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Meeting the Challenge of P&O in Latin America
By Alberto E. Castillo Moreno, OP
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Photos courtesy of Alberto E. Castillo Moreno, OP. |
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Latin America can be divided into three large
parts: Mexico, which borders the United States; Central America;
and South America.
Throughout Latin America two different types of services exist
for amputees: private laboratories and factories, and laboratories
that are controlled through the state or federal government.
Similarly, patients can be divided into three large groups:
- Patients who are financially independent who, in general,
obtain private services from private prosthetic and orthotic
laboratories, or others who travel abroad for their treatment.
- A large group of middle-class patients and workers who are
covered by social security institutions and who receive help from
their families. They are sent to laboratories financed by the
government for their treatment. This type of assistance is provided
in the majority of Latin American countries. In some hospitals or
rehabilitation centers, where the social security services are
provided, medical practitioners write the prescriptions for
prosthetic and orthotic devices and send the patients to P&O
laboratories, taking into account a list of private and government
facilities. The final revision of the device is made in the
hospital or rehabilitation center, generally without the
participation of an orthotic or prosthetic practitioner.
- The large majority of patients are in a low-income group, and
they generally utilize the prosthetic and orthotic labs supported
by the federal government through the Secretary of Health of each
country.
Low-Income Patients Face Difficulties
 Many of the patients in the third group fail to
give their residual limbs adequate care, due to not being given
sufficient instruction and information on how to care for their
amputations by the hospital when they are discharged. When they go
to a rehabilitation center, frequently their residual limbs are in
poor condition with contractures, redundant subcutaneous tissue,
neuromas, etc. Consequently, they may need additional prosthetic
treatment or a surgical revision.
However, indigent patients cannot provide the financial means to
maintain a long treatment period, since their income is very low
and their families very large. As a result, the patient insists on
a very rapid fitting of the prosthesis, thus returning home and
assuming his role as the household provider.
Many of these patients return to the rehabilitation center due
to volume changes in the residual limb and complain that the
prosthesis was fit inappropriately and insist on receiving a new
prosthesis. This situation is common in some Latin American
countries and results in much wasted time and materials.
In some Latin American countries, prosthetic components are
being produced within the country. These low-cost prostheses can be
the answer to the problem of low budgets allocated to the
rehabilitation of amputees, and can help alleviate the problem of
importing components and materials that are too sophisticated to
appropriately meet the needs of the country's amputees.
In some extreme cases, patients are unable to pay for their
prostheses. Those who live in rural areas usually have to travel a
long distance to specialty clinics, which are generally located in
the capital cities, and don't have enough money to pay for food and
lodging while they are undergoing treatment. When their funds run
out, they have to abandon their treatment and return home, many
times without prostheses.
In order to resolve these problems, some governments have
assigned annual budgets to rehabilitation centers, including the
prosthetic and orthotic departments. However, due to small budgets
and the failure to provide the centers with regular supplies of
components and materials, it is difficult for many amputees to
obtain a customized prosthesis. Another obstacle amputees also face
is the difficulty of finding a productive job.
Needed: Recognition as O&P Professionals
 Another problem, which requires the attention of
health authorities, is that the orthotic and prosthetic
practitioner is not recognized as a professional by the clinical
team. His opinions and recommendations in respect to writing the
prescription and prosthetic management are not accepted or
recognized. Through my experience of more than 40 years in the
profession, I know that there are highly qualified colleagues who
have a passion for our profession. Unfortunately, the
administrative authorities are still unwilling to recognize them as
professionals, in spite of the fact that in many Latin American
countries there are permanent schools for allied health
professionals as part of the rehabilitation team. These schools are
recognized by the Secretaries of Health and Higher Education.
Many practitioners' problems begin when they graduate from these
schools. The Administrative Personnel Department classifies them as
technicians, since they are employed in workshops. Although the
government invests great sums of money training prosthetists, they
classify them erroneously, and thus their salaries are smaller.
Consequently, they just leave their jobs in favor of a better
position, and prosthetic and orthotic services are undermined. In
some Latin American countries, prosthetic and orthotic treatment is
limited to only what is needed to satisfy the most urgent
necessities. In rural areas and other places with limited access to
services, simple devices are being created within the community
with local materials.
Progress Despite Obstacles
It is worth mentioning that, despite the difficulties and
obstacles that confront us, we are obtaining good results in
certain aspects of prosthetic and orthotic service. The progress is
related to the improvement of teaching and continuing education.
Some of these educational opportunities are directed to
practitioners, who with an adequate, minimum experience of five
years, can enter the distance Graduate in Orthotics and Prosthetics
program, graduating as a Category II technologist of the
International Society for Prosthetics & Orthotics (ISPO). This
program was instituted by the University Don Bosco and the
cooperative German group GTZ in El Salvador, Central America,
approximately three years ago. Other programs of continuing
education and certification are being promoted by professional
orthotic and prosthetic societies and associations in various
Spanish-speaking countries.
Promoting Education
However, new schools should be founded, and existing schools
should be promoted so that they operate each year, filled with new,
young practitioners. An urgent need exists for the federal and
state governments to focus economic funds on the education and
high-level training of orthotists and prosthetists.
Standards of Care
Personally, I believe that the rehabilitation of the patient who
requires orthotic and prosthetic assistance should adhere to
similar standards, no matter in what part of the world the
treatment takes place. This goal requires a movement toward
uniformity of the educational and training norms and standards and
resulting practitioner qualifications. Our idea is that all the
orthotic and prosthetic practitioners in Latin America should
obtain the same qualification as professionals. That's the way it
should be.
Table Of Contents - June 2005
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