ROMP in Guatemala - An Open Letter to Mr. Fuentes
David Krupa
Description
Collection
Title:
ROMP in Guatemala - An Open Letter to Mr. Fuentes
Creator:
David Krupa
Date:
8/25/2017
Text:
Dear Mr. Fuentes,
The Range of Motion Project (ROMP) was disappointed with the posting you
made on the O&P Listserv yesterday. While we welcome thoughtful commentary
as a means for continual improvement, the broad statements you made clearly
showed a lack of understanding of the ROMP model. This is not the first
time that you have made statements of this nature, and it may not be the
last. The purpose of this letter is to clarify the ROMP model, to leave no
room for misunderstanding; you can choose where to go from there. As you
decided to make your post in the public forum, we will respond to you in
the public forum as well.
One thing that we should certainly agree on is that both ROMP and your
business - Centro Biónico - should put utmost priority on what matters the
most: restoring mobility to people with amputation. That is, after all, why
most people chose to become prosthetists in the first place. In the UN
Convention on the Rights of Persons with Disabilities (UNCRPD), which
Guatemala ratified in 2009, Article 20 stipulates that: States Parties
shall take effective measures to ensure personal mobility with the greatest
possible independence for persons with disabilities, including by: [....]
(b) Facilitating access by persons with disabilities to quality mobility
aids, devices, assistive technologies and forms of live assistance and
intermediaries, including by making them available at affordable cost;
Mobility is not simply a business opportunity - it is a human right. What
argument could possibly be made for not fulfilling this
internationally-accepted right, whether through our operation, through
yours, or through both?
Unfortunately, a significant proportion of Guatemalan people with
amputation do not have access to high-quality prosthetic care. In the
recent 2016 Guatemalan National Disability Survey (full report available on
the ROMP Resource Center), the ratio of people with disabilities using a
prosthesis to people with disabilities who need but don't use a
prosthesis was 1:1; this supports our belief that there is a major segment
of the Guatemalan population without prosthetic care. Furthermore, in the
2017 ROMP CBR Situation Analysis (available HERE on the ROMP Resource
Center) < <URL Redacted>>, numerous participants
interviewed shed light on the extremely limited and oftentimes nonexistent
prosthetic care infrastructure in Guatemala. While there are various
organizations providing prosthetic care around Guatemala, the status quo is
simply not hitting the mark for many people with amputation. The UNCRPD
specifies the role of international organizations, like ROMP, in article
32: States Parties recognize the importance of international cooperation
and its promotion, [.... specifically....] (d) Providing, as appropriate,
technical and economic assistance, including by facilitating access to and
sharing of accessible and assistive technologies, and through the transfer
of technologies. If there is such a great level of need to fulfill the
human right of mobility, and it simply has not yet been done, how could
ROMP justify sitting by and doing nothing?
In your post, you seem to lump ROMP into the same category as other
organizations that use a parachute approach of arriving in Guatemala for
a brief clinic and then leaving patients behind without clinical follow-up.
This is a wholly incorrect way of characterizing ROMP-Guatemala, which is
incorporated locally and functions autonomously as an Asociación Civil
operating a brick-and-mortar prosthetics clinic full-time, year-round, in
the city of Zacapa, Guatemala, as well as a mobile prosthetics clinic that
arrives to the most remote areas of the Guatemalan Highlands and the
Mexican Chiapas. ROMP-Guatemala has seven permanent, local employees that
ROMP-USA, in its technical and economic assistance role has trained,
equipped, and continues to accompany to ensure that the prosthetic care
provided is the highest-possible quality and reaches as many people with
amputation as possible. Part of this accompaniment includes sending teams
of volunteer prosthetists to work hand-in-hand with the ROMP-Guatemala
staff, providing increased bandwidth and knowledge exchange. Every stage of
prosthetic care is available to the patient, including evaluation, casting,
fitting, follow-up, and repairs/adjustments; all care is provided in the
highest-possible level of quality, never in a lower level of quality to cut
costs.
Additionally, in your post, you seem to be unclear on the financial
transactions between patients and our clinic. We do request that each
patient makes a donation to recuperate the cost of the components and labor
that go into their device, per the concrete guidelines laid out in our SOP
for Patient Donations (available upon request). Each transaction is clearly
documented, subject to audit, and invested into ongoing operations of the
clinic. If a patient is unable to make a donation, we still provide
prosthetic care regardless, because, as we established above, prosthetic
care is a human right, not simply a revenue opportunity. Patient donations
alone do not allow ROMP-Guatemala to break even, but they serve as a key
revenue stream for continuing our work to serve Guatemala's people with
amputation.
In the sense that we provide prosthetic care and that we invest revenues
into growing our operations, we have some important things in common with
your business which you may not have taken into account. We appreciate the
challenges faced by businesses like yours because we face many of the same
challenges on a daily basis. We congratulate you on operating a private
company in Guatemala, and wish you the very best in your endeavors at
Centro Biónico. However we must be clear: ROMP will not relent in providing
prosthetic care to people with amputation for any reason, neither to avoid
offending someone nor to protect a private company's market share. We will
stand in solidarity with people with amputation who have been swept through
the cracks over and over again, and we will not rest until every one has
regained their mobility.
--
Sincerely,
David Krupa, CP
Executive Director
(c) ECU: 593.98.440.6680
(w) www.rompglobal.org
The Range of Motion Project (ROMP) was disappointed with the posting you
made on the O&P Listserv yesterday. While we welcome thoughtful commentary
as a means for continual improvement, the broad statements you made clearly
showed a lack of understanding of the ROMP model. This is not the first
time that you have made statements of this nature, and it may not be the
last. The purpose of this letter is to clarify the ROMP model, to leave no
room for misunderstanding; you can choose where to go from there. As you
decided to make your post in the public forum, we will respond to you in
the public forum as well.
One thing that we should certainly agree on is that both ROMP and your
business - Centro Biónico - should put utmost priority on what matters the
most: restoring mobility to people with amputation. That is, after all, why
most people chose to become prosthetists in the first place. In the UN
Convention on the Rights of Persons with Disabilities (UNCRPD), which
Guatemala ratified in 2009, Article 20 stipulates that: States Parties
shall take effective measures to ensure personal mobility with the greatest
possible independence for persons with disabilities, including by: [....]
(b) Facilitating access by persons with disabilities to quality mobility
aids, devices, assistive technologies and forms of live assistance and
intermediaries, including by making them available at affordable cost;
Mobility is not simply a business opportunity - it is a human right. What
argument could possibly be made for not fulfilling this
internationally-accepted right, whether through our operation, through
yours, or through both?
Unfortunately, a significant proportion of Guatemalan people with
amputation do not have access to high-quality prosthetic care. In the
recent 2016 Guatemalan National Disability Survey (full report available on
the ROMP Resource Center), the ratio of people with disabilities using a
prosthesis to people with disabilities who need but don't use a
prosthesis was 1:1; this supports our belief that there is a major segment
of the Guatemalan population without prosthetic care. Furthermore, in the
2017 ROMP CBR Situation Analysis (available HERE on the ROMP Resource
Center) < <URL Redacted>>, numerous participants
interviewed shed light on the extremely limited and oftentimes nonexistent
prosthetic care infrastructure in Guatemala. While there are various
organizations providing prosthetic care around Guatemala, the status quo is
simply not hitting the mark for many people with amputation. The UNCRPD
specifies the role of international organizations, like ROMP, in article
32: States Parties recognize the importance of international cooperation
and its promotion, [.... specifically....] (d) Providing, as appropriate,
technical and economic assistance, including by facilitating access to and
sharing of accessible and assistive technologies, and through the transfer
of technologies. If there is such a great level of need to fulfill the
human right of mobility, and it simply has not yet been done, how could
ROMP justify sitting by and doing nothing?
In your post, you seem to lump ROMP into the same category as other
organizations that use a parachute approach of arriving in Guatemala for
a brief clinic and then leaving patients behind without clinical follow-up.
This is a wholly incorrect way of characterizing ROMP-Guatemala, which is
incorporated locally and functions autonomously as an Asociación Civil
operating a brick-and-mortar prosthetics clinic full-time, year-round, in
the city of Zacapa, Guatemala, as well as a mobile prosthetics clinic that
arrives to the most remote areas of the Guatemalan Highlands and the
Mexican Chiapas. ROMP-Guatemala has seven permanent, local employees that
ROMP-USA, in its technical and economic assistance role has trained,
equipped, and continues to accompany to ensure that the prosthetic care
provided is the highest-possible quality and reaches as many people with
amputation as possible. Part of this accompaniment includes sending teams
of volunteer prosthetists to work hand-in-hand with the ROMP-Guatemala
staff, providing increased bandwidth and knowledge exchange. Every stage of
prosthetic care is available to the patient, including evaluation, casting,
fitting, follow-up, and repairs/adjustments; all care is provided in the
highest-possible level of quality, never in a lower level of quality to cut
costs.
Additionally, in your post, you seem to be unclear on the financial
transactions between patients and our clinic. We do request that each
patient makes a donation to recuperate the cost of the components and labor
that go into their device, per the concrete guidelines laid out in our SOP
for Patient Donations (available upon request). Each transaction is clearly
documented, subject to audit, and invested into ongoing operations of the
clinic. If a patient is unable to make a donation, we still provide
prosthetic care regardless, because, as we established above, prosthetic
care is a human right, not simply a revenue opportunity. Patient donations
alone do not allow ROMP-Guatemala to break even, but they serve as a key
revenue stream for continuing our work to serve Guatemala's people with
amputation.
In the sense that we provide prosthetic care and that we invest revenues
into growing our operations, we have some important things in common with
your business which you may not have taken into account. We appreciate the
challenges faced by businesses like yours because we face many of the same
challenges on a daily basis. We congratulate you on operating a private
company in Guatemala, and wish you the very best in your endeavors at
Centro Biónico. However we must be clear: ROMP will not relent in providing
prosthetic care to people with amputation for any reason, neither to avoid
offending someone nor to protect a private company's market share. We will
stand in solidarity with people with amputation who have been swept through
the cracks over and over again, and we will not rest until every one has
regained their mobility.
--
Sincerely,
David Krupa, CP
Executive Director
(c) ECU: 593.98.440.6680
(w) www.rompglobal.org
Citation
David Krupa, “ROMP in Guatemala - An Open Letter to Mr. Fuentes,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 6, 2024, https://library.drfop.org/items/show/254948.
