Priceless prosthetics

2008-07-15 00:00

Do you know what an orthotic prosthetist is and does? Have you ever met one? Thanks to Oscar Pistorious many South Africans are aware of prosthetics, but orthotics? I had only a vague idea. You probably haven’t met one of these medical practitioners as there are only about 400 of them in the country, one of whom lives in Pietermaritzburg and practises in Hillcrest.

Paul Hoepfl (38), a qualified medical orthotist and prosthetist, practises what he calls “a combination of science and art”. Orthotics involves the design, manufacture and fitting of orthoses — objects that support the body. Prosthetics is the creation of prostheses that replace body parts or devices that are added to the body. An unusual profession, you may think, so how did he get into it? Hoepfl beams as he tells his story. “I was first made aware of prosthetics when I was about 10 and read an article in Reader’s Digest. I remember exactly where I was at the time because it made such an impression on me.

“My father and my uncle were dental technicians like my grandfather before them so they all made false teeth. I didn’t want to work with teeth as you never see the patients you make them for and I enjoy contact with people. I studied for a bachelor of arts at the Pietermaritzburg campus of the University of KwaZulu-Natal and intended to study law. However, I recognised very quickly that I wouldn’t enjoy it as I hated all my law subjects. I finished my BA and then backpacked around the world for several years.

“When I turned 27, I went to study at the University of Pretoria and Pretoria Technikon to do a four-year diploma in prosthetics and orthotics. They took 20 candidates each year. I was employed by the Department of Health during my studies so worked during all my holidays and then qualified at Wentworth Hospital. The orthopaedic department there did all the orthotic and prosthetic work for the province. I spent eight years there before going into private practice."

“So what do these impressive-sounding medicos actually do?” I wonder, taking in Hoepfl’s dusty apron, white-spattered shoes and workshop stuffed full of suspicious-looking tools.

“I get to make a few limbs, but the bulk of my work is foot orthotics for patients who have foot problems. I make arch supports and have invested quite heavily in equipment for this work, including a force plate to scan patients’ feet. I make supports from a combination of thermo-dynamic foams. Sometimes I have to make plaster of Paris moulds of patients’ feet to do this.”

That explains the dust and the spattered shoes, I think.

“I also do other orthotic work like neck or back braces, leg callipers and veterinary orthotics.”

I feel my eyebrows lift: “Veterinary orthotics?”

Hoepfl grins: “It’s fun and very challenging as each job is unique. I work with vets to make braces for dogs that are injured. The last was a pug that ran into a glass door and broke its spine, but didn’t sever it completely. I made a spinal brace and the dog has fully recovered, although it is a bit stiffer and slower than before.”

Aha, I think, that explains the workshop full of unidentifiable tools.

When he worked at Wentworth Hospital, Hoepfl made many prostheses, mostly for patients who had lost limbs through trauma. “Most were victims of car accidents or gunshot wounds. People also injure themselves in unlucky accidents, like the man who cut off his foot with a lawn mower and another who fell through a roof on to a running saw. There are also congenital cases — people born without a limb or with malformed limbs. Then there are diabetics — about 60% of amputees are diabetics who can lose sensation in their limbs and injure themselves without knowing. This can cause trauma and infection, which might heal very slowly or not at all, leading to amputation.”

I am struck by Hoepfl’s self-insight: “In this profession there’s a danger of developing an elevated sense of your own importance because people can be extremely grateful. A young amputee once said to me: ‘You have no idea how important you are to me — you are central to my ability to live my life. Without you I would be restricted to one room. With [your help] I lead an independent life’.

“I see this as my vocation. The ‘highs’ are creating solutions that work and make a patient happy. There are experiences that stay with you forever. I made a prosthetic leg for a woman who was a grandmother. Her entire family came with her to the final fitting. It was the most awesome experience watching her family’s faces when she walked out to meet them.

“The low point of being in private practice is working with medical aids and trying to get paid. Workmen’s Compensation and the Road Accident Fund are very poorly managed. I want to stay in private practice but only people with medical aid can afford my services and I am losing patients as people emigrate. People think they buy a commodity from me, but they really buy a service that is expensive because it involves skilled time and costly materials and components. All the devices I make are individually designed, made and fitted, which makes quoting difficult. I cannot say how long it will take me, first to get the design right and then to make the device.”

As I drive back to Pietermaritzburg, I consider the rhetorical question that seems to encapsulate Hoepfl’s predicament: “How do you put a price on a prosthesis that gives someone the ability to live independently, or on an orthosis that makes the difference between uncomfortable, perhaps even painful movement and an active lifestyle?”

How indeed?

Being an orthotic prosthetist

To follow this unusual profession people need good spatial perception — the ability to visualise something in three dimensions and then design and make it. “You also need some talent with your hands to craft assistive devices. You probably will not be wealthy, so you have to find satisfaction in other things. You need a desire to help people,” Paul Hoepfl says.

History of prosthetics

Prosthetic limbs used to be made of wood or metal. It took about a week to carve a leg, but now they are made more quickly in lightweight materials.

Prosthetics took off after World War I when after care and hygiene improved, so soldiers lived long enough to require prostheses. The first practitioners were probably village blacksmiths who had the skills and worked with the materials necessary to make prostheses.

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