New legs, new life

UP with the good, down with the bad. This could have been a slogan repeated by some street protester or an inspirational speaker, but it isn’t. It was a phrase repeated over and over by physical therapist Chona D. Serra.

Serra is the physical rehabilitation coordinator of the Davao Jubilee Foundation for the Rehabilitation of the Disabled Inc. (DJFRDI) and at that time, she was assisting a middle-aged man who was getting used to his newly made prosthesis, walking through the various simulated terrain in what is called the training area at the center at sitio Escuela, Catalunan Grande.

The man has just been welcomed to the center a few weeks back after two years of walking around in crutches in his home in Polomolok, South Cotabato. The man lost his right leg two years ago.

"Maayo kaayo 'ni. Mura na'g ko'y tiil (This is very good, it’s like getting a new leg)," the man said when asked how he is adjusting to the new leg. "Makapanginabuhi na 'ko balik, naa man ko'y motor (I can now start earning again as I have a motorcycle at home)."

DJFRDI is the only facility in Mindanao for gait training of amputees suited up with prosthetic legs.

The foundation also has the only orthopedic technologist who has a diploma from the International Society for Prosthetics and Orthotics (ISPO) in the whole Philippines.

Legs and more

The DJFRDI center, which is made up of old wooden buildings lined up along a driveway marked with a small street signage the size of which is smaller than the signage of a sari-sari store beside the entrance gate, can escape the attention of many, as it seemed to have escaped the attention of most.

Unknown to many Dabawenyos, DJFRDI has been operating for 25 years now, and has catered to hundreds of indigent patients. Aside from suiting up those who lost a leg or two and train them to walk like they used to but with artificial legs, the center also has a prevention of deafness and hearing impairment program, and its Eyework: Vision 2020 program.

The deafness and hearing impairment program offers early detection of ear and hearing problems through massive screenings in day care centers and primary schools. It also accepts indigent patients referred to them, and they provide hearing aids to those found to be hearing impaired.

The Vision 2020 program involves massive eye screenings in communities for identification of children and adults with eye and blindness problems, awareness orientation for health workers on primary eye health care, detection, early intervention, and prevention of blindness and low vision. And they hold regular cataract surgery missions.

As all these are charity work, DJFRDI works closely with local government units and government health facilities, and maintains a network of partners.

It major donor and partner since 1986 is the Christoffel Blindenmission/CBM International which provides annual operating grants and capital grants for programs, equipment, training, personnel and administration cost, and direct subsidies for beneficiaries.

Its major partners and sponsors are: The Handicap International, which it has partnered with since 1993 for its prosthesis program; Liliane Foods, Netherlands, which has been providing small-scale direct assistant for children with disabilities since 1998; the International Committee of the Red Cross (ICRC), which sponsors prosthesis for victims of conflict since 2001; and the United States Agency for International Development, which has been helping the center since 2004 for building and operation of the center’s wheelchair distribution unit.

Locally, it has partnered with local government units of Davao del Sur and 14 barangays of Talomo District in Davao City, the Department of Social Welfare and Development Field Office 11, Davao City Social Services and Development Office, Association of Differently-abled Persons Cooperative, Maharlika Charity Foundation Inc., Pag-asa ng Batang may Kapansanan Inc., Rizal Sped Center, Social Concerns UCCP Foundation Inc., Rep. Antonio Lagdameo of Davao del Norte, and local government units in Central, Southern, and Northern Mindanao.

When new legs bring hope

Up with the good is the advice given as the patient steps up a set of stairs in the training area; down with the bad, given as he steps down. It means, he should use his good leg first when stepping up and use his artificial leg first when stepping down.

Serra also repeatedly reminded him not to limp as he took slow, measured steps, showing the patient how to move his leg and correct his gait.

Just the day before, Wednesday last week at Benz Caf‚ in Ecoland Subdivision, DJFRDI signed a four-year cooperation agreement with the ICRC to continue professionalizing and modernizing the physical rehabilitation services of the center.

The physical rehabilitation program of DJFRDI operates an orthopedic unit, which evaluates and assesses clients for fitting of prosthesis orthosis or simply, artificial legs, custom-made wheelchairs or wheelchairs designed and fitted specifically for the beneficiary-patient, supportive seating, and other assistive devices. The unit also manufactures fiberglass artificial legs, leg braces, special seats, and walkers that go with fitting and adjustments for these. The same program has a physical therapy unit that offers pre-prosthetic and post-prosthetic exercises for amputees fit for prosthesis.

This includes static and dynamic gait training (physical therapy that involves walking around different surfaces one would normally walk on) and wheelchair training at the training area, patient and device follow-up and monitoring to ensure the device use and quality, home-based therapy for home-bound patient, and device evaluation.

The center has given new legs to amputees through the years many of whom were victims of conflict from all sides -- rebels, military, and civilians.

"With around 75 amputee patients a year fitted with new legs, half of our clients are from conflict areas in Mindanao," Davao City Councilor Bernardo E. Al-ag, a medical doctor who is the chair of the foundation and who has been heading the center since 2003.

These are rebels and soldiers who lose legs to guns and bombs and landmines.

Their civilian patients are mostly victims of motorcycle accidents, patients who lost legs to bone tumor and diabetes, and those with congenital defects.

Operations manager Cheryl Cavan said their maintaining strict confidentiality of their amputee patients’ personal situations has allowed them to cater to both rebels and the military.

Maintaining strict confidentiality while attending to patients, especially victims of conflict, is the way the ICRC works as well.

In a workshop with media practitioners in Cagayan de Oro City last February 26, ICRC head of Mindanao sub-delegation Jean-Robert Jorda said, "We are not here to say who is right or wrong. Humanitarian work requires us to talk to all parties in the conflict."

"It does not mean that because we talked to one party that we are with that party. It's just that we have to have access to those in need and the best way to achieve that is to remain neutral," he added. Confidentiality makes this possible.

"Confidentiality for us is a way, not a principle. Neutrality is a principle," he said. Citing their work with prisoners who are behind bars because of conflict situations, he added, "We have access because the authorities know that when we go out of that jail, we will not be giving out information."

The same confidentiality, especially on the personal circumstances of patients from contending armed groups, is maintaining harmony at the physical rehabilitation center of DJFRDI.

"We practice strict confidentiality especially in these cases and so far, wala pa namang nag-aaway sa center," Cavan quipped as she explained that amputees have to be housed in the center where they have a very basic six-room, 24-bed boarding facility as it takes around two and a half months before a patient can be discharged with a new leg.

At the time of the visit by Sun.Star last week, the center had six stay-in patients undergoing prosthetic fittings, adjustments, physical therapy, and gait training.

More new legs

The really good news about the four-year agreement with the ICRC is that the fiberglass technology, which the center is using now that takes two and a half months before the final leg is ready and the patient can leave for home, will be replaced by polypropylene technology that will reduce the fitting to production of a final leg to just two weeks.

The technology upgrade goes with a training component for the center's technologists in Switzerland.

Serra explained that with fiberglass, an initial leg is made and then this is cut and taped several times until the prosthesis no longer feels any unnecessary discomfort. Once the final fit is found, then the fiberglass leg is cast at its final form. With polypropylene, any adjustment is achieved by just hammering the leg into shape. For every discomfort, the area causing discomfort is hammered into shape. No more cutting up, no more long curing time.

By reducing the time between initial fit to final leg, the center can cater to more patients. One prosthetic technologist, Cavan said, can make as many as 150 legs per year at the initial stages, while the technologist and her technicians get used to the new medium.

From the average of 75, the can cater to more than a hundred a year in the first year. This can increase once the technologist and technicians get very good at it.

This will be of a very big help, Cavan said, as there are many indigent amputees who need legs. At present, she said, they have a backlog. Forty-three patients are listed with them for fitting as of February 2011.
Serra added that the technology upgrade will also allow them to cater to the poor amputee patients of the Southern Philippines Medical Center (SPMC) which has around 400 amputee patients.

Losing a leg, especially for the poor can also mean losing a major part of their means of livelihood and survival.

A soldier cannot return to active service without a leg. Rebels will have to while the time away back in their hometowns with nary a work waiting for them. Civilians will have to limp around or even just stay at home.

With the capacity to make more legs and rehabilitate more patients, this will bring better prospects, better livelihood opportunities and a better life.

Moving on

In a cabinet inside the orthopedic unit were several artificial legs collected from patients who have outgrown them through the center's 25 years.

Wooden, metal, leather, bamboo, some looking more like stilts than legs, a testimony to how artificial leg technology has developed through the two and a half decade DJFRDI has been helping those in need... Serra said that a long time ago, carabao leather was also used, but they do not have any of these as memento of those long-ago years.

"Ito yung mga iniwan na lang ng mga pasyente namin kasi meron na silang iba," Serra said.

The artificial legs in that cabinet appeared like silent witnesses to a new life offered to the patients who once used them and have gone on to get better ones along with, presumably, a better life.
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