Addressing a need by printing prosthetics (First appeared in The Norwalk Patch)

Losing a hand, digits, or limbs can sometimes be viewed as unfortunate accidents or the traumatic consequences of life in war-torn regions. However, estimates suggest that major (amputation above the elbow, below the elbow, above the knee, below the knee, or the foot) or minor (amputation of the hand, fingers, or toes) limb loss occurs more often than we realize in the general population. According to separatereports, almost 2 million people lived with limb loss in the USA and hospital expenses associated with amputations totaled $8.3 billion in 2009. A small fraction of the cost could possibly be attributed to treatment of 1,715 US soldiers (as of December 2012) who lost limbs in Iraq or Afghanistan or congenital limb deficiencies. Based on a 2008 report, the remaining amputationswere mostly caused by vascular disease (54%) – including diabetes and peripheral arterial disease – trauma (45%) and cancer (less than 2%). Thepercentage of non-traumatic lower limb amputations in diabetics increased to more than 60%, according to data from the 2011 National Diabetes Fact Sheet. Moreover, it is estimated that up to 55%of diabetic amputees will require amputation of the second leg within 2‐3 years.

Globally, one amputation occurs every 30 seconds. In addition, The International Society for Prosthetics and Orthotics and the World Health Organization (WHO) estimated that at least 0.5% of populations in developing countries and other regions are in need ofprostheses or orthoticsand related services. Prosthetic devices can range from basic walking support for lower-limb amputees to state-of-the-art devices mimicking human movement, enabling amputees to navigate rough terrain, climb stairs, or perform athletic feats. Physical and societal obstacles, leadership and governance, service delivery, human resources, production, and affordability are key barriers to assisting amputees.

While the WHO made suggestions to overcome these barriers, it means that in practice considerable time would have elapsed before people like Richard Van As in South Africa and limbless children in the Sudan obtained access to affordable prostheses. Van As, a master carpenter, lost four of his fingers in a work accident and collaborated with others to make mechanical fingers (using a 3D printer). Richard has since expanded theRobohand project to making mechanical fingers for people with congenital deformities or who have lost their digits. Similarly, Not Impossible’s Mick Ebeling gave hope to Sudanese child amputees (through Project Daniel) by setting up a 3D-printing prosthetics lab and facility in that country.

State-of-the-art prosthetics may simply be beyond the pocket books of many amputees. Could Project Daniel and the efforts of the Open Prosthetics Project be replicated in other low- or middle-income countries where disabled people may have inadequate health insurance? In those cases, low-cost 3D-printers (such as a prototype currently in development in Togo or the printrbotPLUS) could conceivably be used to print replacement digits while awaiting evaluation by a medical professional. While amputees in poor countries and elsewhere await government support, ordinary folks will likely continue to fill an important need and inspire others through their actions.

The caregiver (First appeared in The Norwalk Patch)

Physical strength is measured by what we can carry; spiritual by what we can bear.

— Unknown

The caregiver pulled his car into the nursing home parking lot. Rhinestone Cowboy, the country song made famous by Glen Campbell, faded with the sound of the car engine. His reprieve from the day-to-day worries over an ailing father, an Alzheimer’s disease-sufferer, was at an end. His brother had suggested the road trip. The weekend admiring fall foliage and reminiscing over the family had been a bittersweet event. The highlight of the trip had been a joint viewing of embroidered narratives by Holocaust survivor,Esther Krinitz, at a local museum. Her stitch-by-stitch tale of horrors encountered during World War II provided evidence of a sharp memory, unlike the jumbled thoughts of his father.

He had seen the warning physical signs marking the onset of his father’s disease and watching the progressive deterioration had taken a toll on his own well-being. He had needed coping tips and the support of a sibling. He felt rejuvenated, knowing that hiscry for help after succumbing to caregiver burnout, had not fallen on deaf ears. He signed his name in the nursing home guest book, punched the door code for the Alzheimer’s wing and knocked on his father’s door.

The massage therapist let him into the room. His sister-in-law had suggested the therapist’s services as a birthday treat for his mute father. When he saw the light in the old man’s eyes, he knew that she had been right. His father had responded to the warmth of the therapist’s caring touch. His own gruff expression softened as he held his father’s hand. The meeting was brief, because there was nothing left to say anymore. However, he felt strangely at peace as he returned to his car and switched on the radio. Someone was interviewing former Supreme Court Justice, Sandra Day O’ Connor, on one of the stations. The interviewer gingerly enquired about her late husband, who had died of the disease in 2009, before shifting back to the more comfortable terrain of her illustrious career.

He reached his home and sorted through the pile of papers and magazines on the kitchen table. A Time magazine article about new biomarkers for detecting the memory-robbing illness in its earliest stages, caught his eye. Another piece of paper about Glen Campbell’s brave fight with Alzheimer’s disease fell to the floor. He would have to read that article another time. He first needed to figure out where to come up with the next month’s payment for his father’s nursing home stay. He balanced his checkbook and marked the calendar. Next week he would attend a caregivers’ support group meeting. The topic would be art and music therapy for Alzheimer’s disease. The purpose that an early-Alzheimer’s-disease sufferer found in Poetry, would also strengthen each member of the group. His courage returned because he could now rely on the support and understanding of other people.

 

Children are our future (first appeared in The Norwalk Patch)

Children are the poorest age group in the country, according to the Children’s Defense Fund. Nearly 22% of all US children live in families with incomes below the federal poverty level– $23,550 a year for a family of four. Current and future health risks are greatest for children who experience poverty when they are young and/or when they experience persistent poverty, according to several reports. Where do these dismal trends fit into the national dialogue about building a healthier America?

According to the Robert Wood Johnson Foundation’s (RWJF) 2014 report, improving the health of all Americans should start with an investment “in the foundations of lifelong physical and mental well-being in our youngest children.” Investing in the very young fosters success in later life and may reverse the negative health consequences of prolonged exposure to adversity (e.g. the Adverse Childhood Experiencesstudy was among the first investigations to report a strong link between adverse early childhood experiences and conditions such as depression, addiction, diabetes, and heart disease). Support for vulnerable young children should therefore be a national health priority. The building blocks for a lifetime of good health should include education and “direct interventions designed to improve health and protect the developing brain from significant adversity that can lead to illness.” Health initiatives may include strategies to decrease widespread childhood obesity– a key risk factor for numerous chronic conditions. The New England Journal of Medicine reported that” incident obesity between the ages of 5 and 14 years was more likely to have occurred at younger ages, primarily among children who had entered kindergarten overweight [1].”

The RWJF report focused on factors that must be addressed in order to prevent the United States from slipping even lower than its 2009 ranking of 27th place in terms of life expectancy at birth (out of 34 of the world’s affluent countries). The recommendations are:

1.       Make investing in America’s youngest children a high priority

2.       Fundamentally change how we revitalize neighborhoods, fully integrating health into community development

3.       The nation must take a much more health-focused approach to health care financing and delivery. Broaden the mindset, mission, and incentives for health professionals and health care institutions beyond treating illness to helping people lead healthy lives

The health and educational rewards of meeting the first objective are currently being measured in different states. For instance, a longitudinal study (2006-7) of the outcomes associated with 3 cohorts of 4-year olds in 11 Utah schools most impacted by poverty, showed that at-risk children (who attended high quality preschool programs) used special education services at significantly reduced rates compared with those who did not receive high-quality early tuition (cost savings of about $1 million). Moreover, the SY06-07 Preschool Cohort had closed the achievement gap by the 3rd grade. Social impact investments, along the lines of the Early Childhood Innovation Accelerator, could increase the access, availability, and quality of early childhood programs for disadvantaged children. The aim of the Accelerator is to “rapidly increase the availability of high-quality early childhood learning opportunities, while building measurable successes backed by evidence, accountability and results.”

The priorities for meeting all the health objectives were summarized in a recent Google hangout and the full report of the RWJF commission can be viewed here.

Reference

1.    Cunningham, S.A., M.R. Kramer, and K.M.V. Narayan, Incidence of Childhood Obesity in the United States. New England Journal of Medicine, 2014. 370(5): p. 403-411.