How P&O Professionals Can Make a Difference

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By Miki Fairley

"There's much more to the P&O profession than the 'cookbook' approaches that are often taught. If you want to be really challenged, just take a look at some of the cases they are seeing in Vietnam, Cambodia, Sri Lanka, and Angola."

Thus says Mel Stills, CO(E), who has spent much of his O&P career with organizations providing assistance and education in developing nations. With his experience, Stills can point out both the challenges and rewards of working-either paid or as a volunteer-in the developing world.

For one, "Often, there may be little equipment or materials available, but the cases are frequently far more complex than what we usually see in Europe or North America, and you're challenged to be creative," Stills says. For instance, in Vietnam and Cambodia, due possibly to chemical agents that have been used there, extremely difficult and challenging congenital deformity cases are being seen routinely in clinics, Stills says. Surgical options often simply aren't available, "so you have to work around the situation. You can't just send them off to a surgeon to make things easier or better."

In many parts of the developing world, there are large volumes of patients, many of whom have not been treated for perhaps 20 years, and so their worsening conditions have become much more complex and difficult to treat, Stills explains. "In some of these developing countries, some people have been literally crawling on the ground their whole lives. There was no one to put them in an orthosis so they could stand up or provide a wheelchair so they could get from point A to point B.

"This is still occurring. You see people wrap rags around their legs and stick them in an old shell casing for a prosthesis. People become extremely innovative in order to survive, and those who aren't innovative don't survive.

"And all we can do is help those people so they can (1) survive, and (2) maybe become productive."

Students from European and Canadian P&O schools have traveled into the developing world. "I think some of those experiences are causing some of these younger folks to seek employment with the NGOs [nongovernmental organizations] working in these countries. They see it as another learning opportunity and an opportunity to make a contribution," Stills observes.

Various Options Available

Stills believes that the U.S. P&O schools haven't, in general, made students aware of job opportunities internationally, but he also notes the fact that the schools have much to impart to students and very limited time to do so. "People need to realize that there are opportunities all around the world in many different settings and environments that make the job interesting, challenging, and, in fact, gratifying."

Opportunities, both paid and volunteer, exist, and not all require a long-term commitment. "People can work or volunteer for one to three years," Stills points out. "Also, people can sometimes volunteer for as little as a week, two weeks, or a month. If they have expertise in say, a specific aspect of P&O, such as socket design, clubfoot, spinal problems, or improving quality of fit in orthotics, they can teach and/or mentor for as little as a month."

Inevitably, volunteers usually have to pay their own way, at least the first time. After that, if the volunteer has expertise and the organization wants him or her back, the organization often will pay the way; it all depends on the contribution you can make, Stills says. Also, volunteer work can lead to full-time employment with some of the organizations, if that's your desire.

Practical necessities can limit the spirit of volunteerism. "I understand, when people have a family and a mortgage to pay, they have to consider those things," Stills comments.

However, P&O professionals can take advantages of opportunities to work in a developing nation either before they acquire the family, the mortgage, and other responsibilities-or they can do this after they retire, when the kids are grown, out of college, and the mortgage is perhaps paid off. "Ron Altman is a perfect example of this," Mel says. "He has the skills, the knowledge, the enthusiasm, and over 40 years of experience. His children have finished their education and are on their own." Ron is now teaching at the Cambodian School of Prosthetics and Orthotics (CSPO) at Phnom Penh, and his wife Pam assists at the school. "It's a great teaching opportunity, but as Ron would probably tell you, it's also a great learning opportunity." Mel and his wife Sue spent a month with Ron and Pam last year, "and they are really enjoying what they are doing." [Editor's note: For more information about Ron Altman and his work in P&O, see "Ronald F. Altman CPO(E): A Lifetime of Making a World of Difference," by Jodi Mills, The O&P EDGE, April 2006.]

While visiting the Altmans, Mel taught a course in fracture management. Mel and Sue have decided to spend some retirement time volunteering at P&O schools in the developing world. "We were planning to go to TATCOT [Tanzania Training Centre for Orthopaedic Technologists] this past January and February, but due to an accident, that has been delayed until October or November," says Mel.

And it's not impossible to work abroad if you have a family-just take your family with you. Stills notes that many Europeans are doing this, and also some other Americans. He cites a couple from Denmark who are raising their children in Cambodia as the parents work at the school. A German couple with children in Vietnam and now Tanzania are a few other examples. "Their children are going to excellent schools and learning a whole new environment," Stills says.

Check Things Out

Stills has some caveats: he points out the necessity for potential volunteers or employees to learn about the credibility and integrity of the organization they are considering; organizations should do the same with potential volunteers and staff members. "Organizations should do a background check, learn if the volunteer has the credentials, work ethic, and personality that works well with others. Volunteers need to also check out the organization-find out its history, who and where you will be working, and if there is a security problem."

Sometimes the volunteer or employee is not a good fit because he or she lacks the needed skill set, has a personality that doesn't work well with others, or lacks the flexibility to adapt to a different environment and a different way of doing things, Stills notes.

But he also stresses the learning opportunities and rewards of helping where help is so much needed.

LWVF 'Has Helped Thousands'

For many years, Mel has worked for the Leahy War Victims Fund (LWVF), which operates under the auspices of the U.S. Agency for International Development (USAID). He is enthusiastic about the good that the LWVF has accomplished and notes that it has for quite some time enjoyed bipartisan support in Washington. However, he worries if this will continue given other urgent priorities seizing the attention of the public and Congress. "Thousands of thousands of individuals have regained mobility and returned to productive lives simply because USAID has through the War Victims Fund made funds available for rehabilitation services." He notes that part of the LWVF's annual $10 million budget is being used to train orthotists and prosthetists and other rehabilitation specialists in developing countries, so that the services and programs can become sustainable. About 25 different countries are represented by the individuals receiving training, and the education they are receiving is on a par with that offered in Europe and North America, he points out.

Although the devices are not high tech, cost is a factor. Fit, alignment, and function are still as critical in the developing world as they are here at home. Patients "are being provided with mobility they wouldn't have if we hadn't been training people to provide those services."

Although landmines are still a big issue, Stills notes that car, bicycle, construction accidents, snakebite, cerebral palsy, and other traumatic injuries, conditions, and diseases take a huge toll and cause an urgent need for P&O and rehabilitation care.

Indeed, opportunities for volunteering or employment abound in the developing world, with the chance to truly "make a difference."