675 million people in South East Asia. Do we have enough Orthotists and Prosthetists?

It is estimated that 0.5% of any population requires Orthoses, Prostheses and Rehabilitation treatment. (1) This would mean approximately 3,375,000 people in South East Asia require Orthotic and Prosthetic (O&P) services. Furthermore, this number is predicted to rapidly increase with an increasing number of people suffering from musculoskeletal conditions and diseases such as diabetes and stroke. Increase in life expectancy will consequently contribute to an ageing population and a larger population affected by disabilities. Therefore, it is now estimated that the number of people requiring O&P services will double in the near future and we are already seeing this in some South East Asian countries.

South East Asia

8.5% of the world’s population live South East Asia (SEA). It comprises of 11 countries and is culturally diverse with hundreds of languages spoken by many different ethnic groups spread over 4.5 million square km. These 11 countries are also economically diverse. GDP per capita range from $5000 in lower income countries to $100,000 in high income countries. Healthcare systems in each country are equally diverse. According to WHO’s ranking of the world’s heath systems, Myanmar ranks 190th , Singapore at 6th place and the remaining countries spread in between.

Access to Orthotics and Prosthetics

It is estimated that only 5-15% who need assistive devices have access to O&P services.(2) Most countries in South East Asia have these services and are established with trained professionals. However, they are mostly located in the capital or major cities. Countries such as Indonesia and Philippines have large populations living outside major cities. Moreover, majority people with physical impairment from rural areas have difficulty finding employment and are in the low income group. Therefore, many people in SEA either do not have access or cannot afford O&P services.

Orthotists Prosthetists

In an ideal setting, O&P services should be provided by a team of trained professionals. In the last decades countries, such as Thailand, Vietnam, Cambodia, Indonesia, Myanmar and Malaysia, recognised the need for qualified O&Ps. Training programmes were developed in universities and  NGOs to produce more O&Ps. Despite the development of O&P schools there is a slow increase of the total number O&P professionals to meet the need.

Telemedicine and Technology

Telemedicine is the remote diagnosis and treatment of patients through the use of telecommunications technology. Does it work for the O&P industry? Recent years have shown us that we can use video conferencing to communicate effectively. O&Ps could carry out their first interview via video conferencing to understand the needs and expectations of their clients and to explain the benefits and functions of the prescribed devices. At present, telemedicine does not have the capability for the O&P to carry out a physical assessment of the patient remotely. However, this could be performed by an on-site healthcare professional, such as a therapist or community nurse, and the findings communicated to the O&P.

With the advancements of CADCAM systems in the O&P industry, we now have the capability to produce prosthetic sockets and orthotic devices at a location far away from the client. Scanners and 3D-printing technology have made this process even more efficient. No longer require carving out foam casts (models of the clients affected body part) before fabrication of O&P interfaces. Thereby streamlining the fabrication process.

Can fittings be carried out remotely? To some extent, possibly. Basic fitting of devices could be carried out by on-site therapists or community nurses with some virtual guidance from an O&P. However, complicated cases would require an O&P to be on-site, for now.

Conclusion

Generally, a lower to middle income country requires about 10 O&Ps per million population. That’s about 6,750 O&Ps required in SEA. Although data of the actual number of O&Ps is unavailable, it is estimated that there are only about 3500 O&Ps in the region. There needs to be more awareness and recognition to attract more people to the profession. However, the answer is not just obtaining or training more O&Ps but also to improve access by increasing service availability to populations living outside of capitals and major cities. Can technology be used to supplement the insufficient numbers of O&Ps? Technology should be used to improve efficiency, so O&Ps can focus on parts of the process that technology cannot replace. Today, we can already leverage on available technology to provide remote O&P services and lower costs. All persons with disability should have access to mobility aids, devices and assistive technology, including prostheses and orthoses.

 References

1.       Guidelines on the provision of manual wheelchairs in less-resourced settings. Geneva: World Health Organization; 2008 (http://www.who.int/disabilities/publications/technology/wheelchairguidelines/en/,accessed 30 August 2016)

2.       Standards for Prosthetics and Orthotics. Part 1 : Standards. World Health Organisation; 2017