Scanio and his patient celebrate after she receives her first set of AFOs.
The Florida O&P Outreach Team (FOOT Foundation) completed another trip to Guatemala on September 22, 2012. More than 40 children were fit with much needed orthoses and prostheses. Just as important, local O&P providers, physicians, therapists, and families were educated on how to provide continuing care for these children once the FOOT Foundation had departed. From our most recent trip, as well as previous trips, we've learned some valuable lessons about how to approach this type of humanitarian endeavor.
Practitioners who decide to participate in international O&P humanitarian trips will have to determine what supplies are needed, where items can be fabricated, and how to obtain the resources to do so, as well as learn the language before departing, since interpreters are not always available. But another consideration we may not consider are the cultural differences of the society we are trying to assist. It is crucial to understand not only the culture, but also the educational structure and teaching methods, plans for ongoing education, and available resources.
One goal for a successful humanitarian O&P trip is to perpetuate the local wealth. Using resources that are readily available—raw materials, supplies, tools, and local talent—is a great way to do so. The less the community depends on outside aid, the stronger and healthier it will become. By using local supplies, and teaching local providers to do so as well, the community will be more successful in carrying on the work after you have left. Teaching local O&P providers how to tend to their patients within the confines of their environment and technological limitations not only increases their existing knowledge base, but I have found that it also helps to increase their motivation.
Some cultures have traditions that we may not understand. For example, in Latin America it is common to have designated break times during the day. No matter how busy you are, you, too, should stop and rest. When traveling abroad, I noticed that our group has a tendency to want to work nonstop to help as many people as we can in the short amount of time we are there. However, failure to respect the country's work culture can be perceived as offensive, alienating those you are there to help.
The most critical aspect of O&P care abroad is education. It is important for humanitarian O&P providers to leave a sustained level of education so the locals will be able to help themselves. Organizations that travel abroad and spend their time in "factory mode" do not benefit that society in a lasting manner. They have left only the dream of O&P devices, but not long-term solutions. This can leave the local community in worse shape than before. These individuals have been given a taste of what it's like to use a prosthesis or orthosis. However, once the device needs repair or the patients need further gait training, then the individuals are left disillusioned, having briefly experienced "normal" life that is no longer attainable because of the lack of ongoing services.
Teaching abroad can present its own set of challenges. Teach as much as possible in the local vernacular, simplify where needed, demonstrate continually, and ask for return demonstrations to confirm your students' level of understanding. Limiting patient volume affords the time needed to educate both providers and patients, which is a vital component.
The end goal of any successful humanitarian trip is to provide services, tools, and knowledge to improve the community, and also to empower the people to continue the work you began. Only then will you have truly made a difference.
Dino Scanio, CO has been an orthotist for more than 12 years. He is the founder and clinic director for the Florida O&P Outreach Team, a 501(c)3 non-profit organization founded in 2007. www.footfoundation.org
