Breaking Down, Building Up

By collecting donated, unused and unwanted items, School of Applied Physiology Research Scientist Rob Kistenberg and students are working to remove significant amounts of material from the waste stream, all while helping provide self-sufficiency and dignity for people in developing nations.

The Prosthetic and Orthotic Component Clearinghouse, or POCC (pronounced "pahk-see"), in Decatur takes in used or unwanted prosthetic pieces. Housed in the MedShare facility near Flat Shoals Road, POCC allows students to break down the devices into their component parts, which are available at a reduced fee to physicians and prosthetics technicians traveling to international clinics.

According to Kistenberg, coordinator of the school's Master of Science in Prosthetics and Orthotics program, prosthetics consist of artificial limbs that work in place of missing or unformed limbs or body parts. Orthotics are external braces that help strengthen muscles or treat deformities. Typically bulkier, prosthetics occupy more space than orthotics and tend to be more expensive.

Established by the U.S. International Society for Prosthetics and Orthotics (US-ISPO), POCC started in July 2007. "Our main goal was to prevent orthotics and prosthetics from being thrown away." said Kistenberg, chair of the US-ISPO.

Used or unwanted items are sent to POCC at MedShare International's Decatur warehouse, where volunteers organize orthotics and break down prosthetics into their basic components, which are then stored.

Clinicians or physicians traveling to developing nations can either collect the parts at the warehouse or can request the parts be shipped to them. A nominal warehouse handling fee and shipping are charged to the group or individual requesting parts. The application process, Kistenberg says, ensures that services providing the requested device are not already available in the patient's country or region, so POCC does not adversely compete with local businesses.

"If there's local industry or facilities already in the area, we may seek to set up a partnership with them," he said. The group also works to ensure that the level of local services provided for prosthetics care and maintenance is in line with the equipment that is provided. "We request follow-up information from our volunteers to check that everything is operating aboveboard," Kistenberg said.

Old and worn parts are recycled, if possible, or discarded. With every prosthetic, the socket-where the prosthesis connects to the limb-is usually made from plastic or carbon fiber and formed to fit the specific patient. "Older components are recycled, while others have gone to MedShare International for [its] use," Kistenberg said.

The organization currently has three tons in inventory, and another six tons have been sent out. The organization gets its materials from three sources: Individuals donate their unused or old prosthetics, and facilities and manufacturers will donate their overstock.

Kistenberg says that shipments of components have been used by professionals in their visits to clinics in Belize, Honduras, Sudan, Dominican Republic, Guatemala, Nigeria and Mexico. Specialists make requests for components, which are patient-specific, according to master's degree student Taavy Miller. "They [will give us] a list asking for [the] specific parts."

Miller is a member of the Promoting Orthotics and Prosthetics (POP) student organization, which has been on campus for three years and has 20 members. The organization works to create "opportunities for service, outreach, education and leadership." During the academic semesters, student volunteers help organize the donations and assist at other events, including the American Academy of Orthotists and Prosthetists, the Amputee Coalition of America, TEAM Buzz and Blaze Sports.

"I always have been interested in the medical or physical therapy field and in international humanitarian work," she said. She says she regularly volunteered at her local children's hospital and the Veterans Health Administration hospitals.

Kistenberg serves as clinical director of Sonrie Ministries Inc. in the Dominican Republic, and works with other clinics in Central America. "I like working with my hands, and I wanted to help people," he said. POCC came about because of his wish to extend that help across international borders. "Anyone can have access to these materials, as long as they meet certain criteria."

Donors have sent POCC various prosthetic legs and arms and several orthotics. Kistenberg says 80 to 90 percent of the knee joints from the legs are not usable. "We don't have any way to test them," he said, referring to the more advanced models. POCC chooses not to send items to other countries where the technology is completely out of the realm of experience for local practitioners.

Sometimes the more advanced items will be sent for use in educational institutions abroad. At the other end of the spectrum, some items received are real "museum pieces," as Kistenberg describes them.

Overall, through POCC students are able to learn much about the items from their time breaking the objects down. "[With working here], some items we learn about before we go into a specific class," Miller said. "It's really great, from a learning opportunity."

Kistenberg said the organization's main priority is placing the inventory online. Those interested in procuring parts are able to apply either through POCC or the MedShare Web site.

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