e-NABLING The Dominican Republic

In the Dominican Republic, many of the people who visit the prosthetic clinics to seek help in obtaining a replacement hand or arm, have lost them due to violent machete attacks. In many cases, their injury is a result from a robbery gone bad and their attempt to protect their faces, heads or vital organs from lethal wounds, by putting their arm up between their attacker and themselves.

Today I want to share a guest blog post from one of our founding e-NABLE Volunteers, Dean Rock, who has been quietly working on design improvements and helping to create e-NABLE designed devices to gift to those recipients in the Dominican Republic with the help of his local Rotary Club.

Dean shares a bit about his experiences below in his guest blog post!

Guest Blog Post by Dean Rock

I first became aware of e-NABLE about 2 years ago when reading a 3d printing forum where Aaron Brown  (Axislab 3D) posed the question, “Are you tired of printing trinkets?” with a link to the e-NABLE site. I have been participating at different levels ever since.

Early on I printed a bunch of Raptor hands until I got good at them, then I started experimenting with improving the design. And this is the area I most enjoy, which is fortunate because that is exactly what 3d printing is also good at: prototyping. I have presented some of my designs at the town hall as well as on Thingiverse and Google+ with mixed results. I am always seeking improved function but with a recent project I had to include form as part of the design parameters too.

LN4 Hand on a recipient in Dominican Republic

The local Rotary Club in Portland, Maine had contacted e-NABLE to see if they had a functional arm design for adult recipients in the Dominican Republic. They had been placing a particular arm for some time, the LN-4, but were not especially happy about either performance or cultural acceptance. Clients wanted something that looked more natural and would, hopefully, match their skin tone. John the Rotarian was referred to me through e-NABLE and, as I live about 20 minutes away, we began a series of discussions about arms.

We started with the Unlimbited Arm design and in the course of producing 15 complete arms for below the elbow amputations, made a few small changes. Because of the hot and humid climate, latex bands were eliminated and a push/pull monofilament tendon system applied. Finally, the fingers were smoothed out to cover where the bands were mounted originally and fitted with permanent silicone fingertips (and palm). We also experimented on some arms with wide elastic straps and velcro closures which will be a future inclusion.

These worked well on short forearm attachments.

John was able to provide me with photos and measurements that allowed me to choose particular fittings for each client. In the course of building them, I relied on advice from some other e-NABLE folks another e-NABLE volunteer, John Diamond, actually helped by making some forearms that were bigger than my machine. Then, my wife suggested that I go help deliver them to the DR. So I did. Our team consisted of John Curran, me, Ricardo from West Palm, FL (translator) and Roger and Elizabeth Fagan who were making their 19th trip to fit hearing aids.

They were all Rotarians and during this trip we fitted 30 hearing aids, 7 arms and made plans for a water filtration system that will serve two schools by next year. If it hadn’t been for hurricane Matthew more people would have been able to get to us, but the roads were often impassable away from the city. We left the remaining arms behind and trained a nurse in fitting them. We also have a follow-up plan in place to see how things are going and where we need to change things for future trips. For now, we plan on returning in May in an ongoing collaboration.

For one recipient, the basic model could not be fitted because his remaining limb below the elbow was just too short. I am working on that now. Another man had been wearing a prosthesis that had been fitted in Puerto Rico in 1986 and he preferred it over the Unlimbited model. However, I was able to give him a working thumb by repairing his existing device. He was appreciative so that was a plus.

The peak experience came with the final recipient who needed two arms. He was using them effectively before leaving. We trained as much as we could for all of them and we have a follow-up system in place whereby they will be contacted in another month or so to see how things are working out. We will find out if the modifications I made are effective as well. If you recall, I used a push/pull system for tendons, no latex bands to fail in heat and humidity, and reinforced the arms in three locations: either side of the bicep cuff which was prone to breaking on the layers of deposition and at the forearm wrist area between the hand mounts. Future designs will incorporate these additions. Also silicone fingertips and palm that are fairly permanent and can be easily renewed with ordinary caulk type silicone.

Although it is not yet practical to train the Dominican clinicians to use 3d printing to make their own devices, the current system is working well. The Rotary Club’s long established ties to The Good Samaritan Hospital in La Romana, the experience of Roger, Elizabeth, John and Ricardo as well as all of the hospital staff made my end of things quite easy. I anticipate other Rotary Clubs, doing service wherever they may be, could well seek additional help from e-NABLE in the future. For now, I’ll continue printing away in my basement, on my modified Delta and trying to continually find and implement changes as needs arise.

While working on this project, a local paper interviewed me about what the Rotary and I were doing. That article resulted in a local man contacting me for an arm after having his prosthetic arm stolen in 2009. I have since fitted him with one of the DR design arms and he has been a great pleasure to work with. It is so helpful to get immediate feedback and he has also kindly, enthusiastically, offered to help in testing future designs.

Right now we are working on an exo-skeleton hand for his other arm which has suffered from overuse through the years. As to his new arm and how it has helped? This is what he texted to me the other day: “

This morning I folded laundry, made my bed, brushed my teeth and drank a coffee without using my right hand whatsoever. I’m so blessed.”

At the time of his fitting he was also very excited about being able to open a pill jar, zip a zipper and scratch his back.

I’m feeling pretty blessed, too.