Providing humanitarian O&P care in a foreign economy and political milieu is fraught with opportunities to not only do great good but also to create problems—potentially undermining local O&P businesses, providing short-term fixes, and creating dependence. U.S. ISPO’s Code of Conduct for International Non-Governmental Prosthetics, Orthotics, and Mobility Assistance was developed to help compassionate workers provide international care as ethically and intelligently as possible. Eva J. Hughes, executive director of the Barr Foundation, Boca Raton, Florida, agreed to join The O&P EDGE in informally auditing the foundation’s humanitarian missions for adherence to the U.S. ISPO code. Because the foundation is a strong supporter of the code, Hughes expected that its mission would easily measure up to each of the code’s principles. However, the Barr Foundation proved an excellent example for other highly principled humanitarian groups—by checking step by step, Hughes found an area in which the foundation had room to grow.
Available to All in Need
Principles 1 and 2 of the code state that aid providers shall not discriminate on the basis of issues such as race, religion, or politics in its projects, and not require patients to endorse religious or political beliefs to receive care. Hughes firmly states that the Barr Foundation neither selects patients or projects on the basis of any affiliation, nor requires them to accept any affiliation in order to receive care. “And the people we help are mostly so poor that they mostly don’t have much political power anyway,” Hughes adds.
Respect to All
Principle 3 requires that assistance organizations respect the local customs and culture. This applies not only to appreciating local ways, but also paying attention to what arises from them. For example, Muslim patients may prostrate to pray five times daily, so it’s essential that their prostheses allow for kneeling.
Hughes says Barr Foundation clinicians not only actively appreciate local cultures, but they also make preliminary trips to target locales “to get the lay of the land, to make sure we’ll have viable missions.” Such preliminary trips can allow care providers to connect with local O&P facilities and patients to ask questions about local needs.
Sustainability
Principles 4, 5, and 6 are concerned with encouraging local capacity, using locally sourced materials, and not creating dependence on outsiders. Following these principles requires subtlety. Sometimes little or no local capacity exists, or when it does, imported devices may be too complex for local practitioners to maintain. Foreign-sourced supplies will eventually need to be replaced, creating the need for recipients to ask foreigners for them over and over again.
Hughes says, “We’ve been fortunate that our missions, from our first one in Guayana, have been in places that have already had a local clinic, so we coordinate with them and just provide the componentry and education…. They do depend on us for supplies, though. That’s why we originally created the Barr Foundation Warehouse—for collecting used components to use in nations that do not have them. We still use local materials for sockets, but as far as the componentry, they just don’t have manufacturers.” The Barr Foundation now also participates in the Prosthetic and Orthotic Components Clearinghouse (POCC), a national componentry warehouse open to U.S. ISPO Code of Conduct signatories who meet certain criteria. Such use of warehouses is a good compromise because it allows the foundation to maintain a steady supply of goods, so that patients are more likely to receive them reliably.
Caring for Colleagues
Principles 7 and 8 are concerned with preserving existing local O&P ventures and coordinating with them and with patients in order to improve service.
Rob Kistenberg, MPH, CP, FAAOP, president of Project Hope Belize (formerly Sonrie Ministries), says that aide providers can help ensure that patients who can actually afford to pay local businesses for care do so by asking new patients a series of simple questions that demonstrate their relative financial situation. They include, “How many rooms are in your house? What kind of windows do you have? Do you have a job? Do you have a car? A bicycle?”
Hughes conceded, “This work is always a learning process. Domestically, we require proof that our recipients have no other resources, and I’m not personally aware of any of our international recipients having enough resources to pay for care, but those are good questions—we can use those.”
Building Local Strength
Principle 9 is concerned with actively developing local O&P capacity. Hughes says that the Barr Foundation works to improve the capacities of the local facilities that they work with, providing ideas and training whenever possible.
“We don’t always do training, but we do always bring new ideas,” Hughes said. “The second time we went to Honduras, our guys took the CAD scanner with them. They [the Honduran clinicians] might not be able to purchase one of those now, but it opens up ideas about what’s possible.”
Hughes concluded that the “audit” was valuable. “After all,” she said, “We’re here to provide help to as many amputees as we can, and, to quote Tony Barr, to make them whole again.”
For more information, see “First, Do No Harm: The New Principles for Providing Humanitarian O&P Care in Developing Nations” in the January 2010 issue of The O&P EDGE.
For more information about the U.S. ISPO Code of Conduct or to sign on to the code, visit the U.S. ISPO website.
