The Importance of In-Country O&P Care

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Last April, a team of specialists from Canada and the United States traveled to Ukraine to provide prosthetic care and rehabilitation to patients. As part of those efforts, the team met with and provided training to Ukrainian prosthetic care specialists from Kyiv, Dnipropetrovsk, Odesa, Kharkiv, Khmelnytskyi, and Lviv. Jon Batzdorff, CPO, founder of the U.S. nonprofit ProsthetiKa, was among the volunteers; his organization had been called in to help.

While there are prosthetists and physical therapists in-county, many do not have the training or education to provide upper-limb or advanced prosthetic care, Batzdorff explains. Additionally, the ongoing transition from the Soviet Union-dictated health system to an independent Ukrainian system has exposed gaps in healthcare training-such as the lack of O&P and physical therapy education, he says.

"What's happening now is that virtually all of the upper-extremity patients are sent abroad," Batzdorff says. "The reason that's not a good thing is, even though they can be fit by competent, experienced prosthetists abroad-whether it's high tech or low tech, doesn't matter-the point is that if they are being fit abroad they're going to have more trouble getting follow-up and all amputees who wear a prosthesis need follow-up whether it's adjustment, repair, or replacement."

He acknowledges that, more likely than not, the patients would be able to receive follow-up care in Ukraine even if they had traveled abroad for their prostheses, but it probably would not be the same level of care as if the devices had been made locally. For instance, the correct tools, proper materials, or exact knowledge may not be available to provide the level of care these patients actually require. The Ukraine Prosthetic Assistance Project and ProsthetiKa are working to change this.

"[W]e are not taking inexperienced people and trying to train them in just a few weeks to do upper-extremity prosthetics," he says. "We are taking people that are experienced prosthetists and just giving advanced education."

He also emphasizes that the project's model isn't to try to fit as many patients as possible, but rather to select a few patients whose amputation levels represent the population the Ukrainian prosthetists have difficulty fitting. Additionally, to demonstrate the importance of a team approach, occupational and physical therapists were among the volunteers who traveled to Ukraine. Of critical importance, Batzdorff says, was that patient assessments were done cooperatively with the local practitioners-as the overarching goal is to foster sustainability, and to create independence.

"Sustainability means teaching techniques that are going to be used in the future. We don't want to create dependence." Part of this approach is finding out what tools the local practitioners have on hand before he even sets foot in the country and making sure the materials he uses in his trainings are locally available-not necessarily locally made-so a distribution channel for easily purchasing those materials is in place.

"One of the important things for sustainability is that you plan your exit strategy as soon as you start," Batzdorff says. "If we can start thinking immediately how they can run their own trainings then we're doing a good job for them."

Author's note: At the time of this writing, Batzdorff was preparing to return to Ukraine, this time to help train prosthetists in a different part of the country. Additionally, in September 2015, the International Society for Prosthetics and Orthotics (ISPO) announced that a new member society, ISPO Ukraine, had been created to address the need to improve the country's O&P knowledge base.