Rotary: Changing Lives in Developing Countries

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By Sherry Metzger

Vairo Chavez, a young Guatemalan man, hadn't been able to work since becoming a bilateral BK and AK amputee after he was electrocuted while working on a construction site. Emine Yuzay, a Turkish woman born without arms, would watch as her nine brothers and sisters went to school, yearning for the education she wasn't allowed to pursue. Mohammed, an 11-year-old Iraqi boy, was left for dead on the side of a road when an Iraqi military vehicle ran over him, mangling his left leg.

The World Health Organization (WHO) estimates that 10 percent of the global population, or more than 500,000 million people, have a disability. Two-thirds of those people live in developing countries, and that number is rising due to poverty, poor healthcare, disasters, landmines, war, and other forms of violence.

There are 250,000 amputees registered worldwide by the United Nations, and the tens of thousands of those in developing countries-people like Vairo, Emine, and Mohammed-face limited mobility, discrimination, and, in many areas, a great deal of shame. Providing them with prosthetic devices obviously increases their mobility, but perhaps other life-changing effects are less known. In countries where amputees are embarrassed, even shunned and secluded, prosthetic devices can be the difference between lives lived in hiding, and lives lived as active and productive members of society. Unfortunately, the need for prosthetic devices, particularly lower limbs and hands, is increasing.

Rotary-Responding to Global Need

Vairo Chavez climbs a ladder to help with the construction of ROMP's expanded facility in Guatemala.
Vairo Chavez climbs a ladder to help with the construction of ROMP's expanded facility in Guatemala.

O&P professionals have long been involved in responding to this global need-taking devices and medical equipment and providing care to those who otherwise would have neither the access nor the resources to get such care on their own. The scope and size of the organizations with which these practitioners have partnered are as varied and diverse as the practitioners themselves. One such organization is Rotary International (RI), a nonprofit organization with more than 32,000 clubs in more than 200 countries.

"Rotarians are welcomed in any club around the world," says Rotarian Linda Smythe, who moved to Washington DC in 1999 after living in Bahrain for 18 years. "I came to the U.S. and dived right in to Rotary projects."

Founded in 1905, primarily as a Chicago, Illinois, social organization, Rotary quickly evolved into the world's first service-club organization when, according to the Rotary International website ( www.rotary.org ), the early members realized that "reaching out to improve the lives of those less fortunate proved to be an even more powerful motivation" to generate membership than fellowship and socialization alone. "The Rotary commitment to service began in 1907, when the Rotary Club of Chicago donated a horse to a preacher."

Since 1913, the year of the first recorded Rotary club project for the disabled, RI has helped fund projects to further the education, employment, accessibility, and other resources such as orthotic and prosthetic devices and surgeries, for persons with disabilities. Today, there are more than 1.2 million Rotarians worldwide who volunteer their time and talents to serve those in need under the motto "Service Above Self."

David Krupa, CP, helps a young girl put a shoe on her prosthesis.
David Krupa, CP, helps a young girl put a shoe on her prosthesis.

"Rotary does a lot of local projects that they're famous for, as well as its international humanitarian initiative, the eradication of polio," Smythe says. "Because of my background, I brought an international feel to my projects. I have worked on initiatives of friendships with the Arab world."

Vairo, Emine, and Mohammed have experienced firsthand the life-changing impact of the Rotary mission. Vairo's life was changed when the Range of Motion Project (ROMP), funded in part by Rotary clubs in Illinois and Gualan, Guatemala, gave Vairo two prosthetic legs. When ROMP co-founders Eric Neufeld, CPO; David Krupa, CP; and Josh Kaplan, Esq., set out to expand ROMP's existing facility, a project that was made possible by equipment donations from Scheck & Siress, Chicago, Illinois, and Chicago-area donors, they bought supplies locally and hired people from the community to help complete the construction. Vairo was hired as a contractor-his first job in more than two years. Vairo was asked to speak at the grand opening celebration of the expanded clinic-named the Loren Jay Mallon Centro de Rehabilitación-held this past May. (See also "ROMP Plans Humanitarian Work Expansion in 2007," The O&P EDGE , February 2007).

John Angelico, CP, FAAOP, and David Krupa, CP,  are all smiles with this little one.
John Angelico, CP, FAAOP, and David Krupa, CP, are all smiles with this little one.

Emine was given the opportunity to pursue her much-desired education when she entered a Rotarian-sponsored concentrated language encounter program (CLE), carefully using her toes to write. She recently received prosthetic arms and now teaches other women to read and write.

Young Mohammed is content to be alive and walking again with his prosthetic leg. He received the leg through the Basra, Iraq Prosthetics Project (BPP), a humanitarian initiative supported by the Montgomery Village Rotary Club in partnership with other Rotary clubs and organizations, to give lower limbs to civilian amputees in Basra, Iraq. Smythe, who is the chairperson and founder of the BPP, met Mohammed shortly after his accident. "His amputation left very little residual limb, but he never complained," she says. "He is full of charm. It is a life-changing experience, extremely moving, to watch a person who's been in a wheelchair get up and walk for the first time. I have met dignitaries, royalty, and people from all walks of life, but my reaction to an amputee getting up from a wheelchair was overwhelming." (see also "Basra, Iraq, Prosthetic Project Aids Civilians," The O&P EDGE, June 2007).

The Rotary Foundation

Michael Mendonca and Carol Fellows, MD, fit Francis Nzioka with an LN-4 hand. Photograph courtesy of the Ellen Meadows Prosthetic Hand Foundation
Michael Mendonca and Carol Fellows, MD, fit Francis Nzioka with an LN-4 hand. Photograph courtesy of the Ellen Meadows Prosthetic Hand Foundation.

While Rotary International's only corporate initiative is the eradication of polio through the PolioPlus program, a global partnership with the United Nations Children's Fund (UNICEF), the Centers for Disease Control and Prevention (CDC), and WHO, Rotary clubs and the Rotary Foundation of RI support a variety of other international projects. The Rotary Foundation is a not-for-profit endowment fund that receives over $80 million annually to provide for worldwide service projects. Partnering with Rotary International is attractive for many organizations, companies, and O&P practitioners looking to extend their services to worldwide humanitarian efforts. RI and the Rotary Foundation are perhaps unique in that they not only provide matching grants for international humanitarian projects initiated and administered by local Rotary clubs and districts, they also help to fund initiatives that are started outside of Rotary-like ROMP-that partner with Rotary at the local or district level because they are seeking additional funding and international pull.

"We often work with other organizations, such as Rotary International," explains Jack Richmond, Barr Foundation, Boca Raton, Florida. "They already have the infrastructure in place and people we can work with to get components to people who need it. They also provide funding."

Nikodemus Ssali drives a taxi with his new hand. Photograph courtesy of the Ellen Meadows Prosthetic Hand Foundation
Nikodemus Ssali drives a taxi with his new hand. Photograph courtesy of the Ellen Meadows Prosthetic Hand Foundation

"Rotary is a good way to get into a country where they have already established connections," adds Eva Hughes of the Barr Foundation. "When we ship supplies into a country, there's someone there to pick them up and get them to the right people."

Neufeld, Krupa, and Kaplan approached Rotary when they co-founded ROMP in Zacapa, Guatemala. "We approached Rotary with our plan," says Neufeld. "We can say we need x amount of money to create x amount of legs or prostheses. They love measurable outcomes and brick-and-mortar' projects," he says. "They were easy to work with and very helpful. They walked us through the whole process. Establishing a presence with that club was a great way of getting ongoing support for our project."

ROMP recently celebrated its 250th leg. "I've never experienced anything like this," Neufeld comments. "I always tell my patients as I'm delivering a prosthetic device, This is a gift from the United States.' This is our way of representing our profession and the U.S. We take that very seriously."

LN-4 Prosthetic Hand Project

Rotary clubs and districts around the world have initiated a number of projects that are specifically targeted to help people with limb loss or limb difference. In addition to the BPP, the LN-4 Prosthetic Hand project is bringing "simple, yet effective low-cost prosthetic hands to amputees, returning them to employability and self-sufficiency," RI President William Boyd is quoted as saying in the June 2007 edition of The Rotarian .

A two-and-a-half-year-old boy, born without hands and legs, holds a toy for the first time.
A two-and-a-half-year-old boy, born without hands and legs, holds a toy for the first time.

Turning the tragic automobile-accident death of his daughter into a living legacy, industrial engineer Ernie Meadows developed the LN-4 hand (named for his daughter, Ellen). Meadows wasn't interested in making a profit from the hand but rather intended it to be given to landmine survivors around the world. In 2004, Meadows approached Rotarian Michael Mendonca, vice president of Menlo Park, California, injection-mold company Stack Plastics, and told him what he was trying to do. After a couple of meetings, the Rotary Club of Pleasant Hill,

California, District 5160, took on the project and provided $5,000 for the first 24 prototype hands. In February 2005, Mendonca traveled to Vietnam with a group called Kids First Vietnam to test the hand. There, he persuaded Tim Bewley, a member of the Rotary Club of Ashland, Oregon, District 5110, who was also in Vietnam at the time doing a different Rotary project, to make a videotape of one of the first hand fittings.

"When Tim saw the fitting, it changed his life," says Carol Fellows, MD, District 5110 Secretary, who joined the project team that May. In 2006, Meadows gave the LN-4 to Rotarians to distribute to the world.

Manufactured by Stack Plastics, LN-4 is a simple, inexpensive, device composed of a cuff, straps, and a hand for below-elbow amputees. With two moveable digits that interlock with three fixed digits, the hand is also simple to use-the digits close incrementally to grasp and release with slight pressure to the outer side. The LN-4 costs $50 and is easy to fit to the residual limb, needing only scissors and a match for the final fitting.

A child learns to drink with his dominant hand.
A child learns to drink with his dominant hand.

Local volunteers and Rotary members assemble the hands on-site. "Once they're assembled, you just shorten the straps, and when they are the right length to fit that limb, you cut them off with the scissors," says Fellows, a retired radiation oncologist. "You need the match to keep the straps from fraying."

The hand was originally designed for adolescent children maimed by landmines, but Fellows says it "works really, really well for many adults as well." Bewley, who is now district governor of Rotary District 5110, Mendonca, and six others took the hand to Nairobi, Kenya, eight months after the initial Vietnam trip. As a physician, one of Fellows' jobs was to screen potential recipients to make sure the limb would work for them. "You need at least five inches of residual limb below the elbow," she says. "It was so discouraging when mothers would bring in their kids, and they would have an above the elbow or too short a residual limb. It was really hard to tell them no."

Bewley says the first thing recipients want to do with the new hand is write. "What they learn in the first day is nothing short of astounding," Bewley is quoted as saying in the December 30, 2006 issue of The Mail Tribune , Medford, Oregon ("Giving Hope, and Hands," by John Darling). "[They're] counting paper money, cutting meat, hoeing a garden, and just feeling like a whole person, not having what they feel is a symbol of disgrace, an empty sleeve hanging down."

A Legacy Fulfilled

To date, more than 250 LN-4 hands have been given to recipients in Vietnam, Uganda, Kenya, Tanzania, and Rwanda. In countries where expensive prosthetics are often tossed aside because of their complexity, the LN-4 hand has had an amazing success rate. On a six-month follow-up trip to see how the hands were working for recipients in Kenya and Uganda, Fellows says, "We saw about half of our recipients back, and all of them were still using the hand, at least part of the time, and some of them day and night. We remember so vividly writing to Ernie Meadows from Nairobi, We have a product. It works.' And he wrote back, You have made our lives worthwhile.' Because they had been engaged in this effort for so long to honor their daughter, who died now 34 years ago."

The success of the project has resulted in the establishment of the Ellen Meadows Prosthetic Hand Foundation, which now works in partnership with Rotary Districts 5110 and 5160. "We've also trained a lot of people to fit recipients when we can supply them with more hands," says Fellows. "Our biggest problem right now is that we only have a few hands." More than $140,000 has been raised among Rotarians to fund production molds for the original adolescent hand model as well as a larger model for adults and to begin mass production, which is expected to begin within a month. Mendonca led a trip to Vietnam in May, and Fellows says she and Bewley hope to have hands to take on a trip to Nairobi and Kampala in September. Several other trips are currently being planned, including one to Cambodia in January 2008.

"This is our life work, really," says Fellows. "Changing lives. It's incredibly gratifying."

Sherry Metzger, MS, is a freelance writer with degrees in anatomy and neurobiology. She is based in Westminster, Colorado, and can be reached at sherry@opedge.com