This was recently posted on the OANDP.COM forum. I have received permission to reprint it from Eddy Fuentes, CPO. I think he brings up some good points. I know for the future I will be contacting him the next time I head down to Guatemala. My eyes have been opened to the fact that my “helping” may not be helping at all, I hope that has not been the case for my past trips.
Here is the letter:
Just over 4 years ago I was enjoying a good practice as a Certified Prosthetist and Orthotist at the Shriners Hospitals for Children in Saint Louis Missouri where I spent close to a decade with previous successful experiences in Kentucky and Texas. When I told the chief of the Staff at the hospital that I was moving back to Guatemala he was shocked and thought that I was crazy. At the time I had two kids born in Guatemala (now I have three). The fact is that for years my wife and I where facing the dilemma if we should give ourselves another chance to live in Guatemala and be reunited with our families. Another important factor was that if we moved back, it had to be before our kids became teenagers in the US or they probably wouldn’t like to come back with us.
After the decision was made to return to Guatemala, we knew we had to face the realities and a lot of challenges there especially as to how we were going to survive financially and have a life style that would not too drastically impact our children. So I invested in a small practice that my brother Julio Cesar was running to make it the best in the region. I evaluated the market and I thought that I had a good chance to make it. I knew about the local prosthetists providing services at the Social Security Hospital, the army hospital and others who also were providing private services as well.
But I never thought that my biggest competitors where going to be some medical teams providing O and P services in Guatemala.
For over 20 years I have been involved consistently with missions providing humanitarian assistance in all Latin America but we always have done it in a way as 1) not to affect local prosthetists and 2) always target specific needs and specific cases that otherwise would never get a prosthesis.
I have participated with many non-governmental organizations (NGOs) such as Children of the Americas from Kentucky for over 15 years and The Barr Foundation from Florida as the Central and South America Prosthetist Coordinator since the mid 90’s. More recently I have worked with Children’s Aid Mission International from Kentucky and Heal The Children Missouri Chapter. I also initially assisted with The Walking Free Project to establish its mission at a local infantile hospital in Guatemala.
Some of these missions come to Guatemala loaded with their good heart and good intentions but with little knowledge as to who is here and which services are being provided. They go to different areas offering free services thinking that they are doing a good thing for the patient and for this country. Some of these teams have established themselves offering full time services to local hospitals, rehab centers and even to private institutions and physicians. Their services are free of charge but they are always willing to accept monetary donations making it at the end a commercial venture for some of them.
In some cases they partner with local Prosthetists who may be less than honest and who see mission activities as an easy way to make some money in many cases without the knowledge of those who came here to help. For example, teams come with a lot of O and P supplies that were donated by private facilities and distributors with good intentions to ease the pain and suffering of those in need without knowing that these supplies may end up in the wrong hands and only enriching the black market.
In many cases International Mission O&P Organizations have provided prosthesis or orthoses to patients that have resources and can pay for private services. I believe these NGOs have the moral obligation to refer those patients to local legitimate practices but often instead they make the legs in exchange for a monetary donation.
This leaves the local prosthetists/orthotists left behind for follow up with resources to make legs for profit without investing on their own. This places unsuspecting and well meaning NGOs in a position as a competitor with an unfair advantage over the local practitioners trying to make a living. We just can’t compete against “free legs”. In this fashion legitimate businesses have almost no chance to be successful; My practice in Guatemala now still has a chance to survive but we have had to switch mainly to high tech services to target a different market where there is still little unfair competition.
There are always people in need and help is always welcome and always needed. These missions can have a positive effect on those amputees in need but only if is done the right way, only if they partner with the right people and resources go to the right hands. My good friend Tom Di Bello, CPO from Texas always tells me how happy he is to see me here working with my own people in Guatemala. Many other friends and colleges wonder if I will ever go back to the US, a thought that did not cross my mind for quite. I guess now I better start thinking about it.
Eddy Leopoldo Fuentes, C.P.O.
ORTOPEDIA CENTROAMERICANA – GUATEMALA
Certified by The American Board for Certification in Orthotics and Prosthetics-ABC
Active member of the American Academy of Orthotists and Prosthetists-AAOP
Professional and Clinical Services – Otto Bock HealthCare