The international organizations-World Rehabilitation Fund Inc.

E. J. Taylor 

Address given at the International Assistance Programmes Session, Second World Congress of the International Society for Prosthetics and Orthotics, 31 May, 1977 New York City

The World Rehabilitation Fund (WRF) began in 1955 as a very small organization. For the first few years our resources were expended to provide fellowships to bring people from other countries to the United States of America and, in particular, to the Institute of Physical Medicine and Rehabilitation, New York University Medical Centre for advanced training.

Most of the resources were spent to provide fellowships for physicians. The Centre had been training physicians from overseas countries prior to the founding of the WRF and many of the leaders in rehabilitation throughout the world have had training at New York University.

In those early days fellowships were also provided directly from the Institute of Rehabilitation Medicine and later from the WRF in the fields of prosthetics and orthotics. When the programme at the Institute was run by the late William Tosberg, I recall we had trainees from Japan, Korea, Burma, Thailand and Colombia.

In the early 1950's our President, Howard A. Rusk, M.D., made a trip around South America to visit a number of former physican trainees. When he returned he stated he was appalled by the lack of prosthetic-orthotic services. Those that were provided, primarily by unskilled persons in private shops, in many instances contributed to furthering the disability of a crippled child rather than correcting it.

I have always believed that the two essential services for a crippled child in the developing country are mobility and education. A child must have mobility and must have some education to have a fighting chance of becoming independent.

In 1957 the World Rehabilitation Fund gave a fellowship to Mr. Juan Monros, a professional soccer player from Spain who had played in Switzerland who recognized that he was approaching an age when he could no longer play soccer professionally and wanted to learn a trade.

At that time we noted that a new technology in prosthetics and orthotics was beginning to emerge based on the use of plastics and prefabricated parts. The WRF decided to test the hypothesis that a person with mechanical aptitude, even though he lacked formal academic preparation, could be taught orthotics in five months. This we did successfully in Peru and then in Brazil.

Since then we have been conducting training programmes throughout the world and have now provided courses for approximately one thousand students. In many instances, however, the student took a course in orthotics and subsequently took a course in prosthetics, therefore, the number of individuals is somewhat less than 1,000.

We have specialized in the developing parts of the world. No fellowships for such courses have been given to persons from Europe, the United Kingdom, Ireland, Canada, Japan, or the United States. Of the 1,000 persons trained, to our knowledge, the vast majority are practising their professions. Around twenty have died or were killed in Vietnam and we know of only four instances where the trained individual has left the profession for another occupation.

The WRF global programme in prosthetics and orthotics has been very carefully developed. After four or five years, the WRF established permanent regional training centres in prosthetics and orthotics. To staff these centres a number of potential instructors were brought to the U.S. for a specialized course in 1971 at the Prosthetic-Orthotic School, New York University Medical Centre. From time to time we have brought individual persons to the U.S. to receive further training at the Prosthetic-Orthotic School, New York University Medical Centre, the Veterans Administration Prosthetic Centre in New York, the Newington Children's Hospital in Newington, Connecticut; and the Institute of Rehabilitation Medicine, New York University Medical Centre. We have received complete co-operation from these training sources.

In June of this year (1977) we will hold a two-week course in cosmetic restoration at the Veterans Administration Prosthetic Centre and a course in the use of plastics in orthotics at the Institute of Rehabilitation Medicine, for trainees from Brazil, Peru, Nicaragua, Taiwan, Korea, and Hong Kong.

In July of this year the eleventh course in prosthetics and orthotics will be held at the WRF Regional Training Centre in Sao Paulo. A total of approximately 200 technicians has been trained from all parts of Brazil and from every country in South America, including Surinam and Guyana. Trainees have been accepted from Haiti, the Dominican Republic, Jamaica, Trinidad, Nicaragua, Guatemala, and Mexico. We have also had a number of trainees from Angola and Mozambique, the former colonies of Portugal, who speak Portuguese the language of Brazil. We have also had trainees from other parts of the world including Hong Kong, and at the course starting in July, there will be one trainee from Korea and two from the Republic of China (Taiwan).

Earlier this month the WRF began a five-month course in Bangalore, India, which will be the third course held at the WRF Regional Training Centre in Prosthetics and Orthotics in Bangalore. This will be the fifth such course held in India. We have had trainees not only from India but also from Thailand, Indonesia, Turkey, Hong Kong and Sri Lanka.

The WRF started a regional training centre in Hong Kong. At that time there was a long waiting list for persons needing artificial limbs and braces. As a result of the courses there is no longer a waiting list, consequently, WRF has transferred its regional training centre from Hong Kong to Taipei, Taiwan. While the centre was in Hong Kong, it gave training to persons from Indonesia, Malaysia, the Philippines, Western Samoa, New Hebrides, and Korea.

The WRF has held two courses in Africa, one in Uganda and one in Ethiopia, and has trained people from Egypt, Kenya, Tanzania, Lesotho, Swaziland, Nigeria, Togo, Camaroon, Benin, Ghana, Guinea, Liberia, Mozambique, Angola, Zaire, Zambia, and Upper Volta.

The WRF entered into a tentative agreement with the World Health Organization, under which the WRF has agreed to provide consultation services, training of personnel, import equipment and supplies, and supervision for prosthetic-orthotic shops in all of the African republics. Mr. Monros was in West Africa in March of this year and was scheduled to spend time at the WHO Regional Office for Africa in Brazzaville, The Congo. As the President of the Congo had just been assassinated a few days prior to his arrival, the borders were closed and Mr. Monros was not able to enter The Congo. This programme has been completely funded.

We believe that prosthetic-orthotic services in Africa must be made available at low costs and should be provided as far as possible with supplies available within the country. We do not believe in long term training, particularly in overseas countries which results in trainees emigrating as their own Governments cannot pay wages comparable to those in the developed parts of the world. Nor do we believe in long term overseas training in which the technician becomes completely dependent upon supplies which must be imported. Neither the individual patient nor his Government can afford to import supplies. Using the same techniques and often the same components it is possible to produce, under the WRF approach, a PTB prosthesis in Africa for USS20-f50 and in India for USS20-S40. The huge difference between costs there and in the developed parts of the world results from the fact that the salaries paid to technicians in Africa and India are one twelfth to one twentieth of the salaries paid to a certified prosthetist-orthotist in the United States.

Prior to the beginning of hostilities in Lebanon, there were two major prosthetic-orthotic services there, one of which was at the American University of Beirut. The WRF provided minor assistance in the training of its director, Amin Haaj, and provided some of the equipment for the shop and the physical therapy section. The second shop was at Al-Kafaat, a voluntary organization providing shelter workshop services for approximately 125 disabled persons, a school for the physically handicapped and schools for the mentally retarded and deaf, as well as the prosthetic-orthotic shop. The shop is intact, and the three principal technicians have remained throughout the hostilities in Lebanon. They have provided services for approximately 400 persons thus far in 1977, utilizing equipment and components flown to them by the WRF from Germany. The U.S. Agency for International Development has made substantial grants to American University, the International Red Cross, and the United Nations, all of which are starting from scratch and ignoring the fact that a well trained cadre of technicians with the equipment is available at Al-Kafaat.

The Dutch Government has sent an expert in prosthetics to Lebanon who has measured the amputees and the prostheses are being fabricated in the Netherlands. The Dutch will send a team of about 20 people to fit the prostheses and give patients training in their use. They have stated they cannot fit more than 450. Currently the British Government is also considering giving some assistance in prosthetics and orthotics. The WRF is concerned that when the foreign personnel leave, there will be no trained prosthetist-orthotist personnel for repairs or to manufacture new devices for children who need new braces as a result of growth. We consider this a prime example of "reinventing the wheel", when administrators who know nothing about prosthetics and orthotics make decisions to import personnel and totally ignore locally trained people who have had six to seven years of experience plus training in the United States.

The WRF estimates that the number of amputees in Lebanon is from 3,000 to 4,000. Actually no one knows. Persons without experience have reported there are 700 to 800 amputees. As so frequently happens, the original estimate has been recopied in all official reports but there is evidence there are far more than the original number.

The World Rehabilitation Fund has every intention of continuing its prosthetic-orthotic services until all the needs have been met.