrillas or FARC
combatants who have surrendered and asked to begin life again as
mainstream Colombian citizens.
The US focus on aid to Colombia is developmental in nature.
Unlike other US projects, funds must be directed specifically
against the drug war. Humanitarian concerns appear secondary but
are not omitted from the plan. Our focus has consistently been on
refugees and displaced persons. It is our hope that such
appropriate targeting will resonate positively among USAID's
planners. At the least, they will recognize physical rehabilitation
is a unique type of humanitarian aid that can serve as a fulcrum
against the drug interests in Colombia.
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Dr. Kohler and one of her regulars. |
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During our early trips, we learned that the
Colombian government does make funds available for the disabled and
ill, but these rarely reach the poor. This is due to pervasive
corruption that feeds the cause of guerrillas and other
antigovernment groups. Consistent and positive movement towards
change in the healthcare and rehabilitation of the poor and
disabled could lend creditability to the democratic government of
Colombia. Encouraging democracy and stability of institutions
remains of paramount interest to Hanger RFD.
Developing the Needed Social Context
Hanger RFD is also concerned about developing the social context
in which the project must also "develop." Sustainability and
competent "hand-over" to full Colombian ownership depend on a
proverbial Petri dish of necessary elements. The two medical
students who have volunteered their time for this clinic were
invited to sensitize the city beyond the camps to the plight of the
refugees.
Many in the well-off strata of Barranquilla are not even aware
of the camps or of the suffering that brought about their
existence, although the effects of refugees and displaced persons
are impossible to ignore. Reports of volunteers and other community
members who joined our previous clinics have reached the ears of
prominent Colombians. During our visit, we were asked to present a
summary of the project to Barranquilla's equivalent of the Chamber
of Commerce. At the end of the talk, they pledged their
assistance.
We meet with a candidate for mayor running in part on the
refugee problem. He says thousands of refugees and displaced
persons have migrated to the Atlantic coast, mostly to
Barranquilla.
"Our city now has more murders per capita than anywhere else in
Colombia," he says.
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A child, one of many ravaged by scabies. |
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"Even Bogotá?" I respond.
"Sí. The refugees come here; there is no food, no shelter,
no water. They have no recommendation for a job, so no one trusts
them. Their children begin to starve, so they do what they must to
care for them. What would you do?"
What would I do? The cries of hunger, thirst and disease of your
own sons and daughters must be quite compelling indeed! It leaves
one to contemplate what laws of man could overrule them.
Child Soldiers
The US government is also concerned about child combatants.
Perhaps as many as five to eight of our technician trainees will be
attempting to start life over beyond the horrors of violence and
deprivation they experienced as children forced into war.
Eventually they will provide O&P and perhaps physical and
occupational therapy services from a clinic and rehabilitation
facility also sponsored, in part, under the grant. The 18 scheduled
medical/rehabilitation visits will serve as teaching clinics to
extend their education through the instruction of credentialed US
practitioners.
Guerrillas, FARC Combatants
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A stray dog who poignantly illustrates the harshness of normal life in the camp. |
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Recently many guerrilla and FARC combatants have
walked out of the jungle. We are told the government policy is
harsh if they continue to fight, but big-hearted if they turn
themselves in. The new president is living up to the electorate's
expectation of a dramatic change for the better. So far, the
guerrilla and FARC are welcomed with open arms and the program is
having a positive effect--at least from the government's
perspective.
Solutions?
Establishing quality healthcare in a country whose government is
not sound and secure--or remains tyrannical--provides little hope
that positive change will occur beyond the pill taken or the shot
given. Hanger RFD is long-term in scope. "Rehabilitation for
Development" is not just a convenient name. The concept of change
must begin with the pill or shot and then reverberate all the way
through the social and governmental system, if suffering like we
see daily in the camp is ever to be permanently relieved. Jeff Fredrick, MS, CO, BOCP, is director of Hanger’s Rehabilitation for Development (Hanger RFD) and branch manager at Hanger Prosthetics & Orthotics, Tallahassee, Florida. 
Table Of Contents - February 2004
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