June 18, 2017
June 18, 2017
Getting a prosthesis through Argentina’s health system takes time and considerable effort. Low-cost prosthesis workshops are filling the gap by using creative substitutions to perform the same functions at far less cost.
BUENOS AIRES, ARGENTINA — When part of Roxana Itatí Godoy’s leg was amputated after an accident, her first thought was that she would do whatever it took to walk again.
As soon as she began the process to obtain a prosthesis through her health insurance, she learned that it wouldn’t be easy.
“There was a lot of bureaucracy, the health insurance doctor who saw me at the hospital would lift my blanket to see if I really was missing a leg; they were investigating me,” she says.
After months of paperwork, she was put on a waiting list for at least a year and a half to receive a prosthesis.
“It takes a long time to qualify. Sometimes the person dies without being authorized,” says Godoy, who is 41.
INSIDE THE STORY: GPJ reporter Lucila Pellettieri learned during the course of her reporting that stories of innovation don’t always have to be followed by glitz and glam, or cutting-edge technology. Sometimes, stories of creativity and resourcefulness can be just as exciting. Read the blog.
“I was already thinking about getting rid (selling) of some stuff and asking my father-in-law for help to buy one, but they’re very expensive.”
Fortunately, she heard that a nearby health center was putting in a workshop to make prosthetics and provide them free of charge.
“That same day I returned home with my prosthesis, I walked out with crutches,” she says. “I was very lucky; if it were not for them I wouldn’t be walking now.”
Given how difficult it is to obtain a free prosthesis through Argentina’s health system, organizations seek alternative solutions to provide them for people in need. El Instituto Nacional de Tecnología Industrial, INTI, an Argentine federal agency in charge of industrial technology development, has created a system to open low-cost prosthesis workshops in public health centers, while the nongovernmental organization Amputados Sin Fronteras conducts prosthetic recycling and offers legal advice so that people can be reimbursed through their health coverage.
Seven prosthetic and orthotic workshops operate free of charge throughout Argentina now. INTI plans to open between five and seven new workshops this year and the Ministerio de Salud, Argentina’s ministry of health, will create 10 more. The current workshops are in Santo Tomé, Corrientes province; Río Grande, Tierra del Fuego province; 9 de Julio y Malvinas Argentinas, Buenos Aires province; Río Gallegos, Santa Cruz province as well as in areas of the Catamarca and Mendoza provinces.
“We want people to be able to do what they did before and demystify that it takes a lot of technology or a workshop of $40,000 to achieve it,” says Daniel Suárez, a prosthetic practitioner who works with INTI.
Suárez and his team succeeded in replacing the machines used to make prosthetics with a pizza oven, a vacuum pump and other common equipment to make a machine that costs about 60 times less. This reduced the cost of establishing a prosthetics workshop down to $3,100, Suárez says, when normally they can cost between $200,000 and $400,000.
“The problem is that the issue of prosthetics is handled commercially, it has a lot of surcharges,” says Suárez, who makes monthly visits to the INTI prosthetics workshops to train staff and check on people who’ve already been fitted with prosthetics. “I care about patient integration, that they can be independent and be able to socialize.”
A workshop can make a below-knee prosthesis for $654, while on the market it costs about $1,300, Suárez says.
Lucila Pellettieri, GPJ Argentina
Laura González Arroyo, an attorney who founded Amputados Sin Fronteras in Argentina after an orthopedist defrauded her, says the lack of orthopedic devices creates difficulties and places people apart from the rest of society. When mobility is lost, they feel excluded and lose independence, she says.
“Health insurance programs and the State have the responsibility to cover prostheses but they don’t want to do it because of the high cost,” she explains. “We try to help equip those who are seen in public hospitals and we advise others to pursue their claims with health insurance programs.”
Susana Sequeiros, a physician and director of the Comisión Nacional Asesora para la Integración de las Personas con Discapacidad (Conadis), a government organization that seeks to protect the rights of people with disabilities, says it’s important for people to quickly access the devices.
“If you’re working with an amputee, the person has to go through rehabilitation and learn to walk with the device; if I don’t have the device, the prosthesis, what I do is prolong the process,” she says.
The commission works closely with INTI to create a federal network of rehabilitation centers and workshops of prosthetics and orthotics.
“Being able to have the workshops at the local level in various regions eases the process and speeds up access,” Sequeiros says. “The idea is to be able to build a network so that the resources we have are efficient, focusing primarily on what it takes for people to mobilize and do the paperwork to get their devices.”
Joaquín León Sánchez, 27, lost his legs when he was 8. Since he lived in Bolivia’s countryside with his family and it was impossible for his parents to pay for prostheses, he moved to an orphanage for children with disabilities, where he got the devices and underwent rehabilitation. But prostheses wear out and break. As an adult faced with the hardship of buying new devices, Sánchez decided to move to Argentina.
“Ideally, I wanted to get a job as quickly as possible to have health insurance and get prosthetics, but wearing prostheses complicates the job search,” Sánchez says. “You can’t do heavy physical work.”
He later learned that the Argentine government offered prosthetics to people without health insurance, and he started the paperwork in 2014. In 2015 Amputados Sin Fronteras in Argentina fitted him, and in January 2017 he completed the process with the state and obtained his new prostheses. Getting the documentation took the longest.
“Many people get tired because health insurance programs don’t easily give them prosthetics,” Sánchez says. “If one keeps trying you can obtain them but the paperwork is labor-intensive. For someone who has just suffered an accident and is just getting used to it, I can’t even imagine how difficult it must be.”
Lourdes Medrano, GPJ, translated this article from Spanish.