This last week Tim casted, fit, and sent a patient home with a new prosthetic leg. For the patient, it was his first prosthesis. For us, it was the first prosthetic or orthotic fabricated and delivered by Haiti Adventist Hospital’s O&P clinic. It’s also the first leg Tim has made in over a year (he was furloughed early March last year due to COVID). It’s all pretty cool!
I got to be in the room with Tim and the patient during the fitting and as I watched I thought of all the things that have gone into the making of the moment. Tim’s hands cast the limb, shaped the mold, selected the componentry, and tightened the bolts, but to enable that many other hands have been involved. Our first patient walking out on a new leg is truly an act of God-but one that we hope to make routine. I have written about how Tim and I came to work at HAH, but I would like to share more about how this O&P clinic puts together leg days.
The mission of Haiti Adventist Hospital is to continue the healing ministry of Jesus Christ by providing quality care to all classes of people. Specifically, the problem the O&P department is addressing is an under availability of O&P care to patients in Haiti, particularly poor patients. The goal has been to open an O&P clinic at HAH to provide quality care at a price that is appropriate for the needs and means of our patients. The logistics of doing so are complex. Simply making prosthetic legs anywhere requires large amounts of bulky equipment and a laundry list of supplies. The mechanics of fabrication requires grinders, an oven, heat guns, a sandbox, suction stands, an industrial sewing machine, plus a large assortment of hand tools, as well as consumables like plastic, plaster, glue, rivets, and componentry (prosthetic knees, pylons, and feet, plus all the little things to get those to stay together). Setting appropriate prices is another gambit. Health insurance in Haiti doesn’t cover prosthetic devices so everything here is essentially cash pay. If we give prosthetic legs away for free, we will decimate the industry in Haiti (there are a few-precious few-O&P clinics that already operate in Haiti and we’d very much like to see them continue). But if we set prices based on the cost to actually deliver the service, we may provide for the rich, but rarely for the poor. What do we do? How do we get the stuff here and figure out how to provide it?
First of all, we pray. These are multifaceted issues that are beyond us. We pray for wisdom, partners, guidance. We’ve been nudged and directed and others have too.
To meet the challenges of equipment and supplies, our philosophy has been to purchase what we can locally, as long as the price is not significantly more than in the US, both because it is better for the economy and the climate, and because it is (sometimes) easier than shipping things down. What we cannot purchase in Haiti, we procure and import from the US. Much of the specialized equipment and supplies could not be purchased in Haiti and so it was acquired by donation or with donated funds in the US, and loaded onto a container that HAH was already planning to ship down. A few items (for example: glue, an industrial sewing machine) were available locally and so were purchased in Haiti. Initially, we explored the idea of manufacturing our own components locally, but the equipment to do so was costly and complex, and the product inferior. Instead, we have accepted donations from Tim’s O&P network and created a partnership with a company in the US (Penta Prosthetics) which cleans, tabulates, and shares out used prosthetic componentry to international clinics. Through these partnership we have been able to get componentry our patients will benefit from at the cost of getting it down here. There are certainly supply and shipping costs, but through these collaborations, they are much reduced.
The sum of all these efforts is that O&P clinic operating expenses are low enough that we can set prices-not on our costs or on for-profit targets-but based on Haiti’s funky market and patient need and means. We determine what the patient pays in a few stages. To determine base pricing, we evaluated the local products and prices, our costs, and developed a price list. From there we rely on HAH’s financial counseling office. The financial counseling department assesses patient need and means and can adjust the price paid, pulling from outside sources as needed to get the patient care and keep the hospital solvent. Our systems are not perfect and we have made mistakes (there will be more), but we celebrate that our first patient walked out last week with a leg that fits him. Assuming he continues to show up for follow up visits, and nothing too crazy happens, he will continue to get follow up care at our clinic in the coming months. It’s all pretty cool. We rejoice, thank you for lending a hand, and invite you to join with us in praising a big God who has been knitting legs together for a lot longer than we have.
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| Leg #1 |
