Asian Ties

Training P&O Practitioners to Help People Walk Again

Prosthetics and Orthotics (P&O) is a medical profession that involves the fabrication and fitting of artificial limbs, corsets, and other devices to assist persons with physical disabilities. In Southeast Asia, where there is strong demand for the services of P&O practitioners, the Nippon Foundation is assisting with the operation of schools to train them, in the hope of restoring the mobility and independence of persons with disabilities.


The Job of P&O Practitioners

Each prosthetic or orthotic device needs to be customized to fit the particular patient. The process begins by taking measurements and creating a plaster mold, followed by the actual fabrication of the device and final fitting—and a P&O practitioner handles every step of that process. Ryota Itagaki, an instructor at a P&O school in Jakarta, Indonesia—one of six such schools supported by the Nippon Foundation—explains the important role played by P&O practitioners:

“In the case of an artificial leg, to take one example, if the socket of the prosthetic does not properly fit into a user's amputated limb, his or her weight will press against the residual limb, making it too painful for the person to even walk. And an artificial limb used by a child also needs to be adjusted in line with the child’s growth. Even for adults, adjustments have to be made periodically because a residual limb might expand from the use of different muscles to accommodate the prosthetic—and in other cases it might contract. The pivotal moment with regard to an artificial limb is the fitting. This is when the P&O specialist needs to adjust the device to the patient’s body so that he or she can walk in comfort.”

The question of whether an amputee can find a trusted P&O specialist to fit them with a needed artificial limb can have a huge impact on that person’s future.

The need for artificial limbs is particularly high in Southeast Asia because of accidents from uncleared land mines from civil wars, and polio and other diseases. Also, in recent years, the increase in motorization in the region has led to an increase in the loss of limbs from traffic accidents. These factors have created a situation where there are not enough artificial limbs available to meet demand. The Nippon Foundation has been supporting the activities of Exceed, an international NGO that runs P&O training schools (known as the Cambodia Trust until January 2014), for many years. Exceed aims to foster the human resources to provide P&O devices to persons with disabilities who are not able to receive them through public assistance.

A School that Gives Patients New Hope

PhotoIn 2009, a new school to train P&O practitioners opened in Jakarta, and currently around 50 students are enrolled in the three-year program. As part of the students’ practical training, free prosthetic or orthotic devices are provided to patients. On the day we visited the school, a plaster mold was being made to fabricate a prosthesis for a woman whose right leg had been amputated below the thigh. She had the following to say about school’s efforts:

“I had previously had another prosthetic made for me at a hospital, but it felt so uncomfortable that I couldn’t walk—so I was soon back on crutches. A friend of mine who was also injured in a traffic accident told me that she was able to walk again after receiving an artificial limb from the school. This rekindled my desire to walk and inspired me to try a new prosthesis. The plaster for creating the mold felt a bit hot, but I didn’t mind so much when I thought about how I might be able to walk again.”

It can take anywhere from three to eight weeks to complete a prosthesis, depending on individual differences including the nature of the injury and the adjustment period. In countries like Indonesia that have large Muslim populations, there are also cases in which some patients or their families might object to a woman being treated by a man, so attention has been paid to having female patients be assisted by female students. Even outside of Indonesia, it is common for female specialists to treat adolescent female patients, so this is a field in which women need to play an active role.

At the building next to the school in Jakarta, patients fitted with their new artificial limbs can practice walking. One patient, assisted by one of the students, slowly stands up and then, to begin with, walks about 10 meters while holding on to a railing. Just a few minutes later he is walking normally, without holding on to anything. His once tense expression gradually eases into a smile. In contrast, the nearby students have serious expressions as they earnestly listen to the feedback from the patients and jot down careful notes that will be helpful in fine-tuning the adjustments.

Patients’ Smiles Provide Motivation

Photo of Ryota Itagaki, an instructor at a P&O school in JakartaItagaki is in charge of training second-year students to fabricate prostheses. On the day of our visit, he was explaining how to create an artificial socket for a person whose leg has been amputated at the knee joint. He offered his students advice while observing their work.

“Most of the patients with whom P&O specialists come into contact have experienced the shock of losing a limb,” Itagaki noted. “As an instructor, I think that my role is not just to convey technical knowledge on how to fabricate an artificial limb, but also to remind students of the crucial importance of always bearing in mind the situations and feelings of our patients.”

Itagaki studied mechanical engineering at university and worked as an engineer after graduation, but ended up switching to the P&O profession because, more than just creating parts for machines, he wanted to be involved in the creation of things that would truly meet the needs of the people who use them. For two years, starting in 2007, he lived in Burkina Faso as part of the Japan Overseas Cooperation Volunteers program. During that time, he became aware of how many people around the world desperately needed a prosthetic or orthotic device. After returning to Japan he became intent on working in a country where there were not enough of those devices available.

“It was around that time that I happened to see the website of the Nippon Foundation and learned about how it is assisting P&O schools,” Itagaki recalls. “I thought that if I wanted to work in this field, this was a golden opportunity. I sent an e-mail and received a reply the same day, putting me in touch with the person in charge. After that, I had three interviews via Skype with the Cambodia Trust, and became a teacher at the school in Jakarta starting in August 2013. All of the courses are taught in English. I am confident in my abilities as a P&O instructor, but not so much in my English. Still, I do my best, while relying on the students at times to help me find the right word.”

PhotoThe students, meanwhile, are equally enthusiastic. One female student from Jakarta had the following to say about her aspirations:

“Whenever I saw a patient trying to walk with an artificial limb for the first time, it makes me realize that I am training for a truly fulfilling job. At the same time, though, the hardest part of the job involves the fitting adjustments made when a patient tries on a prosthesis. When you adjust for one problem, another problem often appears. I want to overcome each of the difficulties I encounter so I can make the artificial limb comfortable for the patient. After graduation, I would like to study at a university in Thailand so I can qualify as a category-1 P&O practitioner—the highest category under international standards.”

Along with supporting P&O training schools in Indonesia, Thailand, Sri Lanka, and the Philippines, the Nippon Foundation plans to open a training school in Yangon, Myanmar, in 2015. The original P&O school in Cambodia, opened through collaboration between the Nippon Foundation and Exceed, is now independently run and no longer relies on foundation funding.

The Nippon Foundation is also involved in facilitating exchanges among instructors at schools in various countries. The hope is that by training P&O practitioners in each of these countries, it will be possible to meet the needs of even more people for prosthetic and orthotic devices.

Photographs by Kei Kodera