Each morning, Marco Antonio takes to the streets of Ibarra, Ecuador. He and his wife spend their days selling candy on buses, a common way to make extra money in South America. The work isn’t easy - they’re on their feet all day and sales aren’t guaranteed - but they do what they must to provide for their family. Arduous as it is, the work brings extra challenges for Marco.
Why? Because he’s a below-the-knee amputee.
For millions of amputees like Marco, lots of everyday activities become difficult. However, these problems are exacerbated in communities like Ibarra, where public accommodations and adequate medical care are less accessible. Recognizing the need to help amputees in such communities, several BYU departments have joined forces to take action.
A UNIFIED EFFORT
In early 2024, the BYU College of Engineering reached out to the College of Nursing and several other programs with the goal of forming a multi-department team to tackle this issue. With experts and students in engineering, sociology, economics, nursing, and other fields, they set to work creating better prosthetic technology and resources for below-the-knee amputees in Ecuador.
The group partnered with two organizations in Ibarra that support amputees: Cielo de Amor, a clinic that serves people in wheelchairs, and Protesis Imbabura which supplies prosthetic limbs and other adaptive equipment to people such as Marco.
In January of this year, a team returned to further the work and see what improvements could be made. Group members included nursing professor Scott Summers, Global & Population Health Nursing Coordinator Ryan Rasmussen, engineering faculty member Terri Bateman, and several students involved in research and development for the project.
The diversity of disciplines involved has made this project truly remarkable! Every base is covered by a different set of people; engineering handles product creation, economics works to make it affordable, and nursing/sociology handle what Dr. Summers called the “human aspect” of the project – treating patients and seeing how they’re affected by the work.
PRODUCT DEVELOPMENT
A large portion of the project relied on researching and developing new prosthetic equipment to give to patients, and this was handled mainly by engineering students. Two teams have been working to create inexpensive and efficient products, including prosthetic foot shells that replace the actual limb and liners that protect the patient’s skin from the socket.
Students are also working to solve the issue of designing comfortable cushions for wheelchair users. Clinicians normally have to place their hands under a patient to identify where the most pressure is put on the seat, and as would be expected, this isn’t very comfortable or informative for the patient.
Reagan Hutchings, an engineering student who leads the team focused on this issue, explained their approach. They're designing a sensor that can be placed under a patient in a wheelchair that detects points of greater pressure hands-free. While the product is still in development, it will ultimately make the experience of using a wheelchair much safer for those Ecuadorians requiring the use of a wheelchair.!
Donating this BYU-created tech to amputees is amazing work, but the team has a long-term, “teach a man to fish” approach in mind. “The real idea is to allow this to be self-sustaining, providing jobs and opportunities for people in Ecuador,” said Dr. Rasmussen. to make this a reality, The team is currently working to make the products easy and inexpensive to manufacture locally in Ecuador.
LOOKING TO THE FUTURE
Designing technology like this is a process, so many iterations are needed. “I think that [having a finished model] would be a perfect world, but at least we have a framework of what we want to do,” said Professor Summers. “This is going to be an ongoing project where we’re constantly modifying things.”
While the engineering and economic teams handle the technical improvements nursing students also play a pivotal role in improving the program. One big change that Professor Summers hopes to implement is a greater focus on “the one,” visiting individual patients in their homes and seeing their progress on a daily basis. “You can see the problem more easily when you’re there,” he said.
Nursing students will also continue to work on educational videos for amputees. The literacy rate in Ibarra is low, so the 2024 students created several educational shorts in an effort to help patients understand their prosthetic tools.
Dr. Summers envisions several new additions, such as a “What to Expect” video for those who recently lost a limb, as well as videos featuring the perspectives of real clinical patients like Marco.
SEEKING TO UNDERSTAND
The group also wanted to understand how they were connecting with Ibarra’s culture, and that’s where BYU law student Camila Cevallos Jalil came in. The group wanted to blend with and support Ecuadorian culture as much as possible, and there were several things to take into consideration as they sought to mesh their service with the lives of everyday Ecuadorians.
One surprising adjustment was the color of the foot shells. According to Reagan, Ibarra has a high “craftsman population.” In other words, the people are accustomed to making handmade, high-quality products. Though they were wonderful functionally, the rough plastic and black shade of the shells were off-putting to some amputees who wanted a more polished, skin-toned shell.
This initially went right over the BYU teams’ heads. After all, the foot shells are completely covered by a sock and shoe! Upon further consideration, however, they understood that small changes like the color could make a big difference.
In future visits, nursing students will also seek to have more consistent contact with their patients even after leaving Ecuador. “Trust and friendship are part of Latino culture,” said Camila. As a native of Quito, Ecuador, she understands the need for nursing students to develop deeper relationships with people that last more than a few days.
BLESSING PATIENTS, BLESSED BY PATIENTS
The trip showed the team what was working well, but it also highlighted several areas for improvement. The purpose of the trip was to see where things can be adjusted, and further work will be done to make the products the best they can be. While some improvements must be made, the students touched the hearts of many citizens and had a positive impact on their lives.
“What we’re doing is expensive, and we’re making it very [affordable] for them,” said Reagan. “It will help them provide for their families and have a more stable income.”
As they served, the group learned quite a bit about charity and positivity from their patients, especially from Marco. “When he walks into the clinic, he always has a smile on his face. He loves to be around other people,” said Dr. Rasmussen, “he’s a phenomenal person.”
Marco will get to work with even more nursing students when they return to Ecuador this spring!
With those they serve in mind, students and faculty will be hard at work polishing the project for that return trip. Through each prototype built and every hurdle cleared, hearts are changed and lives are brightened.
An educational video from 2024 can be viewed here.