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Prostheses and orthoses in developing countries

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World Health • 48th Year, No. 5, September-October 1995 13

Prostheses and orthoses in developing countries

Anders Eklund

There is a pressing need for better manufacturing and supply systems to provide artificial limbs and support devices in developing countries.

S

ervices to provide artificial limbs (prostheses) and appli- ances to support or correct a deformed limb (orthoses) play an important role in the rehabilitation of people with physical disabilities.

The provision of prostheses for amputees, calipers for people with paralysed limbs, and orthopaedic sandals for leprosy patients -to mention a few examples - can make a dramatic change in the life situation of the disabled person. Instead of being dependent on charity, or even isolated from society, the person may be able to work and lead a normal, independent life.

However, just as in the case of rehabilitation services in general, prosthetic and orthotic services are rarely given the priority they deserve.

Though general awareness about disabled people has increased in developing countries during recent years, the financial resources for this sector are still very limited and the reality today is that only a small percentage of people with disabilities get assistance. Those resources are unlikely to increase much in the fore- seeable future, but it is still possible to improve the situation for people with physical disabilities. A new way of thinking is necessary, and an approach that is adapted to the local conditions of the developing country

rather than to working methods in the industrialized world.

Imported components

In developing countries, prosthetic and orthotic production is often based on imported components (such as ready-made feet and knee joints for prostheses). These are used in high-quality orthopaedic appliances but, because of the high costs, only a limited number of people will bene- fit. If a less sophisticated technology

is used, many more patients can be

fitted with appliances. Such tech- nologies, which still provide comfort for the patient and look good, are all based on local production of the components. Even though some raw materials have to be imported the appliances will cost considerably less than those made with imported components. Moreover, most of the money which would otherwise have favoured foreign suppliers will

remain in the country and benefit the national economy.

In some countries, prosthetic and orthotic services have been linked to community-based rehabilitation programmes. This makes it possible to identify people with physical disabilities in remote areas and to refer them to orthopaedic work- shops. Since the workshops must not be located too far from the vil- lage, there is a need for small, decen- tralized satellite workshops, not permanently staffed but visited regularly by technicians from the main workshops. Provided appro- priate technology is used, the run- ning costs will be reasonable and the distribution of services to those who need them will be ensured. •

Mr Anders Eklund is Proiect Manager of the WHO Collaborating Centre for Orthopaedic Technology, Department of Biomechanics and Orthopaedic Technology, University College of Health Sciences, Box I 038, S-551 I 1- )0nkoping, Sweden.

Locally made prostheses and appliances ore reasonable in price, enabling more disabled people to lead normal, independent lives.

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