Nepal Trek 2019
Trip Perspective: Improvement of prosthetic services through silicone liners and clinical education in Nepal
By Malena Rapaport, CP
In October 2019, I had the privilege of participating in a trip to Nepal with Operation Namaste, a not-for-profit organization striving to improve access and quality of prosthetic and orthotic services in the developing world. We visited Nepal with a team of prosthetists, a physiotherapist, and a peer-support amputee liaison. We went with the goals of education and collaboration with Nepali practitioners, as well as testing Operation Namaste’s new method for making sustainable and cost-effective silicone prosthetic liners.
A prosthetic liner is the interface between an amputee and the prosthesis. The material and quality of the liner greatly affects the users’ comfort and mobility. Silicone prosthetic liners have been shown to improve comfort, decrease pain, result in less frequency of skin issues, and improve overall walking function (Baars & Geerstzen, 2005)*. This translates into amputees’ ability to walk longer, maintain employment and live their lives to their fullest potential.
In North America, the use of prosthetic liners made of gels, such as silicone, has become the standard of care for many decades. However, this is not the case in countries such as Nepal due to their high cost. SILC (Silicone Interface Liner Comfort) Solutions is Operation Namaste’s system for fabricating silicone liners locally, in standard sizes (e.g. small, medium, large and extra-large) using CAD-designed, 3D-printed molds. This allows Nepali prosthetists access to high-quality, medical-grade silicone liners for less than $50USD as opposed to the current cost of $200USD.
Access to prosthetic liners and cost are not the only barriers to use. Prosthetists need to know and understand common practices and skills to use silicone liners with patients not only effectively, but most importantly safely. This is was one of the main goals of this year’s trip to Nepal. Each member of our team presented at Operation Namaste’s 2019 Education Summit aimed to enhance knowledge and skills pertaining to silicone prosthetic liner use in amputee care for both physiotherapists and prosthetists. Held in Kathmandu, this interdisciplinary education conference was extremely well-attended allowing participants the opportunity to gain hands-on experience with patients, while accessing our collective expertise and knowledge. Through this collaboration, we also developed relationships with prosthetists and physiotherapists in Nepal, and various places in North America, helping to establish the beginnings of a global network of clinicians and experts.
During this trip, we also visited a number of rehabilitation hospitals and met many prosthetists and physiotherapists working with amputees of all ages and amputation levels. Through these visits, we were able to further expand this global network and learn about questions, concerns and desires of prosthetists with regards to silicone prosthetic liners.
Malena’s first introduction to prosthetics was while playing sitting volleyball with members of the national team during her time as a kinesiology student at the University of Toronto. Since then, she fell in love with prosthetics through interactions with passionate professionals in the field. She graduated from the P&O program at BCIT and shortly after finished her Masters in Rehabilitation Science from McMaster University, both which ignited her curiosity for holistic, patient-centered and evidence-based care. Malena has been using outcome measures and research evidence as tools to help achieve patient’s goals and enhance quality of care.
Born and raised in Argentina, Malena now lives in Vancouver, BC, Canada.
*Baars, E. C. T., & Geertzen, J. H. B. (2005). Literature review of the possible advantages of silicon liner socket use in trans-tibial prostheses. Prosthetics and Orthotics International, 29(1), 27-37.
Trip Perspective: From Founder Jeff Erenstone, CPO
The purpose of our trek to Nepal was to assist with developing world care. However, we also had a lot of fun too! The trip started with some sightseeing in Kathmandu, including visits to their amazing historical and cultural sites, most notably the famed Swayambhunath Stupa (Monkey Temple). Later in the trek, we spent 3 days hiking in the Himalayan mountains. Toward the end of the trip we visited more cultural sites in Bhaktapur. These sites, punctuated with great food, wonderful people, and first-rate accommodations, made for an amazing trip.
Below are some pictures from our 2019 Trek.