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Bismark’s First Semester

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Here is an update regarding Bismark, the apprentice prosthetist who works under the tutelage of Florencio. We told you about Bismark a few months ago, and about how he was studying remotely at Don Bosco University in Guatemala with the intent to become one of the very few ISPO II certified prosthetists in Bolivia. Bismark is only 20, but he really took charge while Florencio was in the hospital. Someday Bismark will probably become the lead technician for our prosthetic clinic partner in Bolivia. In early August Bismark flew to Lima Peru to take his first term exams and here is what Bismark had to say:

“I traveled to Lima, Peru on the 13th of August 2017 to complete my exam from my first semester of the course. The exam was held in ‘La Moderna’ one of the biggest orthopedic centers in Lima, Peru and the exam consisted of a written exam, oral, and practical components.

On Monday morning I met the group of people I’d be taking the exam with and my examiner for the module. The examiner was a professor called Gilberto Abarca German from the University course in El Salvador. My new colleagues for the week were Juan Carlos, Fernando, Julio Funtes, Victor, Hector and Felix. All together they have more than twenty years of experience in this area compared to my 2 years but they were all friendly and kind. I was very nervous for my exam week partly because the workshop was really different. The manner that we worked was more modern and ordered, but I had help from some of my work companions to settle in and find my feet.”

 

Bismark’s exam included making a prosthesis for a below knee patient and one for an above knee patient. During this process, he was asked by the examiner to explain his work, talk through what he was planning to do before he did it, demonstrate what he’d learned from his first semester and his background knowledge and skills in the area of prosthetic manufacture.

“On Monday in the afternoon, I met my two patients, Sr Fransisco with a trans-tibial (below knee) amputation and Sra Trinidad with a trans-femoral (above knee) amputation. I proceeded to the take the molds from the two patients that afternoon and started my practical component of the exam. I was a bit stressed with the pressure of studying and work, and I had to adapt to the new center environment, but with the help of my new work companions I began to feel calmer.”

The two patients which Bismark was working with were both older adults, both had lost their limbs due to circulation issues and they both had type 2 diabetes. Bismark had a good founding knowledge of older patients and diabetic amputations from his work in Funprobo and what he’s learned so far from working with Florencio and the volunteers in La Paz. He has added his previous experience to his new knowledge from the course to be able to demonstrate how far he has come in the last 2 years.

Bismark went on to explain about the two patients he worked with during his week:-

“Sr Fransisco was using an old prosthesis which helped a lot in making a new one, as he already had the confidence and expectations around having a prosthetic leg. To make that prosthesis we put a KBM prosthesis with a soft lining and the patient walked from the first day he tried it.”

A KBM (Kondylen-Bettung Münster) is a different way to fit a prosthesis which is currently not used in Funprobo. It consists of a mold with soft padding on the inside and a sock system for added comfort for the stump. This is a new technique that Bismark has learned and is able to bring back to Bolivia for further consideration for Bolivian amputees.

“Sra Trinidad had huge problems with confidence. It was very difficult to practice with her with the prosthesis because she felt pain in her seat bone where she was weight-bearing but the above knee prosthesis style requires that she fully weight bear through that point. I had to make many modifications to her prosthesis for her to feel comfortable. In her case we used a suction valve and a belt for more security, we put and Ottobock knee 3R40 and a specific style of foot made to assist with blocking the knee to give her more confidence in the prosthesis. After three days of practicing Sra Trinidad could walk with help in the parallel bars and had more confidence and felt happier. I learned a lot from this experience and was very pleased with how I handled the situation and was able to make her a prosthesis she was happy with.”

Bismark was able to manage this lady so well from the great foundations he has from Funprobo and working with Florencio, as the suction and belt system is used a lot in above knee amputees in Funprobo. This prior experience meant Bismark had the knowledge, skills, and confidence to manage this patient perfectly for his exam.

“On Friday we delivered the two prostheses to my two patients along with my examiner. Sr Fransisco and Sra Trinidad were very happy with my work and thanked me for their prostheses and chance to walk again.”

One of the main themes through Bismark’s synopsis of the week was how well the students all worked together and supported each other. Bismark is a very modest young man so is likely to have played down how much support he was also able to give his classmates from his experience and studies prior to doing the exam.

“Really it went very well, I worked with companions with lots of experience, they helped me and guided me and I learned a lot from them, they have helped me improve a lot on my work at Funprobo. We supported each other throughout the week and ensured we got a break each lunchtime by going out and eating lunch together. They told me about their previous experiences, how they treat patients and how clinicians should treat patients. The experience and the knowledge of the other prosthetic students made me feel very positive about my future and the way that I wish to continue learning and growing in my role. When we finished the exam we all went out to eat together and shared our last dinner as friends more than colleagues.”

As well as the experience and learning Bismark gained from the week of study and exams it was also the first time he had left Bolivia. He reflects on this as well:

“I tried lots of different foods, saw some of the city and learned about a new culture in Lima, I returned to Bolivia very thankful for the beautiful experience I had in Lima, Peru.”

We would like to thank everyone who has donated to make this happen for Bismark and for this charity. In particular, we would like to say a huge thank you to Share A Dream (www.share-a-dream.org) for their large educational grant, and all their support and positivity to make this happen for Bismark and for Funprobo. We are incredibly grateful to each and every one of you who has supported Bismark’s journey so far and we are excited to know what the future holds for Funprobo with this new knowledge and skill set that Bismark brings back to Bolivia.

You can continue to support this incredible work of providing more prosthetic limbs to low-income amputees – limbs which will be made by Bismark and Florencio – by donating here

This story was written by Amy Souster.

Florencio Needs Surgery So He Can Help Others

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Donate to Florencio’s surgery bills so Florencio can help others to walk again.

Florencio was born in 1963 and he first lost his leg when he was only 17 years old.  He was working with his father on a road crew doing street construction.  On one fateful day, there were some huge rocks that were on a hillside and obstructing the path of the roadway.  There was no specialized blasting crew to take crack them so Florencio and his father laid their own dynamite charges to break up the rock.  But after arming and attempting to detonate the dynamite, it didn’t explode.  After waiting some time, and with great trepidation, Florencio and his father started to approach the charges they had laid to see what went wrong.  As they were getting close suddenly the dynamite went off with a roar and massive rocks came crashing down the hillside.  Florencio’s father turned to look and saw that Florencio’s leg has been pinned to the ground under a huge rock.

Florencio’s first thought was to jump up and run away but he was trapped.  Rocks and dirt had also smashed into his head and peeled off a large chunk of skin from the side of his skull. His father ran to him in a panic and started to clean the injury, first with his own urine and afterward alcohol. And then his father sewed the skin of his head together with regular sewing needles and thread before they could take him to the hospital.  

After days of waiting in the hospital, the doctors finally amputated his hopelessly crushed leg.  But something went wrong during the surgery and days later they had to amputate again, a little further up the leg.  After more time spent in agony, they amputated even high up the leg for a third and final time.  Florencio was left with a stump below his knee and he was not yet even 18 years old.

When he finally got out of the hospital, he felt humiliated to be without a leg,  He didn’t want anybody to see him so he moved to a different city to try to start a new life.  After arriving in the new city, he knew that he had to work again to support himself, and he decided he wanted to study nursing.  But due to a fortuitous meeting with a man who worked for an NGO named “Terre des Hommes” Florencio found work.  At the NGO Florencio was introduced to prosthetic limbs and he decided that that was what he was going to do with his life – help others who had lost their limbs so that they could not only walk again but also regain their sense of dignity, pride, and self-worth.

Working for this NGO Florencio was given the opportunity to study Orthotics and Prosthetics in Peru and Brazil. He worked for Terre des Hommes for many years until they finally had to close.  But Florencio’s life path had now been set and for the next 30 years, Florencio constructed 1000’s of prosthetic legs as he also continued to pursue any additional training classes as he could find.

In January 2011 Florencio joined with our partner, FUNPROBO in Bolivia, to be their one and only prosthetic technician.  Working with FUNPROBO Florencio has already made an additional 350 prosthetic legs in the past 6 years.  And every one of these patients is low-income amputees who would never otherwise have had the opportunity to walk again without crutches, canes, or wheelchairs.

But one month ago, tragedy struck again when Florencio went to a local hospital due to intense pains in his amputated leg.  The doctors there realized that he had a severe infection and they operated to try to clean it.  Unfortunately, the operation was not successful and two weeks later he returned again in great pain only to find out that they were now recommending that he get a fourth amputation.  This time they would remove his leg about his knee.  Florencio knew that being an amputee above the knee is three times as difficult as below the knee and so, with medical bills mounting, he decided to go back to his home city of Cochabamba for a second opinion. He was desperate to avoid that additional amputation.  At the hospital in Cochabamba, in late June 2017, they performed another surgery to try to clear the infection again.  Florencio was in the hospital for 10 days and just got out this past weekend.  Now it is a wait-and-see game to determine if this final surgery was a success or if he will really need another amputation.

Due to all this, Florencio’s medical bills have already exceeded $4000 and could easily reach $5000 with follow-on care.  If Florencio truly does need another amputation then his medical bills will possibly reach at least $7000, and probably even more.

It is for this reason that we have set a fundraising goal to help Florencio so that we give back to the man who has helped so many others.  We want to be sure that Florenico is well taken care of after he has spent a lifetime taking care of others. All additional funds, over and above his medical bills, will be used to build more prosthetic limbs for other low-income amputees.

Please help Florencio and help other Bolivian amputees to walk again.  Donate here.

TV Interview – ATB

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On April 27th we were invited to appear on a live Bolivian TV morning news show along with Dr. Dante Chumacero, the president of our partner organization in Bolivia, FUNPROBO.  Channel 9, Asociación Teledifusora Boliviana “ATB” is one of the largest networks in Bolivia with national exposure.  Although our air time was very short, we were able to get our message out about our work in Bolivia. Immediately after the show, the phones at FUNPROBO started to ring with new patients who were just learning about the prosthetic center for the first time.  We hope and expect that this will be one more stepping stone to getting more TV exposure about the ongoing services that are offered by the prosthetic center, as well as getting more local donations and support from the government and other local organizations.  You can see the interview here – but spoiler alert, it is in Spanish 😀

Bolivians Without disAbilities is 2 years old

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Bolivians Without disAbilities is proud to announce that we are just over two years old now.  We incorporated in the state of Florida on March 4th 2015, and received our IRS official non-profit status on March 23rd 2015. From a short year in 2015 through the end of 2016 your donations have been able to double the number of disabled Bolivians that we have been able to help.  In 2017 we look forward to providing even more prosthetic limbs for low income Bolivian amputees.  As we continue to work with our past supporters, expand our reach to new donors and foundation grants, as well as make new associations with other organizations such as Handicap International and International Red Cross. 

To see how how many Bolivian lives have been changed based on our support, check out our statistics.

Machines and Component donations

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Late last year the Bolivian clinic received a very generous donation of machines, donated from Italy and shipped all the way to Bolivia.  

 

 

To achieve this goal Matt corresponded for three years with Elena Bonacini, the president of YouAble, a very generous charity in Italy. Working together tirelessly, Matt and Elena comprised a list of vital machines (valued at thousands of dollars). Fortuitously, the new clinic location is much larger, and now these machines will be put to good use.

Elena and YouAble’s support did not stop there.  They also donated thousands of dollars directly to BWD to purchase prosthetic components in the USA at a great discount. We shipped the components to Bolivia using volunteers’ suitcases, and now even more patients can happily walk again.

 

Opening week at new facility

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The first 10 days of 2017 were very busy and productive for our partner in Bolivia. Although the center was still closed for the holidays, the team worked long hours to transition from the old location to the new, bigger, better building.
There was not even a prosthetist on duty yet because the clinic was officially closed, but new amputees started arriving without appointments! Although the amputees were disappointed to know the clinic was not officially open yet, they were relieved to learn they’d receive new legs the following week.
Opening week was so exciting, and the clinic was packed with patients! The prosthetist, Florencio, worked like Superman, along with his assistant, Bismark, for countless hours to produce five prosthetic legs. Normally five prosthetic legs could take a MONTH, but desperate times call for desperate measures. The clinic team came through with flying colors.

The prosthetic center in Bolivia has moved

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Our partner in Bolivia has finally found a new location for their prosthetic center  Moving from a tiny, cramped 1000-sq-foot house, which was barely adequate, they have moved into a place that’s twice as large.  The new location is a classic 80-year-old registered landmark house with wooden floors and 15-foot high ceilings. The new building has a spacious area for physical therapy activities, as well as additional dedicated rooms for fabrication. The new building also has a larger office so that volunteers will no longer be falling all over each other to get their work done. The new location offers cheaper rent and a MUCH better location in town – near one of the main squares. After a lot of painting, repairs and hard work, the move took place ten days ago. We are excited to start serving patients when the doors open on January 9, 2017!

Employee Spotlight for January: Bismark Sandoval

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We are excited to announce that Bismark Sandoval has joined the team at FUNPROBO as an assistant prosthetist!  Bismark is Bolivian, and he is now the second prosthetist which means that FUNPROBO can start handling even more patients per month.  Bismark is young, eager, bright and passionate about this great cause. The chief prosthetist, Florencio Calle, has been working hard to train Bismark and help him ramp up his skills quickly so that he soon can take on his own patient load.  We hope that this is the beginning of a new era for FUNPROBO—training local specialists from Bolivia, to serve their own citizens—rather than relying on a single prosthetist, and the efforts of volunteers from other nations.  

You may also recall in our June newsletter that the internationally-known prosthetist, Jon Batzdorff, started Bismark’s training.  We hope to further Bismark’s education by supporting his tuition expenses when he enrolls in one of the few Latin American prosthetic schools, Don Bosco University in Guatemala, which is famous all over Latin America. After completing his education, Bismark will be one of the few fully accredited prosthetists in Bolivia. To this end, we are starting a special fundraising effort to collect $13,500 to send Bismark to Don Bosco University.

If you want your donations to go to a sustainable purpose, please consider donating to Bismark’s education fund.

 

 

Clinic keeps expenses rock bottom

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One reason we are happy to support the work at the Bolivian prosthetic clinic is that we know that, besides doing great work, they also stretch every dollar as far as possible. Hence, your donation will have maximum impact. The cost of a prosthetic limb is largely driven by labor costs, as well as the prosthetic components that go into a leg. In Bolivia, labor is a major factor in the overall expenses. It is a travesty that the main prosthetic technician, like many workers in Bolivia, only earn a few dollars per hour. And yet in Bolivia, that is actually not too bad.  But even a few dollars per hour adds up in this labor intensive process.

In order to keep the second largest cost (components) down, virtually all components are made in-house in the tiny workshop at the clinic.  There are occasional imports of a limited number of components, but they are always sent as donations.

ABOVE-THE-KNEE LIMB (AK)
The most critical part of an above-the-knee (AK) prosthetic limb is the knee itself. In 2011, Matthew Pepe, our founder, convinced an international organization, LIMBS Intl, to provide the design and training to our partner FUNPROBO, in how to make the amazing polycentric knee.

 

This knee:

• Is far more advanced than any other knee made currently in Bolivia.
• Provides the patient a very realistic feeling.
• Resembles a normal walking gait (especially compared to the traditional Bolivian single axis, or fixed knee, leg).

Last month, two more dedicated BWD volunteers at FUNPROBO, cranked out 20 more knees for the next AK patients.

• A polycentric knee, when purchased in the US, costs between $700 and $7000, depending on many variables.
• FUNPROBO’S ‘in-house’ knees can be made for less than $100.

 

FEET
Feet are another problematic component do to the high load and stress they must sustain day-after-day, and year-after-year. Again, it was our founder who introduced the “Shape and Roll” foot design invented at Northwestern University in Chicago.

• FUNPROBO has now made 100s of these feet since 2011.
• Instead of spending $50-$250 on an imported foot, these feet can be made for about $10.

 

CONNECTORS
A third critical and expensive component is called a connector which attaches the prosthetic foot to the lower prosthetic leg.

• The clinic invented its own connector, which saves $1500/year.
• These durable in-house connectors cost less $4 to make.
• These components are made from durable engineering plastics and stainless steel nuts and bolts.

The above measures show the attention to costs that the Bolivian clinic exercises to ensure that all donated funds stretch as far as possible. Your donation will be efficiently used.

POST – PPAM Aid – Patients practice walking early

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We are happy to share news about our physical therapy training aid, which allows amputees to start walking before his/her leg is ready. This project was made possible in the physical therapy department of our partner organization, FUNPROBO.  One of the clinic’s volunteers, Amy Souster, (sent by BWD) bought a new physical therapy aid which allows amputees to stand up and practice balance and exercise before their prosthetic limb has been attached.

The aid is basically an inflatable bag contained within a metal frame. The patient inserts his/her residual limb into the bag and the entire system is supported by a shoulder harness.  This device gives the patients a great boost of confidence that they can walk again.   This device is called a PPAM Aid, which stands for “Pneumatic Post-Amputation Mobility Aid“. Although it is not not well known in the US, nor Latin America, it should be. Now every amputee can practice walking before his or her limb is ready, and therefore, greatly ease the transition to using their new prosthetic limb(s).  The patients also adapt to their final prosthesis much faster if they have first practiced in the PPAM Aid.  

Since that time, Amy has also done her own fundraising, and along with the efforts of Mr. Michael Higginbottom and family, they purchased and donated an additional PPAM Aid system. In addition, they donated the expensive, but necessary, pump system which can maintain the bag at the exact pressure so as not to injure the patient.

If you would like to support purchases of future physical therapy equipment, then you can donate here