B. Activities by country :
Latin / America / Nicaragua
The outstanding event of the year was the decision by the ICRC Assembly in June 2000 to transform the ICRC Special Fund for the Disabled (SFD) into an official foundation under Swiss law. The Assembly also decided on that occasion to open the Board of the SFD to non-ICRC members.
The SFD was established in 1983 in response to Resolution XXVII of the 24thInternational Red Cross and Red Crescent Conference, held in Manila in 1981. The resolution noted that 1981 had been proclaimed the " International Year of Disabled Persons " by the United Nations General Assembly and recommended " that a special fund (...) be formed for the benefit of the disabled and to promote the implementation of durable projects to aid disabled persons " .
According to its new statutes, the SFD has two objectives:
1) to ensure the continuity of treatment for war disabled of ex-ICRC projects in countries where hostilities have ceased and consequently left by ICRC because in this case its mandate is no more applicable
2) to ass ist the disabled of low-income countries by placing at their disposal techniques and expertise which have been developed in aid of war disabled.
In 2000, the SFD assisted 62 projects in 37 countries through its three regional projects in Addis Ababa, Ho Chi Minh City and Managua by providing refresher courses for local prosthetists from the various projects, equipment and orthopaedic components, plus expertise via the SFD expatriate prosthetists.
B. ACTIVITIES BY COUNTRY
1 - ETHIOPIA
The SFD has its main technical base in Addis Ababa at the Prosthetic-Orthotic Centre (POC), which is run by the Department of Physical Rehabilitation of the Ministry of Labour and Social Affairs. The POC is a well-known and appreciated partner of the ICRC; collaboration between the two institutions dates back to the very beginning of the ICRC's rehabilitation programmes in 1979, when the first project started at Debre Zeit near Addis Ababa.
Within the premises of the POC the SFD has set up a small orthopaedic workshop which can be considered a basic module to be reproduced in the various countries receiving SFD assistance.
Main SFD activities
In the above premises three SFD expatriate prosthetists and two Ethiopian prosthetists organize a four-week training programme every two months for prosthetists from Africa, the Middle East and Asia who wish to develop their skills in a prosthetic manufacturing technique based on the use of thermoformable plastics. This training is also useful for new ICRC expatriate prosthetists as a technical introduction before their first assignment.
In 2000, the courses were attended by 26 prosthetists from assisted rehabilitation centres in eight countries: Ethiopia, Mauritania, Myanmar (Burma), Zimbabwe, Somalia, Kenya, Yemen and India. In addition, five new ICRC expatriate prosthetists from Switzerland, Japan, South Africa and Denmark received training at the POC.
Apart from those in Addis Ababa, two other training courses were organized:
In Nigeria : in September and October 2000 a Swiss expatriate and an Ethiopian prosthetist gave a course on treatment of partial foot amputations and knee and hip disarticulations, together with plaster-casting demonstrations, for 12 participants from the country's various orthopaedic workshops. Of the prostheses made for training purposes, 22 were delivered to patients. On completing the seminar 11 participants were awarded a certificate.
This course took place at the National Orthopaedic Hospital of Enugu, which is currently supported by GTZ (German Technical Cooperation).
In Mali : in November and December 2000, an Ethiopian and an SFD prosthetist from Addis Ababa held a two-week training course for 10 prosthetists from seven Malian orthopaedic centres.
b) Technical visits
Besides these training activities, the three SFD prosthetists and two Ethiopian prosthetists made technical visits to 19 projects in 14 countries to monitor the quality of prostheses and advise on the use of the various machines and orthopaedic components.
One of these visits served to assess the needs of the Sahrawi amputees in Tindouf, Algeria, in order to set up if possible an assistance programme on their behalf in cooperation with Norwegian People's Aid, an NGO from Norway.
c) Support in the form of equipment
As another part of the SFD's activities, material support was provided from Addis Ababa to 48 physical rehabilitation centres or orthopaedic workshops in 31 countries.
It included supplies of orthopaedic components (artificial feet, knee-joints, sets of alignment devices), crutches, raw materials, spare parts and machines.
Only 15 countries have supplied their production statistics for 2000. Six countries assisted by the SFD receive operational support from the ICRC and therefore give statistics within the framework of the operationa l reports.
Ten countries receive donations other than prostheses (i.e. wheelchairs, crutches) or do not feel obliged to provide statistics.
In the year 2000 the 15 countries which did send statistics to the SFD produced 3,097 prostheses in polypropylene (excluding those produced by the six operational projects).
e) Relations with the SFD's counterparts: the Prosthetic-Orthotic Centre and the Ministry of Labour and Social Affairs (MOLSA)
In accordance with the advice of consultants hired by the ICRC, the production of orthopaedic components at the POC was gradually reduced during the year and proportionally replaced by products of the firm CR Equipment, Switzerland, in order to obtain better quality.
The cooperation agreement with the POC was renewed in May 2000 and signed by MOLSA and the head of the ICRC delegation. This agreement defines the tasks and obligations of both parties.
f) Links with the ICRC's operational activities
In the year 2000, the border war in Ethiopia continued until June and the operational plan of action for its disabled victims was implemented. Four agreements were signed for this purpose with representatives of the authorities in charge of the orthopaedic workshops in Mekele, Dessye, Harar and also the POC in Addis Ababa.
This project, which is being carried out by two ICRC prosthetists, is placed under the responsibility of the SFD supervisor in Addis Ababa.
To sum up, in 2000 the SFD gave technical support and supplied orthopaedic components to the following ICRC operational projects: Asmara (Eritrea), Lokichokio (Kenya), Luanda (Angola), Yangon (Myanmar) and Fort Portal (Uganda).
2 - VIET NAM
The programme started in 1989 in Ho Chi Minh City under the umbrella of ICRC operations and focused on production of orthopaedic components, training and manufacture of prostheses for all amputees of the " South " .
In April 1995, the project became an SFD project and the provision of prostheses for destitute amputees was continued. After a survey in February 1997 it was decided, together with the local partner, the Ministry of Labour, War Invalids and Social Action (MOLISA), to introduce the ICRC technique based on the use of thermoformable plastics at the provincial centres of Can Tho, Quy Nhon and Da Nang. In March 1998, an SFD expatriate prosthetist was based at the Ho Chi Minh Rehabilitation Centre to implement the project by means of on-the-spot training and material assistance.
In December 1998 two more provincial centres, Vinh and Thanh Hoa, were added. At the same time, several prosthetic assessments revealed that the quality of the prostheses made in Ho Chi Minh was not satisfactory. To remedy this situation, two additional prosthetists were assigned to the project in 1999 and were present throughout 2000.
Objectives for 2000 and achievements
a) " To provide a first prosthesis to the destitute amputees "
A final effort, with the help of the Vietnamese Red Cross, to reach the last registered destitute amputees and to refer them to the HCMC Rehabilitation Centre to receive a prosthesis was successful.
b) " To improve the quality of the prostheses at the Ho Chi Minh Centre "
With the arrival in 1999 of the two additional prosthetists assigned to this task, procedures showed a marked improvement as a result of on-the-job training and classroom instruction in basic anatomy and alignment.
The quality of components is now acceptable and enough are produced to meet the demand of all centres of the South which depend for their supplies on the Ho Chi Minh Centre.
c) " To implement the polypropylene technique in five centres "
This objective has been partly achieved. The five centres have been trained in the manufacture of trans-tibial and trans-femoral prostheses (with the exception of Thanh Hoa for the latter). An orthopaedic centre in Kontum has also benefited from this training. The Kontum project serves an ethnic group, the " Montagnards " , and is supported by Nouvelle Planète , a Swiss NGO.
To improve the quality of prostheses, training courses with emphasis on alignment, fitting and delivery procedures were held at the HCMC Centre. A few hours per week were dedicated to the basic theory of anatomy, biomechanics and prosthetics. A step-by-step manual following the outline of an instruction video made at the ICRC workshop in Battambang, Cambodia was used for the trans-tibial and trans-femoral cours es in the provinces.
In addition, the SFD paid a three-year scholarship for two prosthetists from the HCMC Centre to attend a training course at the Viet Nam Centre for Orthopaedic Technology (VIETCOT) in Hanoi, which is run in close collaboration with GTZ.
In 2000, 1,024 prostheses were delivered to destitute amputees and 1,055 to other civilian and military amputees . Since 1989, a total of 22,552 prostheses have been manufactured for all categories of amputees.
In March 2000, a one-year cooperation agreement was signed between MOLISA and the ICRC/SFD.
During the year, three SFD prosthetists and three Vietnamese workers were employed by the ICRC/SFD.
The HCMC Centre employed 23 workers in the year 2000.
3 - LATIN AMERICA / NICARAGUA
From 1984 to 1993, the ICRC ran an orthopaedic programme in Managua in cooperation with the Ministry of Health to provide war amputees with prostheses.
In 1988, twelve Nicaraguan prosthetists completed a three-year training course with a final examination held in the presence of a representative of the International Society for Prosthetics and Orthotics (ISPO).
In 1993, the project was handed over to the Ministry of Health From then on the Managua centre, meanwhile known as the Centro Nacional de Producción de Ayudas Técnicas y Elementos Ortoprotésicos (CENAPRORTO), received additional assistance until August 1998 through yearly visits, donations of equipment and raw materials, and technical training.
In 1999, after management difficulties and their evaluation by an external consultant, it was proposed to the Ministry of Health that the centre be reorganized and that a full-time SFD expatriate prosthetist be assigned to it .
Achievements in 2000
In February, an agreement was signed by the Ministry of Health and the ICRC/SFD to define the tasks of both parties.
As part of the agreement, a new director was appointed by the Ministry of Health in February and the number of employees was reduced from 41 to 31. At the same time, all staff were given clear job descriptions. In addition, a new incentive system for staff performance and production was introduced.
A computer hardware and software system was set up to promote efficiency and transparency in the accountancy department and store management.
The various workshops were renovated and new rooms were installed (reception and casting rooms) to provide better services for patients.
The technical competence of the local employees was upgraded by practical training sessions with emphasis on quality control. Two candidates were selected for training in San Salvador in 2001 at the Don Bosco University, which is backed by GTZ expertise.
A cost calculation system w as established to provide the Centre with an exact price list of all items produced.
Polypropylene technology was further developed and the former local production of orthopaedic components was replaced by ready-made polypropylene components of better quality from Switzerland.
These components are also delivered to the orthopaedic workshop in Léon, which is run by a local foundation, " Walking Unidos " .
During this first year of resumed activities, 312 prostheses and 664 orthoses were delivered .
According to the figures we have received from the projects covered by this report , the production of prostheses was as follows:
Projects receiving assistance from Addis Ababa : 3'097
Viet Nam : 2'079
Managua : 312
Total prostheses :5'488