Prosthetics in Colombia, Part Two: The Military System
August 2019 Issue
I showed up to a gate that was barricaded and covered with razor wire, and my taxi driver hesitantly mimed if I was sure this is where I wanted to go. There were ten or so soldiers with machine guns and police dogs. Taking a deep breath and wondering what I was getting myself into, I got out and made my way to the entrance.
New to Colombia with no interpreter and trying to remember the Spanish I needed, this is where I found myself after I decided to try to visit a Colombian military base to see what resources were available for their service members with amputations. My curiosity had been sparked after volunteering in Bogota fitting landmine survivors with prosthetic devices at Hughes International Clinics at Fundación Cirec. After multiple inquiries, I eventually connected with the son of a respected retired general and received a text about a week later that read: "Show up at this address at 3 p.m. and ask for this person," with a rank, name, and address.
That day, with my minimal Spanish, I did manage to come up with the words for appointment, the name of my contact, and 3 p.m. I gave the guard my passport and hoped for the best. Once through the gate I was brought to the headquarters. The colonel I was to meet with was the base commander, and I met with him and several of his senior officers. Polite and curious, they asked me about me and my intentions. I explained who I was, my clinical background, that I grew up in a military family and had an interest in learning about the Colombian military's medical system. An appointment was made for me to tour the military hospital and the recently built rehabilitation center, Dirección Centro De Rehabilitación Inclusiva (DCRI).
The Military Hospital
The military hospital in Bogota is the main facility where active and retired military are fit with prosthetic limbs. In Colombia, serving remote areas efficiently and cost effectively requires a service delivery model that uses mobile outreach units. Through telemedicine, orthopedic doctors at the military hospital do adjustments, fittings, and follow-up appointments with technicians working remotely from mobile labs. The program is called Programa de Atención Descentralizada del Paciente Amputado (PADPA) and serves 80-160 patients at a time depending on the location. After an initial appointment to evaluate, and a second visit to check the socket and alignment, the prosthetic limb is delivered on the third; most visits, however, are for adjustments.
During the initial evaluation, one of three orthopedic doctors at the hospital prescribe specifications and componentry based on an internal prescription guideline that uses Ottobock componentry exclusively. Ottobock also has an exclusive bidding contract to supplement the hospital's own rehabilitation staff. PADPA has 12 CPOs and technicians who produce about 80 prosthetic limbs and socket replacements a month.
The military hospital is the key player in managing and treating landmine injuries among army personnel. A medical response unit deploys by helicopter to quickly pick up injured survivors after a landmine event. The unit provides emergency medical response while en route to the nearest medical facility that can provide lifesaving measures. Once stable, the injured service members are brought to the military hospital.
Post-amputation physical therapy occurs before and after a prosthesis is fitted. About four to six weeks after surgery, an orthopedic specialist makes the referral for a prosthesis. Parts are ordered from Ottobock and the fitting process begins.
The Rehab Center
Fourteen service men with amputations were waiting for me to interview them when I arrived at DCRI. Most were service men from Company C at various stages of transitioning into retirement. The rest were retired soldiers who were part of a competitive sports league for people with amputations. Company C is part of the infantry, which is the only group that DCRI houses during the process of retirement. The center offers services to all branches of the military and retired National Police.
Eleven of the 14 men's amputations were caused by landmine explosions during reconnaissance or operations near paramilitary positions or while rescuing comrades. Two others reported their injuries were from bullet wounds and one from electrocution from high-voltage wires. Tragically, the use of landmines has been common in certain areas of Colombia during the conflicts between paramilitary organizations, drug cartels, and the government. There is now international funding and support for landmine removal, so incidents are decreasing. This has been made possible by a ceasefire with the Revolutionary Armed Forces of Colombia/Fuerzas Armadas Revolucionarias de Colombia (FARC) during the peace process that started in 2012. At the time of my tour, there had only been five new landmine injury patients that year. Most new amputations were from vascular issues, which had not been the case in the past.
Transportation can be an issue in Colombia. The roads are often difficult to travel, and even manageable distances can stretch into days because of landslides, construction, poor roads, and zones with little government protection. Because of this and that military pensions are not high, it can be challenging for people from some parts of the country to get to the DCRI. Those who come from a great distance can stay at the center, where their food and housing are covered.
The rehab center is around three years old and has room for 160 people to stay at any one time. Retired service members are eligible to return to the DCRI for further prosthetic care and physical or vocational training. There were 33 enlisted service members from Company C and eight officers staying at the center for rehab and fittings during the time of my visit. Others come during the day for training, rehab, or education such as technical training in bicycle repair, electronics, baking, or to finish high school. There are 15 athletes with amputations that are in the competitive sport leagues based out of the center as well. In addition to the prosthetic fittings and rehab programs, continuing education is offered for computer skills and other technical careers.
I was told that in past years amputees felt abandoned by the system, their fittings taking a long time with little support. The new initiatives to support soldiers who acquire amputations go a long way to address the problems of the past. This has included greatly improving delivery times to less than two months, improving the quality of prostheses, providing additional vocational and therapeutic services, and including eligibility for a new prosthesis every three years.
Jason Rovig, CPO, is from the Pacific Northwest and has been on a sabbatical traveling Latin America working on projects with O&P organizations, refugee centers, humanitarian groups, and art galleries. He is currently working on humanitarian projects through www.borderscrossed.com and using art for activism through his art collective www.artforimpact.org.
For more information about Hughes International Clinics, visit http://hicsga.com.