In, “Clinical management of quadriplegia in low and middle-income countries: a patient’s road to physiotherapy, prostheses and rehabilitation,” Choong et al provide follow-up on a patient they had previously described. The follow-up was largely concerned with how the patient arranged chronic care after losing all four limbs in a traumatic electrical accident. Through a crowd-sourced fundraising campaign, the patient was able to receive all four limbs.
Management of amputees continues to be a problem for low and middle income countries globally (LMICs). Despite coverage from the national government health system, prosthesis for one limb along with physiotherapy and rehab are an insurmountable cost burden for the indigent in the Philippines, despite over 600,000 amputee patients being present. It is estimated that over 30 million people in need of prostheses reside in low income countries. This population is particularly challenging to reach due to the high percentage of rural populations in low-income countries as well as other challenges that disproportionately affect them including poor travel infrastructure, low life expectancy, remnants of civil unrest and conflict such as landmines, and the changing prevalence of diabetes.
Obviously, the etiologies of limb amputation must be addressed. Innovative solutions are needed to prevent chronic disease such as diabetes. Healthcare professionals must invest themselves in social determinants of health, speaking out against civil unrest, improving infrastructure and workplace safety, and helping to eliminate poverty. In the meantime, however, delivery systems must adapt to meet current needs.
Some promise has been shown in the Philippines with the addition of Z MORPH to the national healthcare package. Other countries, such as Malaysia, have also improved their models. However in many circumstances, the cost is still prohibitive to patients in these low-income countries. While temporary solutions such as charity fundraising or NGO provided services may benefit a few, a more systemic approach is necessary for all.
Some of the possible innovative solutions are addressed by Choong et al. They describe 3D printed prosthetics as a more affordable option. There has been some success with this in multiple different prosthetic forms, and this solution “can potentially provide limbs for LMICs (low and middle income countries) where there is a significant demand for high quality and affordable products.”
BMJ Case Reports invites authors to submit global health case reports that describe solutions to the problems faced by amputees in low and middle income countries. These cases could focus on:
-The factors contributing to these injuries and innovative ways to address them.
-The ability of these patients to access care and prosthetics.
-Interventions that result in the successful management of these patients.
Manuscripts may be submitted by students, physicians, nurses and allied health professionals to BMJ Case Reports at www.bmjcasereports.com. For more information, review our guidance on how to write a global health case report and look through our online collection
To read more about traumatic injury and amputee management at BMJ Case Reports, please review:
To read more about traumatic injury and amputee management from other sources, please see below:
 Stevens P. Prosthetics in Resource-Limited Countries. The O & P Edge. [internet] June 2015. Obtained from https://opedge.com/Articles/ViewArticle/2015-06_02 on 9 March 2019.
 WHO. A new leg, a new lease on life in the Philippines. 2018 http://www.who.int/features/2013/new_leg_philippines/en/ (cited 9 March 2019)
Arifin N, Hasbollah HR, Hanafi MH, Ibrahim AH, Rahman WA, Aziz RC. Provision of prosthetic services following lower limb amputation in Malaysia. The Malaysian journal of medical sciences: MJMS. 2017 Oct;24(5):106.