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Reaching Beyond
Our Borders


Ukraine Prosthetic Assistance Project – Report to USISPO from Jon Batzdorff

Based on conversations with the amputee veterans and prosthetists in Ukraine, it became clear that there was a need for help in the area of prosthetics and related rehabilitation. Specifically they needed assistance in fitting upper extremity and highly involved lower extremity amputees. The discussion that began in November developed into the ProsthetiKa Ukraine Prosthetic Assistance Project.

Ukrainian Canadian Congress Toronto and Canada Ukraine Foundation agreed to lead the project, and Jon Batzdorff of ProsthetiKa agreed to organize the technical aspects and assemble a team of…

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Batzdorff's Teaching
in Tanzania

Jon Batzdorff was contacted by the International Committee of the Red Cross (ICRC) / Special Fund for the Disabled to provide training in fitting above-the-knee amputees with ischial containment sockets.

(read more)

Al Ingersoll Working
in Bangladesh

Al Ingersoll, CPO, USISPO Education Chair

I was fortunate to visit Bangladesh this past year and meet with numerous people and organizations focused on the disability/rehabilitation sector. Bangladesh is well served by local organizations, (BRAC)

(read more)

Please send us your stories.

 

The First Orthotic Mission Trip to Belize


Thursday, October 14, 2010 11:15am

Prelude: On the Flight to Belize City:

Project Hope Belize (PHB) has been providing prosthetic services to the people of Belize since 1995. What started with making a set of legs for Adrian Camara, a congenital bilateral transfemoral amputee, developed into annual prosthetic missions from 1996 to 2002. In 2003, Project Hope Belize was formally incorporated as a Belizean Charity and established the first and only full time prosthetics facility in the country of Belize. Mission trips have continued regularly ever since. Adrian is now the full time clinic manager and he serves to provide ongoing care, follow up treatment, repairs and evaluations between practitioner mission trips. As the clinic has focused almost exclusively on prosthetic services, equipment for fabricating orthoses has not been needed.

In the summer of 2010, the International Hospital for Children (IHC) contacted PHB to see if custom orthotic devices could be provided for 10 – 15 children who would be receiving soft tissue releases or osteotomies in September 2010. When surgeries had been conducted in the past, arrangements were made for orthotic services to be provided in Mexico however traveling to and from Mexico from Belize proved challenging for the families and children so an alternative was being sought.

Even though PHB had never provided custom orthotic services before, this seemed like the ideal time to start. The challenges lie in equipment, materials and personnel.

The personnel challenge was overcome readily when Josh Utay, CPO of Orthotic Solutions in Fairfax, Virginia stepped forward to come to Belize. Josh had come to Belize in 1999 after he graduated from UT Southwestern's P&O program. Not only did Josh want to come, Mike Malavari, CO, FAAOP and their technician Craig Violette, RTP also wanted to experience the provision of orthotic clinical services in a developing nation. The clinical team was set.

Materials were acquired through donations from Orthotic Solutions and Cascade Orthopedic Supply. The only challenge remained in getting everything to Belize. Items were divvied up so that each team member had not more than 2 bags which were not more than 50 pounds apiece. As there is no way to order in components or materials in a timely manner while in Belize, hopefully everything needed is coming along.

In order to pull plastics to make custom orthoses, a fairly sizeable oven is needed. PHB has never had an oven so all the prosthetic services provided have been laminated. For pediatric orthoses, lamination is really not the way to go.

When the conversations started between IHC and PHB two options were considered. First, since we had no oven, we could take the impressions in Belize, return to the US for device fabrication and then return at some future date to Belize for delivery. While this was a feasible option, it would require the clinic team to make two trips to Belize there by doubling the transportation costs, it would require some facility to bear the time and material costs of fabricating these devices and then it would require the children and their families to have to wait for the return of the team. While this option did eliminate the need for PHB to get an oven, it was far from ideal.

The other option was to set up a 5-6 day long mission trip during which everything would be fabricated on site. The team would only have to take one trip and the devices would be immediately fit. The only challenge was getting an oven in the clinic. Where could we get one and how could the costs be covered? While we didn't have answers to these questions, PHB committed to getting an oven in the clinic in time for the mission.

Sometimes, you just have to go with your gut. If you know in your heart that what you are doing is good and for the right reasons, then the details will work themselves out.

Initial investigations to acquire an oven focused on buying one or getting one donated in the U.S. and then having it shipped to Belize. But the cost of shipping an oven was between $1,500 - $2,500 and even if the funds were available, transport time might take longer than the time available. Also, an electric oven would require that the electrical wiring in the clinic be re-done to handle the additional load. PHB has received funding for an electrical upgrade but that also would take time.

Oven acquisition then shifted to finding one in Belize. Adrian drove across most of Northern Belize looking for a suitable propane oven. He finally found one for $BZ2,600 (or $US1,300) and had it installed in the clinic on Tuesday (10/12/10). Yesterday, he had the gas delivered and tested the oven. So, with a day to spare, the equipment challenges have been overcome. [Thanks to Prosthetic Orthotic Associates in Middletown, NY for their generous donation to cover the cost of the oven.]

The rest of the mission team includes two budding prosthetist/orthotists from the MSPO Program at Georgia Tech, Tyler Dunham and Christopher Dunning as well as myself, Robert Kistenberg, President of Project Hope Belize and founder of Prosthetic Hope International

Clinical Plan for Today, Thursday 10/14/10, and the Rest of the Mission.

Everyone was up at 3:00am in order to catch our various flights. The three team members from Virginia and the three from Atlanta all converged at the Miami airport. We arrive in the Belize International airport at 10:15am. After (hopefully) collecting our bags and getting through customs, we will be met by Adrian, catch some lunch and get to the Karl Huesner Memorial Hospital (KHMH) for a 1:00pm clinic start time.

At KHMH we will not be met by Milagros Garel who serves as the IHC Coordinator in Belize as she will be working to coordinate an IHC general surgery team and the surgeries going on concurrently with our clinic at Karl Huesner.

We will be met with a nine families and their children who had surgery a month ago to correct foot/ankle deformities. In order for the surgical correction to be maintained, custom orthotic devices are required. Without the orthoses, their legs would return to their previous positions in a matter of weeks or months rendering the surgical procedures unsuccessful. Basically, surgical correction without custom orthotic intervention afterward is a waste of time.

Some of the children will need one ankle foot orthosis (AFO) and some will require a set, or bilateral, AFOs. In addition, 9 other children will be coming for evaluation even though they did not have surgery in September. As there have been no orthotic services available in Belize, there is a pretty long waiting list.

After the children underwent surgery, their legs were put in fiberglass casts in order to facilitate healing and provide protection of the surgical sites. Today these casts will be removed temporarily at the hospital so that impressions of their corrected legs can be obtained by the orthotists. Once the impression has been obtained, the post-surgical casts will be re-applied to the children until they are fit with their AFO's on Sunday or Monday.

Once all of the children have been evaluated and or had impressions taken this afternoon, the team will then travel to Orange Walk Town an hour and half northwest to the Project Hope Belize Clinic where the impressions will be poured with plaster. Once that is completed, we will be on track for today.

On Friday, at least 2-3 prosthetic patients will be evaluated so they can receive prostheses as well. Meanwhile, orthotic fabrication will commence. On Saturday, it will be additional patient evaluations, socket fittings and possibly deliveries. On Sunday and Monday, the orthotic children will be returning for delivery of their custom devices.

Thursday, 10/14/10. 11:08pm

Figure 1: At the Chinese Restaurant, from Left to Right: Craig Violette, Josh Utay, Rob Kistenberg, Adrian Camara, Mike Malagari, Tyler Dunham, Chris Dunning


Figure 2: Patient Darwin Polanco waits patiently to be seen.


Figure 3: A child with bilateral fiberglass casts about to be removed


Figure 4: A cast reapplied and secured with duct tape.


On Tuesday morning, we all fly home.

It's always unknown what will happen when we arrive in Belize despite all good intentions and planning. Over the last 15 years we have experienced blackouts, insect infestations, floods, numerous vehicle breakdowns and a few hurricanes. We also have experienced the richness of the human experience. We have had the gift of watching elation wash over someone who, days or weeks ago was living in depression or despair as a result of an amputation, and now had received their first prosthesis, was taking their first steps, was free of their crutches or a walker and who could now commence to re-building their lives. We have experienced tears of sorrow and far more tears of joy.

What is certain is that we will find people who need prosthetic and orthotic services and that these people are extraordinarily grateful that people from the States come to Belize to provide these services. Also certain is that, while we are sharing the skills and gifts we have acquired from our clinical training, by virtue of the experience we will have over the next six days, we assuredly will receive far more back than we give.

That first entry seems a world ago instead of 12 hours.

Everyone's bags made it to Belize and Adrian arrived shortly after we did. After introductions, we headed off to find food before the clinic day began. Seeing as the vehicle held everyone's bags and was not entirely secured, we had to find a restaurant with a view of the parking lot. The Everyday Chinese Restaurant fit the bill. Food was good, fresh, fast and bountiful. Bellies full, we were off to Karl Huesner.

An assistant of IHC, Jermaine, met us in the lobby and took us to the two rooms which would serve as our clinic spaces for the next 5 hours. The waiting area was already peppered with families with children and seeing as some had on orange fiberglass leg casts on one or both legs, it was not difficult to identify who the patients were. They of course had no difficulty recognizing us and several started crying at the sight of another group of fair skinned Americans. The last such group had performed surgery on them 4 weeks prior so their response was justified.

Over the course of the next few hours, we removed the post-operative casts from 8 children, obtained measurements and impressions of their now un-encased legs and then re-applied the casts over two layers of cotton stockinette and webril. Duct tape served as the temporary means of keeping the casts together until the orthoses are to be delivered on Sunday or Monday. We also evaluated 4 additional children for orthotic treatment who did not recently have surgery but needed orthoses from previous interventions.

As a prosthetist, I have not spent much time working with children post operatively and I had never really experienced cast removal for children who just a few weeks earlier had endured corrective surgery on their feet and ankles. While I completely understand the necessity of treatment being provided, I was not prepared for the crying and wailing of these young Belizeans. As a parent, it truly hurt my heart. I cannot imagine what it was like of for the parents trying to sooth their own little ones. All in all, the parents did great as well. Some of the children had to have pins or sutures removed as well. Dr. Garzon from KHMH assisted with that process.

Figure 5: Dr. Garzon and Mike Malagari attend to suture removal


Figure 6: A Mom devotedly calms her child as Josh takes an impression of her leg.

I must at this point give credit to Craig Violette who cut each of these casts off with rapid precision, kept talking to the children in as calm a voice as possible so that even though they were distressed and possibly didn't even understand English, they knew what was happening and that it was going to be over soon; that all would be okay.

Then, almost as fast as we started, we were done. We had removed casts, evaluated and then recast 8 children for 13 AFO's. In addition we had evaluated 3 other children who needed orthotic services. One of the children who had surgery had correction that was so severe, the surgeon, Dr. John Davids of the Greenville Shriner's Hospital, asked that he be evaluated and cast on Saturday. That will be a two day turn around if all goes well.

The final chart notes were completed and we were ready to pack up and head off to Orange Walk Town and the PHB clinic. Copies of the charts were made at the IHC office. It seemed only fitting that as we were about ready to depart for OWT, the sunset blazed across the sky.

Once we arrived at the clinic around 7:30pm, we started unloading the supplies while the impressions were prepared for filling and then poured. Having achieved our goals for the day, it was off to dinner at La Hacienda and then check-in at Hotel de la Fuente. We all went to sleep recognizing that the mission had gotten off without a hitch and that we were well on our way to getting these orthoses made so that over the course of the next four days, the kids who could walk, would be walking again, and; those who were too young to walk, would get orthoses that would greatly facilitate that process when the time came.

Friday, October 15, 2010 11:15 pm

Sunset welcoming our departure from Belize City after a long days work.

Today we met at 7:30am to walk to the Food Court. It was the first trip through OWT in the daylight. Breakfast was uneventful except for intersecting with a man named Martin who had been "chopped" in the head and now suffered a left leg neurological deficit. (Chopped means being cut or attacked by a machete, a not uncommon occurrence in Belize.) Anyway, he could ambulate with a cane however it was quite unsteady. It resembled a shuffle more than walking actually. After MIke's quick assessment at the Food Court, we invited Martin to come to the clinic for a more thorough evaluation.

We walked to the clinic and got to work. Martin showed up and Mike took a cast of his leg so that we could try to make something for him too. If we had the time & materials, we would get him done but the priority was the children.

Our two prosthetic patients arrived. I took impression of the patient needing bilateral transtibial prostheses (Marvin) while Josh and Chris evaluated and obtained an impression for Victor who needed the transfemoral prosthesis.

Marvin gets cast for a new set of legs

As the impressions from yesterday were stripped by Tyler, Mike and Craig began modifying them in rapid succession. The impressions from today were filled so they could be modified. The day flew by.

The highlight of today's lunch was when Chris errantly ate some of the habenero peppers at the Come n Dine. They literally brought him to tears.

In the latter part of the day, the oven was fired up and we started pulling the inner part of the AFO's. The oven worked great but after six of the inner portion of the AFO's, called supra-malleoloar ankle foot orthoses or SMAFOs, had been pulled, the plastic started sticking to the Teflon sheeting. Without any silicone release spray, we were dead in the water.

Mike checks the alignment of a pediatric positive model

While it was another fantastic day and things continued to progress, we were faced with the necessity of getting something that would prevent plastic sticking to the Teflon. We'd already lost 3 sheets of the plastic we brought with us trying to unstick the plastic. While we brought extra sheets of copolymer, we couldn't afford to lose much more.

Off to a Chinese dinner at the Hong Kong restaurant (there are many Chinese restaurants in Belize), the hotel, showers, some reading or journaling and then sleep. We had three more days to fabricate and fit everything.

Saturday, October 16, 2010 10:45 pm

In the mornings, the team usually meets downstairs in the lobby of Hotel de la Fuente, enjoys some of the complimentary coffee and morning food (bananas, meat pies, pastries or "stretch-me-guts") and then we walk to the food court for breakfast. Then we walk onto the clinic and get started with the days' business. This allows Adrian to enjoy some time with his family, get his kids off to school and then come and join the team at the clinic. It's a pleasant ritual for starting the day and it gives us all a chance to enjoy Orange Walk Town as she and her people awake as well.

This morning, Adrian was waiting for us in the truck outside of the lobby as he recognized that we had a number of orthotic evaluations scheduled for today and without some type of silicone release spray, we were going to have to come up with some creative solutions to get the devices fabricated. He had gone to Landy's hardware store yesterday to try and find some type of release spray but they didn't seem to know what he was asking for. So we ate breakfast at the Food Court and all went to Landy's to see if they had something that would work. Fortunately, they did have a type of silicone release spray and we were in business.

By 8:30 we were at the clinic and ready for a fabrication marathon. Six SMAFOs were pulled yesterday so we had 9 more SMAFOs to pull today. After they were pulled and trimmed down, they had to be reinstalled onto the impressions so that the outer plastic portion of the AFO could be pulled. Basically we had 24 plastic pulls to achieve today. Then, after the plastic was pulled, it would need to be cut off the models, trimmed down, have the edges buffed down and then have the straps installed. While Craig and Tyler were cranking out the plastic pulls, Josh, Chris and Mike attended to the kids in needing orthotic evaluations.

Seven additional children came in for evaluations and one came for impressions. While we have never had the capacity to fabricate orthoses on site, we have had orthotists bring down sets of pediatric AFOs that could be retrofit. While the children who had recently had surgery required custom orthoses, we were able to fit three of these kids with bilateral AFO's after some significant adjustments.

We also were able to fit a set of knee immobilizers to Silas M. but he will need to come back to see us on the next mission to get his orthoses. He was born with amniotic band syndrome which affected both his legs and one of his arms.

Rodolfo, a guy who had the misfortune to be electrocuted 7 years ago and lost both legs and one of his arms, came in for an assessment of his legs. He definitely is ready for a new set but we will not be able to make his this trip. He didn't bring his arm but that seems to need replacement as well. He'll be seen in January.

We broke for lunch at almost 2:00 and went to a restaurant that served traditional cow's foot soup. Both Tyler and Chris were brave enough to enjoy this Belizean delicacy.

Ranhel C and his sister came to us as they were both born with Spina Bifida. He was one of the kids we were able to fit a set of AFO's to however he ideally would get a set of bilateral knee ankle foot orthoses (KAFO's). Since we don't have the components here for that, we will have to try to get them done next time. A set of AFO's is still better than nothing at this point.

His sister, who we evaluated after Ranhel's treatment, presented with another challenge. She had a large ulceration on her foot which had been there for three months. Her family had been treating it with traditional medicine, mainly honey, but it had not healed. Upon inspection it was infected and needed to be treated and debrided.

Adrian had to have a serious conversation with the family about the serious nature of her foot and that she needed to go see the doctors at the hospital first thing tomorrow or Monday. There is a real possibility that she might have to have an amputation if the infection is in her bone.

Victor, the patient with the transfemoral amputation came in for a plaster diagnostic socket fitting which went well so we will proceed with his lamination and assembly. We were able to get the liner fabricated for one of the Marvin's sockets but that was all for the day.

By the end of today, all of the orthoses scheduled to be delivered tomorrow were completed, the team had evaluated six additional bilaterally affected children for orthotic treatment and three of those were able to be treated with retro fitted ankle foot orthoses. We will follow up with these and fit the rest of the kids when we return in January. One child was cast for a unilateral AFO and she'll be back tomorrow for delivery.

So far this mission, we have evaluated one adult for an AFO and three adult prosthetic patients for 5 legs and one arm. We have also evaluated 19 children for a total of 32 AFOs. Six AFO's (three pairs) have been delivered so far. Not a bad start. Tomorrow is a big delivery day. Hopefully all will go well. We also need to finish fabricating the prostheses.

We went to a restaurant that only serves Ceviche for dinner. Landy, the owner of Hotel de la Fuente, offered to treat the team as thanks for all we do for the people of Belize. Just on example of the many kind gestures we experience while down here.

Food generally takes a while to be served because everything is made fresh. But it is well was worth the wait. They offered conch ceviche and Shrimp ceviche. Yum.

Sunday, October 17, 2010. Delivery Day.

We had 8 children with a total of 13 devices scheduled for delivery throughout the day today. They have appointment times but their arrival was more dictated by when they could arrive, bus schedules and taxis than by any pre-determined time. One has to flexible when working in Belize.

We also anticipated more patients would show up for assessments. One in particular, Justin, needed as many days as possible in his post operative casts as he had to have pins inserted into his feet order to get proper skeletal alignment. The pins would have to be removed at Karl Huesner hospital and then Milagro was going to bring him directly to the clinic for evaluation. We would have to get him cast and then go to fabrication so he could be fit tomorrow.

As I experienced more pediatric orthotic deliveries today than I ever before, I have more and more appreciation for Orthotists coupled with greater and greater certainty that I never want to be one. On Thursday, they were cutting off casts (this definitely makes children cry) followed by taking an impression of their leg which had been in a cast for almost a month (read-cry more) and then, they put the original post operative cast back on the child as if the first two activities weren't bad enough. If the child had any shred of strength left at this point, they spent it, you guessed it, wailing. None of these procedures seem to be painful, just scary.

I get that this is necessary treatment and all in the best interests of the children's' well being. But these kids still spend all of their energy expressing that they do not want to be there having done to them what is being done. Yet Mike, Craig and Josh work quickly and methodically to accomplish what needs to be accomplished.

On delivery day, they do come with a few tricks up their sleeves. The first step of delivering the orthosis or orthoses to the children is to give them all, and often their siblings, lollipops. Somehow, that makes everything a little bit better. Fitting commences, adjustments are made and for the most part, the kids stay engaged with their treats more than what is going on with their feet. As an extra distraction, toys are often provided mid fitting.

The parents assist and are educated as to wearing instructions, trouble signs, etc. and then the child stands, when possible, and walks.

Once the orthoses have been fit, the families no longer need the post-operative casts which held the surgical corrections in place until the body could heal. As a result, we have a pile of casts to show for our efforts.

On some level, these little ones must recognize that while what they are experiencing is not comfortable, it is being done for their own good, that everyone working with them cares for them deeply and that, in the end, it will be okay.

While the serial fittings were going on in the front room, the prosthetic fabrication was continuing as rapidly as possible since we were aiming to deliver Marvin's legs today. We wanted to give him a chance to wear them all evening so that if they needed adjustments, we could do so tomorrow.

As this day was pretty non-stop patients, we brought lunch in and ate it when we could.

In addition to the 13 deliveries today, we had an additional 5 children come in for evaluations. The last one arrived at 6:30 for their 4:30 appointment. So it goes.

We finished Marvin's legs and he came in for delivery. Initially we were considering using a supracondylar suspension but in the end, he preferred the cuff straps as he likes to ride bikes. He was nothing short of ecstatic with his new legs and was quite happy to leave the old ones with us. He didn't even need a lollipop.

We also finished the fabrication of Victor's transfemoral prosthesis. He will come in tomorrow. We also had enough materials to get all of the kid's devices done and have some left over for Martin's AFO to be fabricated. He too will be coming in tomorrow.

By the end of today we have also evaluated 25 children for a total of 44 AFOs. We have delivered 19 AFO's to 11 children and one set of transtibial (below knee) prostheses.

Monday, October 18, 2010, 7:15am

And just like that, it's the last day of the mission. Tomorrow we all fly away back to the reality of day jobs, insurance regulations, traffic. We also get to go home to our families. It is usually a drastic transition back to the Real World from this world.

We have a few patients scheduled for this morning. Our hope is that we can get all of them done by midday so that we can enjoy some of Belize. We did not schedule any "fun" days as we did not know how the trip would go.

There was one child, Ranhel, who would really benefit from a pair of bilateral KAFO's. As we didn't have the necessary components here, we were only able to retrofit him with AFO's until January. Since KAFO fabrication is a bit more involved than AFO fabrication, Mike thought it would be prudent to take impressions of his legs and fabricate the devices in U.S. Since Adrian knows that it is a challenge for the family to make it into Orange Walk Town, he suggested we go to their village and obtain the impressions at their house. So that's the plan.

Our two orthotic patients came in the morning as did Victor for delivery of his prosthesis. The kids did well. Celine had worn an AFO for a while and just needed a new one. Justin was not too happy with the fitting of his devices but made it through nonetheless.

Victor had to experience the difficult reality that walking with an above knee prosthesis is difficult and tiring. He lost his leg to diabetes and has been in a wheelchair for almost a year. While he does stand up often and get around his house with a pair of crutches or a walker, he was hoping that the prosthesis would bring him back to his pre-amputation level of function. That may happen but it will take some time and some work.

He was able to walk up and down the clinic a few times and then needed to rest. The socket fit pretty good and was suspended by a belt. We provided him and his family with instructions, socks and some idea of what to expect moving forward from here. As there is not really any physical therapy available, we offer instructions and suggestions for strengthening as well.

We planned to see Marvin today as well but he felt that he was doing so well in his legs that he decided to take the first bus back home as it would be over 7 hours to get to the south of Belize.

So, having fit all of the patients we had scheduled for the day, we had a quick lunch, got some supplies for a road trip, loaded up in Adrian's truck and headed off to the village of San Pedro.

While this whole experience was incredible for everyone, going to San Pedro was a phenomenally great way to end our last day in Belize for two reasons. First of all, we were able to catch up with Ranhel and his family. His sister was in the hospital and was going to have to have surgery on her foot. The type of surgery was not known.

By going to perform this house call, we were able to experience how many of our patients live. Their homes are dirt floors, walls are made from found materials, wood slats and usually tin roofs. They have outhouses and outdoor cooking hearths. Dogs, cats and chickens amble around freely. And yet while they have little material wealth, they are as happy a people as ever you will meet.

Mike and Craig proceeded to cast Ranhel while the rest of us walked around nearby, visited with his family and soaked up what life must be like living in a village like this. The plan is to have the orthoses fabricated in the States and bring them back for fitting in January.

After we finished with Ranhel, Adrian drove us around the village so we could see the rest of the houses, the school and whatever else there was to see. This was the second reason stopping in San Pedro was a great way to end the mission.

We stopped at a soccer field where a bunch of kids were playing around with a soccer ball. Only one had cleats. The rest were barefoot.

Tyler broke out his Frisbee and from what we could tell, they had never seen one before. So we threw Frisbee for a while and some started playing soccer. It was only a matter of time before a soccer game broke out. We split ourselves between the locals and had a terrific time although. I believe Chris even scored once or twice. We played until it was too dark to see the ball.

Having thrown ourselves immediately into our clinical activities as soon as we arrived, as was our mission, left us with only a peripheral sense of what life would be like in Belize. The experience of seeing Ranhel's home and then enjoying some time playing soccer and relaxing made for a terrific wrap of the mission. It was one of those experiences that we couldn't have planned to have happened but happened anyway. Things like that almost always do on a mission trip.

As a final universal sign that we were in the right place at the right time, doing what we ought to have been doing, a man walked out from a house across from the field using crutches. He was shyly observing the game but not coming out to far where he could be seen. From where I was standing, I saw him and thought that here was one more person who might need our help.

I spoke to Adrian and asked him to inquire with the family. Within minutes, we were completing our last assessment of the mission. He was in an accident when he was a teenager that left him with a hyperextended, weak and painful knee. The orthotists among us quickly concluded that he would do great with a knee orthosis. We have some at the clinic but if we don't have one appropriate for his condition, we will bring one down in January.

Tuesday, October 19, 2010. Flying home

Mike, Craig and Josh are flying back to Virginia. Chris, Tyler & I are on our way back to Atlanta. All in all this First Orthotic Mission in Belize went better than anyone could have expected. We assessed 25 children and two adults for a total of 44 AFOs and one knee orthosis. We delivered 23 AFO's to 13 children and one adult. We also delivered set of transtibial (below knee) prostheses and one transfemoral (above the knee) prosthesis. Not too shabby for four and a half days.

Furthermore, we have established with certainty that we can provide custom pediatric and adult AFO's in Belize. This ups the amount of follow up and patients we will be seeing and also adds to the logistic challenges Prosthetic Hope International and Project Hope Belize will be facing from here forward. But the partnerships with International Hospital for Children and CARE Belize only help to elevate everyone's abilities to provide hope, care and devices for people who really need them.

We all have been given gifts and the best way to show gratitude is to give back. I can't express the innumerable ways I have been touched by the people I have met and the work being done in Belize. And by sharing that experience with others, be they practitioners, technicians, therapists, or students, we all are enriched.

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