<b>I've never seen an outbreak of bugs that have no\r\nname.<\/b>\r\n\r\n<b>"They are everywhere," we are told by a well-armed\r\npoliceman. "They are crawling all over the woman with the new\r\nbaby."<\/b>\r\n<table class="clsTableCaption" style="float: right; width: 49.2883%; height: 309px;">\r\n<tbody>\r\n<tr>\r\n<td style="width: 100%;"><img src="https:\/\/opedge.com\/Content\/OldArticles\/images\/2004-08_09\/Salute1.jpg" alt="Debbie with Bianca and family. Photos courtesy of Jeff Fredrick, MS, CPO." \/><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style="width: 100%;">Debbie with Bianca and family. Photos courtesy of Jeff Fredrick, MS, CPO.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n"We can go to Barranquilla and buy some bug spray," I automatically respond.\r\n\r\n"Not a good idea," Ligia Applegate of Humanitarian Universal Connexion joins in from the makeshift pharmacy. "It might hurt the new baby!"\r\n\r\nOops! Bad enough idea even in the States--spraying a whole house full of bug juice with a critter still in a crib--and it's worse here. Safety restrictions on chemicals are immune to North American warnings. Chemical companies are not above shipping whatever they can sell--even if the FDA will not allow the product to be used around our own kids.\r\n\r\nGreg Fox, a rehab specialist, and I follow four policemen\r\nthrough the refugee camp. It's a good time of year to travel to\r\nColombia: hot, but windy. Unfortunately, the wind does more than\r\ncool. "Fecal snow" is one term for it. A powder of dried, raw\r\nsewage is picked up and blown through the camp. It's the same smell\r\ngiven off by treatment plants in the United States. There is one\r\njust beyond the runway we departed from two days ago. But back\r\nhome, it is only a smell--no particle ingestion!\r\n<table class="clsTableCaption" style="float: right; width: 39.2786%;">\r\n<tbody>\r\n<tr>\r\n<td style="width: 100%;"><img src="https:\/\/opedge.com\/Content\/OldArticles\/images\/2004-08_09\/Salute2.jpg" alt="Colombian soldiers on a bug-fighting mission." \/><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style="width: 100%;">Colombian soldiers on a bug-fighting mission.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nKeeping bugs off a baby--is that anything like saving cats out of trees? Five combat-ready policemen evidently think so. They discuss the problem as seriously as if planning an assault on a guerilla stronghold. They seem genuinely concerned about the plight of the woman and the baby. It's the true heart of Colombia, which is seldom reflected in worldwide media reports of the violence here.\r\n<h1>Great Day for Rehab Care<\/h1>\r\nDeb Plescia, CPO, is eight for eight: five lower-extremity and\r\nthree upper-extremity prosthetic fittings with clinically excellent\r\nresults. A day of such spectacular deliveries is rare even\r\nstateside, especially since there were no diagnostic fittings, no\r\nlaboratory, and few tools. The reasons are simple: good preliminary\r\nfocus, clear documentation, excellent fabrication technique, and no\r\ntime compression during the actual fitting\/delivery process. The\r\nresults: a great day for a good prosthetist and her patients.\r\n\r\nThe success rates of the physical therapists and orthotists are\r\nthe same. Three adaptive wheelchairs, rejects thoughtfully\r\ntransported by Delta without extra compensation, are painstakingly\r\nadjusted by Catherine Knickerbocker, PT. Three severely involved\r\npatients whose positions without chairs were a harbinger of worse\r\nthings to come may dodge a decubitus bullet. Mike Hanna, PT, also\r\nworks patiently until the children are fit as professionally and\r\nsafely as if the chairs were specifically ordered for them.\r\n<h1>Providing Help Realistically<\/h1>\r\n<table class="clsTableCaption" style="float: right; width: 25.6494%;">\r\n<tbody>\r\n<tr>\r\n<td style="width: 100%;"><img src="https:\/\/opedge.com\/Content\/OldArticles\/images\/2004-08_09\/Salute3.jpg" alt="The face of a refugee." \/><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style="width: 100%;">The face of a refugee.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nWe stop to discuss our needs for the next trip. Too often it is a question of how close you can get to what is needed. Sometimes, "appropriate technology" is a misnomer that can mean "less technical." It represents a cap, a limit defined not by\r\nfunctional level or need, but by availability and economics (sometimes even geography)--the least humanitarian and most crude of the determinants that drive the rehabilitation process.\r\n\r\nIt makes sense to provide the appropriate device when one can. If there is a need, and a less-than-perfect substitute exists, maybe we should ask the patients to decide. Decisions for a person's well-being in developing countries are often made by expatriates who have everything. It's easy to be philosophic when your child gets the best care and your own stomach is full. Occasionally we need to be reminded there are two sides to the appropriate technology issue! To serve effectively, sometimes we must serve the need, not the ideal.\r\n<h1>Can Do--No Matter What!<\/h1>\r\nBianca, who lost her leg in April 2002 in an assassination\r\nattempt on the then president-elect of Colombia, Alvaro Uribe\r\nV\u00e9lez, comes to the clinic to walk for the first time in two\r\nyears. The 17-year-old has lost weight and matured into a beautiful\r\nyoung woman, just since our last trip.\r\n\r\n"You look great," I tell her.\r\n\r\n"I've accepted my difficulties--I feel better now about\r\neverything," she responds, as though recognizing her earlier\r\nobsessive focus on the tragedy had affected her looks.\r\n\r\n"See, I'm okay!" she says with a big smile as Deb Plescia\r\ncarefully fits her new AK prosthesis. Those are pretty brave words\r\nfor a 17-year-old. I don't know who's smiling more as she walks\r\naway on the new prosthesis--her or Debbie Plescia. Debbie's\r\nattitude as well as Mike's and Catherine's remind me of the old\r\nWorld War II adage, "can do," with a twist: "Can do, no matter\r\nwhat!" It reflects a depth of professionalism that is unaffected by\r\ninconvenience. Whether it's in the most beautifully furnished\r\noffice on Physician Road in Anytown, USA, or a mud hut with filthy\r\nfloors in Colombia, it doesn't matter. Their attitude and output\r\nwould remain the same. I couldn't be more proud of them. Problems\r\ndon't matter; output and results do. It shows on the amputees'\r\nfaces as they walk by to leave the clinic, and in the expressions\r\nof the mothers pushing their catastrophically challenged children\r\nin new wheelchairs, instead of carrying them.\r\n<h1>Medical Clinic<\/h1>\r\n<table class="clsTableCaption" style="float: right; width: 52.2893%;">\r\n<tbody>\r\n<tr>\r\n<td style="width: 100%;"><img src="https:\/\/opedge.com\/Content\/OldArticles\/images\/2004-08_09\/Salute4.jpg" alt="Current and appropriate enough technology." \/><\/td>\r\n<\/tr>\r\n<tr>\r\n<td style="width: 100%;">Current and appropriate enough technology.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\nThe next day, we're back at the the primary\r\nmedical clinic in Barranquilla.\r\n\r\nWe don't find any orthotic and prosthetic needs, just scabies, worms, malnutrition, and a few untreated wounds from war and traffic accidents.\r\n\r\nSometimes humor coexists with tragedy.\r\n\r\n"I feel bad about it," I overhear Debbie Plescia confess from the pharmacy.\r\n\r\n"What?" I ask provocatively.\r\n\r\n"I gave a prescription to the wrong patient," she confesses solemnly. "He nodded his head when I asked if he was the man the prescription was written for."\r\n\r\n"Is it serious?" I ask, growing more concerned.\r\n\r\n"He took a stool softener that was meant for a constipated\r\nchild," Debbie responds, still solemn.\r\n\r\nWe laugh as we imagine the results, until Dr. Lisa Kohler\r\ninterrupts with news that a ten-year-old she saw last clinic for\r\nroutine problems has died of pneumonia.\r\n\r\nI can't help wondering, if we hadn't delayed so long in\r\nreturning, perhaps we could have saved the little girl? I doubt if\r\na stool softener will hurt the man who misrepresented himself and\r\ntook it, but it might cost him some inconvenience for a while. In\r\nthe end, maybe it will do him some good!\r\n<h1>Corruption, Violence: People Suffer<\/h1>\r\nSometimes I feel the same way about this whole country. It, too,\r\nseems to have taken a wrong drug or two. In the end, the violence\r\nof the old drug cartels, the cruel kidnapping by guerrillas, and\r\nthe retaliation of the paramilitary would benefit from a similar\r\nerror that might soften their rhetoric and agendas. Who knows? In\r\nthe meantime, sadly, the people continue to suffer. There's nothing\r\nnew about this in the historical sense. It's always the people who\r\npay for corruption and violence. It's what scares me so much about\r\nour own country. The corners we cut and our growing disrespect for\r\nlaw and order could be seeds of the anarchy, chaos, and violent\r\ncompetition that cost people so much in Colombia.\r\n\r\nThe trip ends with over 500 medical and 80 O&P and physical\r\ntherapy patients served, including one man who perhaps has learned\r\na valuable lesson. Maybe sitting around a little more over the next\r\nday or two will give him pause to consider the importance of\r\nrepresenting himself more honestly?\r\n\r\nJeff Fredrick, MS, CPO, BOCP, is director of Hangers\r\nRehabilitation for Development (Hanger RFD) and branch manager at\r\nHanger Prosthetics & Orthotics, Tallahassee, Florida.