This may be one of the most important episodes we have done. We discuss the myriad of options when it comes to providing access to prostheses worldwide. This episode doesn't stop at global access, we dive headfirst into the challenges and unique opportunities in bringing prosthetics to developing countries. We explore how technology is shaping the future of prosthesis, discussing the innovative use of online information exchange, 3D printing, and even thrilling stories of successful remote fittings with a doctor from India and a prosthetist in the US.
As we charge into the future of prosthetics and orthotics, we get real about the idea of a "library" of prosthetics, repurposing old prosthetics for new users, and the potential for DIY prosthetics through 3D scanning technology. We also address the crucial need for collaboration and communication within the industry, balancing commercial and humanitarian efforts, and the potential solutions in providing prosthetic devices in developing countries. This episode is not just about information, it's about inspiration, advancements, and the betterment of lives through access of prosthetic care.
Special thanks to our sponsor: Vorum
This may be one of the most important episodes we have done. We discuss the myriad of options when it comes to providing access to prostheses worldwide. This episode doesn't stop at global access, we dive headfirst into the challenges and unique opportunities in bringing prosthetics to developing countries. We explore how technology is shaping the future of prosthesis, discussing the innovative use of online information exchange, 3D printing, and even thrilling stories of successful remote fittings with a doctor from India and a prosthetist in the US.
As we charge into the future of prosthetics and orthotics, we get real about the idea of a "library" of prosthetics, repurposing old prosthetics for new users, and the potential for DIY prosthetics through 3D scanning technology. We also address the crucial need for collaboration and communication within the industry, balancing commercial and humanitarian efforts, and the potential solutions in providing prosthetic devices in developing countries. This episode is not just about information, it's about inspiration, advancements, and the betterment of lives through access of prosthetic care.
Special thanks to our sponsor: Vorum
Welcome to season seven of the prosthetics and orthotics podcast. This is where we chat with experts in the field, patients who use these devices, physical therapists and the vendors who make it all happen. Our goal To share stories, tips and insights that ultimately help our patients get the best possible outcomes. Tune in and join the conversation. We are thrilled you are here and hope it is the highlight of your day.
Speaker 2:Hello everyone, my name is Joris Beals and this is another episode of the prosthetics and orthotics podcast. Brent Pyt how you doing, Brent?
Speaker 1:Doing well, man. You know it's crazy, man People actually listen to us. We've been listened to in over 80 countries, and over 40% of that is outside of the United States. I think that's an amazing story to tell and a special thanks to our listeners as well.
Speaker 2:You've got some other news. I'm really proud and happy to say that we have a sponsor for this show and it's VORM. Vorm is like a end-to-end software solution Anything from tool-pathcing software to carving to any kind of solution that you would need to do for end-to-end tools and OMP professionals. They also offer scanning right. They have scanning solutions.
Speaker 1:Yeah, so I think that's one of the neat things about what VORM is doing is not only with the end-to-end scanning is such a foundational part of what we do. It is the foundation of what we do. You get a bad scan, you're going to have a bad end product. One of the things that they've released is this Luma 3D scanner. It is end-to-end solution, but you can do all your digital landmarking.
Speaker 1:You can clean things up, you can pause and remove resume scans. You can put patient data on there, you can. Also it goes to a Windows Surface Pro or you can put a tether on it for those kind of weird to reach places or underneath a foot or what have you. You can actually not have to have it on the screen itself, which is pretty interesting, because there's some other options out there that use, like an iPad or even the iPhone, but you talk about getting into a weird angle without a tether. That's what happens. So I think it's really neat what they've done, and just watching some of the videos of how you can clean up the scans and such has been really, really neat. Okay good.
Speaker 2:I like that dude. It seems like an integrated solution scanner software, clean up kind of stuff plus your workflow from one vendor. So if that's all works together, really nice. It's a beautiful way to not get any headaches and have one supplier for this key element of obtaining that scanning information. So yeah, sounds really good, sounds really solid, and thank you so much for Voreum for sponsoring this episode.
Speaker 1:All right, and this episode is special to me and I wanted to give a little bit of context before we hop in almost to the middle of a conversation of what Joris and I had to say about creating access worldwide for people that need prostheses.
Speaker 1:Listen in Katie Leatherwood, who we've had on the show that lives in Latvia, has been there for a while, came and visited us at not only East Point but Advanced 3D and we just had a great discussion and it really led me to think like there's obviously multiple ways to reach people right. But what's interesting is that Katie is unlike many other orthodontists in process. She actually lives in Latvia and has since 2018.
Speaker 1:And so she set her roots up. She has a team that help her on the technical side of things, but then also travel where she can't travel as an American, but then she has also taken the time to do the things the right way. So she has the nonprofit that's established in Latvia, also has the nonprofit in the US, but then she also has a for-profit prosthetic place in Latvia as well, and I think she's doing a very nice job, kind of melding the two, and I know we've talked about this before, but I think it would be interesting to talk a little bit more about it.
Speaker 2:So just the idea of how to get everyone prosthetics, something like that, or how to spread the program.
Speaker 1:Yeah. So how do we do it? Do you do it with nonprofit? Do you do it with business? Is it going to mix of both, with life enabled? And then we've had some other people on, like Jeff Erinstone from Operation Namaste Katie. We had Paul on from Lev Legacy. All those I think it would be an interesting discussion.
Speaker 2:Okay, that's cool, we can do that, we can do that, okay. So first off, let's just talk to a couple of scenarios. I think I think the first thing let's call this the integrated scenario, with Katie's doing this idea I have a nonprofit for, I guess, the poorest or the people that can't be reached, right. I also make a practice to build capacity in the country and I live in the country and I love this very much and I think it's really good.
Speaker 2:It's very dependent on one person though. It's her charisma and her work, life's work, if you will. And with these organizations it's difficult for me to see, like, if she falls away or she can't do this anymore, who's she going to take the power that through? So there's a lot of capacity building, but there's also some organizational design. She has to find, ideally, like a young 20 year old love. You know, who's going to carry that forward to the generation? So that's a very every small business. You know, small business has to have. Okay, it's the family maybe, but there have to be people in that organization who care for it. I think that's it's very people dependent, that kind of approach. So it might be very limiting but it can be very long lasting if it's done right.
Speaker 1:Yeah, well, I think that's I think that's an interesting way to put it and I think you know what you said and just the I mean Katie's, I mean she's younger than me, so young Gish and she is really investing into local people and so, like this idea of and I think she even used it like what happens if I get hit by a Mack truck, those are real decisions.
Speaker 2:The chance of that happening in Europe is very little, very low. But if she would get hit by a Volvo truck or a. Renault that chance is much higher.
Speaker 1:Yeah, yeah, well, and just the nature. I mean La Ville is very safe, but there's around that conflict area there are other things that could happen. So who can carry that torch? And so that's an important discussion to have, and I think she's really having that discussion. So that's what makes me excited about that sort of thing. So yeah, so I like this integrated model, you know, let's talk a little bit about so that's the integrated model, right? So then you know what are some other options? You've got the you know complete nonprofit realm, and let's just go to the other one.
Speaker 2:The other one is the airdrop prosthetics realm Like kind of like you know what I mean.
Speaker 2:We come and we like make some video and stuff. Everybody takes a two week vacation and I think there's some examples of this really working and I've seen some examples. I'm going to have to anonymize this. I've seen some examples of these people raising money to go and then they raise like money and then most of it is like plane tickets for them and they get a whole bunch of pictures taken with smiling children and the effectiveness is really low. That's one one like bad example.
Speaker 2:I also know those, these, these, what are these eye surgeons and stuff? They have like a plane outfitted with like a, like a, with like a complete surgery and everything and they go and it's also their free time and they're. Really. That seems really effective because it's a procedure. You walk in, do it, boom, and all of a sudden you don't have a counteract or whatever, right, so so I think those are the two extremes of that kind of the vacation model. Right, where you're parachuting in there, you're doing something. Where one is, it's not effective because it's way too expensive. Right, you're, you're, you're, the plane ticket is is 1500 bucks and then, and then you're giving $500 worth of goods to people and the other one is a super effective, like you're taking these really amazing surgery people in there. It's only two weeks but they'll do a thousand patients in whatever country, right? And I think with orthopedics this is aftercare thing and that always kind of really makes this model for me a really, really problematic.
Speaker 1:Yeah, no, and I agree, and and you know for, and one thing that we didn't talk about, with what Katie's going on like for the prosthetic market, you know, people are changing all the time. They're losing weight, gaining weight. They might have had, you know, a few extra tortillas, you know some salty beans and their beans and rice, which makes them retain fluid and then all of a sudden they're bigger and they can't get into their prosthesis. So, having somebody local that can actually lead them through that, because it's a journey of this fluctuation, because you've got a real live human that their body is changing all the time and it's something that doesn't change and we can go into that another time because I think that's part of the socket is there should be some opportunity for these things to change and and people self manage that. So, but what Katie?
Speaker 1:When one interesting thing that Katie had done is she has her people that take care of some of the follow ups and make sure that everything's going well, but she also will do like video follow up calls on a very frequent basis. And so this one guy who was in the Ukraine said hey, I'm up to 10, they're called ply of socks, two socks very thick. Well, that's a known dimension and she goes. Not a problem, I'm going to reduce the socket file that you currently have 3d printed and then when my guy is back there next week he's going to take it and put it on you. And sure enough, now it happened.
Speaker 1:And so this idea of follow-up care you have to talk about follow-up care when you're talking about the prosthetic and orthotic field, and so you have the parachute in model, not great. And one thing that is very interesting and this is what I tell people when they're looking at nonprofits to donate to or whatever is if there's a bunch of if, go to their social media, go to their website. If it's a bunch of pictures and no video, bad news. If there's no video, that means there's no outcomes. There might be smiling people, but they're not wearing their prosthesis, so video does not lie. And so that's just a little hint for people that who do I donate to? If I want to help a mission or whatever of prostheses, you want to do one that does a lot of video.
Speaker 2:Okay, then on another approach, we could talk about just the local manufacturing. So that to me is like is it kind of, what are you doing? But then you would just focus on either one of the smorgasborders you don't have to do everything at the same time, but you would then, of course, try to make as much as possible in that country, right, and that could be like the people are making things out of wood again with a lathe, because that's what they have. That could be very radically different prosthetics than we're used to, but maybe they've made super-duper affordable.
Speaker 1:Yeah, I mean, and I think that's interesting and I was. That's where I was really surprised when, at this Lathe Otha with the Hope to Walk people, they literally are using the same casting tape fiberglass casting tape that you use to break your arm. So it's the casting tapes and they're using that to make a prosthesis and they actually take an oak dowel and slide it through a PVC pipe as the pipe that attaches to the foot and that is actually testing better than the pylons that we use here in the US, because they're a little bit dynamic and they're not going to break.
Speaker 1:And so it's interesting. You know that, take on it. But I think where people make the mistake, though, is they focus too much on that and this idea of locally-sourced materials and they say, hey, we're providing jobs and that sort of thing because they're sewing our leather and I'm like you know, you're not delivering that many prostheses, so it might take them like maybe an hour to sew up all these leather straps and put some stuff together, so you're not really giving somebody a job. I mean, it's more of a talking point, but to another end of that is like, if you actually put them on payroll right and teach them how to make these devices, how to fit these devices, that's when you level up and then allow those people to teach another people, and then that's a way to scale.
Speaker 2:Yeah, I think that's really exciting, but that, I mean, I think that really requires you could do this in six months. You know that would require, like you relocating, essentially just like what Katie did. So you would have to like literally live there for a number of years and in order to find someone to pass the baton on and is local, I think, which is still. I don't think this scenario should ever be, 20 years from now, like we import a new Canadian every six months. You know what I mean.
Speaker 2:I think the idea of capacity building and them doing the manufacturing themselves should actually be them doing everything, and especially if we're talking about super poor countries, where this kind of the infrastructure, part of it, is really really different. And then, another thing I want to point out is, of course, like, I think what you talk about this is like the countries are all very different. You know, whether you go into Bolivia, which is a, you know they have very remote areas some of the areas are really poor, but there's also giant cities and it's also quite connected to the world or where you go into some mega remote jungle area or a mega remote or a country that's, you know, south Sudan or something like that, that's going to be a lot more difficult you know, Car or Congo is going to be.
Speaker 2:You know the operating scenario. Bolivia is already going to be going to be tough, I think, for a lot of people compared to the stuff, the comfort level you have in the States and all this stuff is going to be different. But if you always want to translate that same model that could work really well in Bolivia, then you go to Congo. Yeah, good luck, you know.
Speaker 1:Well, and that's so true, and I think that's also important, like when this, when the world broke out in Ukraine and all that stuff, all these processes were like, oh, we can make them prostheses. Yeah, they didn't realize that Ukraine is a first world country, like this is not developing world. They're not going to go for your wooden pylon, wooden foot thing. It's just not the right thing, and you know. And then you have in the various areas where you know going to the bathroom or is a squatting over a hole in the ground, well, you can't use the foot that I use because it doesn't have the range of motion to get into a spot.
Speaker 2:Oh wow, that's a huge problem in large parts of Asia, large parts of also in Europe as well. Wow.
Speaker 1:So you've got to think about that as far as okay. So what are they actually going to do? And then you know you go into like a Middle East area and Cosmesis is everything. How does it fill out the apparel to make it look like they have two legs and that sort of thing, or even the arm stuff? And so, you're right, it's different for every single one, and so anybody that is saying they have the answer, they don't have the answer and you have to enlist local help to kind of figure that out, or come alongside of them to help figure it out and not try to fit the square peg in the round hole.
Speaker 2:No, definitely I think. And also like local solutions with local people, not just. I think it's really like that white man's burden kind of stuff, that really kind of like horrible attitude where you know everything better and you just come in like, yeah, this is it. No, you don't know everything better. You've been there for two weeks, right, you don't even know how to you know, you can't even navigate the place properly and all of a sudden you're telling everybody, just because you're from like a richer country, that you know everything better than that person.
Speaker 1:I think that's great, right, right, and I think that's a big, big time struggle and it's it is a struggle and you know, people want the funding right or the access, and so they kind of sometimes go just along with it just to get that. Yeah, exactly. But then you have two people communicating two different things with expectations in the two different ways, and it can just be a disaster.
Speaker 2:So that's definitely something.
Speaker 2:And what about, if we like, separate the problem into two, because this is, like you know, your iPhone, not this one, maybe, well, this one kind of right, but it's going to be a 3D scanner, but the Com app. We've seen how that kind of works now for a lot of people. So imagine we could just like it's iPhone 17 or something right and we've got like the Com Plus or something like that and works even better than it does now and the cleanup is even better than it does now. You know, can we have a model where you just like you just you take Bob, bob's a local dude, he doesn't have to be trained, you give him an iPhone and you just say scan all the people. Is that a thing? Can we do that? And then you're like in North Carolina or whatever, and you're like going to make these things and then send them over. Can we do this? What feasible thing do you think?
Speaker 1:I think so, and it's not just and I don't think it has to be a random person.
Speaker 1:So, like, one of the interesting thing is, medical centers exist everywhere, and so there's nurses, doctors that are interacting with patients, that know the anatomy and such that love technology. You know, and I think about the orthopedic surgeon that wants to print his own medical models right, why not train that guy to take some scans? Or he can train some nurses or what have you, but maybe he's the main guy to take scans and send them to an area to be produced, so that you're not having to learn, okay, another whole software, and maybe that's part of the journey. It's like you take that burden off for a little bit, get them really good at scanning, and then, hey, now we're gonna take you through the journey of modifying so you could do it right there, and then the follow-up is now you're gonna be able to do everything to your 3D printer, and then what I want you to do is then show somebody else, maybe in another country or in the city down the road, to do the same thing.
Speaker 2:Yeah, that would be really exciting. And also to print locally thing as well, but maybe use the Americans' expertise to make the prosthetic because they don't have enough prosthetors there, because we know that that's a huge problem with these and then we partially print them on site and maybe have a local prosthetist who now, with much less time, doesn't have to do all the work and they can just fit, like I don't know, 10 people a day instead of two people a day.
Speaker 1:Yeah well, and so this really resonated with me. It was about six, seven years ago. I had a doctor who was from India. Her dad had just had an amputation and had been to all the prosthetists or people that made prostheses around his city and he still was not walking. She goes Brent, is there anything that you can do? And so I took her, and this was before scanning. So I took her and showed her how to take a reasonable cast and she brought that back to me and I actually made it and then she ended up taking it to back to India to fit her dad Pretty much all set up, we had the measurements and all that stuff and she facetimed with me and we got the alignment right and then her dad was as happy as could be.
Speaker 2:That's crazy. I love this. Wait a minute, I love this. It's just so simple, dude. This is.
Speaker 1:It's totally possible that's all I'm saying To be able to use the expertise from other areas if you're outkicked your coverage. Essentially and it was a simple phone call, a video call, and I mean the technology's way better now, so there's no reason why that can't be done Okay.
Speaker 2:I like that. That's very helpful because I think that we're using cell phones, the internet, all this technology to connect us, and I think that gives me a lot of hope that we could do at least part of this kind of information value exchange like online. I think would make everything way, way cheaper and way more scalable as well, like make it much bigger.
Speaker 1:Well, and you alluded to it, for me to hop on a plane to go to India I have to leave my for one patient, say, if I was to go see her dad or whatever. And let's just say I saw 10, which is a lot of work for a week. I'm into that for $2,000 probably. I'm eating and food and hotels, maybe another $1,500. And then the pieces and parts for all that and I've left my practice for a week, and the design stuff, like all that. You know it's a fairly big sacrifice all the way around, so that the end price of that one prosthesis you know it's going to be $15,000.
Speaker 1:But with her going back and forth she's already standard dad. We're working together. We were literally into it for probably less than $500.
Speaker 2:Super nice. I love this. This is really good. I like that example very much Because, yeah, you can take a lot of a cast seems like this seems like not a really insurmountable thing to do. And this is actually also how all these hearing aids like millions of 3D printed hearing aids they get made and it's like a custom wax impressionary ear that goes on a box and that gets scanned in another country and that file is then used to make the to. Then they customize the electronics inside of the. Look at the software, like, oh, this is the electronics, go this way, this is better for this one. And they print it out and then they send the thing to the people. So that's like you know, that's being done like tens of millions of times, yeah.
Speaker 1:Yeah, I think you know it's interesting. I mean a lot of people, and I think that there's, I think it's something to be achieved, but they look at, you know, hearing aids and a dental, you know, as a great as parallel to the prosthetic realm, but I would. I would say too, though, is those are dimensions that don't change right. The teeth and gums, and the same thing with your ear stuff.
Speaker 1:You can be pretty close and you're going to still have a result. That's, that's reasonable. But this is also where it's exciting for 3D printing, because we have materials that we've never had to use before. So I believe and this is just through we've had Richard on. Remember the marathon guy where we used his same shape. That was not working for him to run the marathon or to even train, but we changed the materials and now he ran a marathon. So I think you have that opportunity in 3D printing where you have some materials and you've we've talked about air pockets and that sort of thing, even with FDM, where, even if they have some some variability, flexibility, you have some protective mechanisms that are automatically built in. That is maybe a suboptimal prosthesis, but because we're using these technologies to their fullest extent, we're going to be okay.
Speaker 2:Okay, that's interesting. But then can we make, is there a universal fitting? Like? You know these boa clips and I know I'm obsessed with them, but can we use them to make one prosthetic that'll fit everyone? You know what I mean. You know what I mean that we have like a prosthetic and then you just adjust the screws, the telescope, the middle bit out and up, and you can, you know, make everything bigger and smaller. Is that a conceivable thing, kind of like a IKEA prosthetic that can deal with like a lot of people, or I think it's an interesting thing and I think it's something that we should strive to, but I'll never forget.
Speaker 1:You know, we had that David Boone on, and he touched on how all the surgeries are different. Right, so every solution is different, and everybody talks to the prosthetist about how well, you don't have a good fitting prosthesis. Well, no, you did a bad job doing the surgery, and so we have that situation, too, where all these surgeries are not consistent. And then the other part of that is, many of these surgeries are due to people dysfascular disease, diabetes, that sort of thing and so if you automatically give them something like a bow or something they don't have feeling a lot of times in their legs.
Speaker 1:It could actually be worse for them. So this is where having these air cushions and that sort of thing, I call it kind of like oops, like okay, the prosthetist may not be that good and the patient's not very compliant. Well, if we use the right materials, we might still have good outcomes, does that? Make sense.
Speaker 2:Yeah, I think I get it. I think it's a good point. I think it kind of increases your safety factor, your comfort factor, just by having a lot more, better material. I think that's a good point. I didn't realize that. I think I'm really really happy you made that. But okay, how about this? The great big library of prosthetics? So we take everybody's old prosthetics, we put them together and then we scan everybody else who needs one and we match them up. Then your prosthetic twin gets your old prosthetic and they're exactly the same size. You're exactly the same thing. Now something else. Well, you know it's, it's.
Speaker 1:It's sometimes it's not. Far from that We've. We actually last year had a guy he was this is hilarious he was a left above the knee amputee. Saw a right above the knee amputee leg on eBay, bought it, chopped it up a little bit and he was walking around on it. It was suboptimal, but I think it does point to the resilience of of people and people's tolerance.
Speaker 1:Right, people want to be up and walking. So I always hate the saying well, you know, it's enough. But a lot of times, especially with the 3d printing and scanning and things like that, I think we can get a lot closer to enough and be comfortable and have a good outcome, rather than these suboptimal like kind of what you talk about, this library and we match you up close. I mean this guy took a right and made or a left and made it a right, or the other way around and was doing okay. So I think that there's a little bit of room between a very well-fitting socket and somebody taking the wrong side and putting it together. I think that there's can be a very happy medium where it's good enough and you're off to the races.
Speaker 2:Okay, I think that's a really good approach and I think, you know, are we seeing also, like another thing we have to discover? Is there a lot of DIY stuff, the stuff I'm triggered a little bit by this this woman doing the casting herself. You know, can we put a lot more work in the by the person that needs this prosthetic, if they, if they're going from having nothing to getting something good enough? Can we have like a more DIY kind of a thing, the thing where they're more involved in the making process, the thing where they do part of the work? You know, because, hey, I would do that. If my option is like I have to do part of the work or I'm not walking, then hey, I'm going to be like you know, I'll take your online class. You know what I mean, I'll do it. Is that something you would believe in as well?
Speaker 1:I think 100% you know, and I think you know, when we talk about like scanning and that sort of thing or even the casting, I mean, casting material is available anywhere in the world. Yeah, I mean, I think that there's there's definitely some options there. And I think the other thing is that there are some people kind of coming down the line that are using, instead of photogrammetry, they're using, like this, video geometry, which it doesn't really matter what mobile device you're using. So almost you know most, a lot of people have mobile devices, or at least they know somebody with a mobile device, and so that can make it more accessible into that DIY area as well. So I don't think that's far off.
Speaker 1:I think where you, where you can really run down the rabbit hole, is the rest of the stuff, the alignment, that sort of thing. So it's like it's a it's a whole package type of deal, so you've got this fitting and then you've got how does it fit in 3D space? How is the person walking? Is it tall enough, short enough, that sort of thing. But absolutely, I think that is. That is a very interesting take.
Speaker 2:Yes, but then, okay, imagine we had a really good 3D scanner, right, Big 3D scanner, and we traveled around like some less than developed country on site and we did that, and then a week later they come back, we print it and they come back. We'd scan them again to see how the alignment's working and we scan them again to see how they're walking. I mean, the only thing that really needs to be local is the scanning. If we can tell all those things from the scanning, right, I mean if we can get an accurate assessment from just the scanning or the video of the person or that kind of thing, and then we can do all the other stuff remote. Yeah, yeah, 100%.
Speaker 1:Yeah yeah, well, and here's the other cool thing is, you know, we talked about some local supplies and all that stuff. I believe that these materials are getting good enough to where we're going to be able to prevent print feet and such. So you're going to be able to print the socket and the foot, and then you just need something to connect the two, and that could be like extruded aluminum or whatever that could be, or whatever it could be, a piece of bamboo. I mean, bamboo is very strong, but I think so a lot of people are like well, brent, you could just print the whole thing from the top to the bottom. You can, which is called exoskeletal prosthesis.
Speaker 1:It's been around for forever, but you have zero alignment capability. So let's say, you missed the alignment by just a few degrees and you print it all together. That's not good, and so being able to make a quick alignment change via a pipe or whatever is going to be your most effective way to go for the best outcomes. And so I wanted to make that clear too, because I actually take probably a message, at least probably once a month, about this idea of oh, you could just print it all together. The people that print it all together have aligned everything first and then scanned it, which may be a great model to do, but they don't go straight into putting it all together. You're on mute.
Speaker 2:Okay, so I take the patient first and then I align, or what? What's the difference?
Speaker 1:Well. So you know how we talked about the pipe where you connect the socket to the foot and there's a pipe in the middle and you can actually change the alignment. A lot of people are like well, why don't you just print it all together? Well, without knowing what the patient's true alignment is, you can't print it all together. But what you can do is say, on their first socket you have this alignment thing and you dial in their alignment and they shrunk. Well, you can take their 3D socket down and then capture their alignment in a scan and then you could 3D print it all together if you wanted to. But right out of the gate it's literally like gambling. It's very unlikely that you're going to hit it.
Speaker 2:That's good to know, I mean, I think. And then there's the other example what if we just made? This is also always comes up when we talk about customization and 3D printing. What if we made a thousand sizes of prosthetic? With a thousand sizes of this, can we do like a big library of standard things? Maybe it won't work for everyone, but it'll work for 30% of people. These 30% of people, boom, easy, you come in, you set a size 3 plus a size 5 plus a size 9, ta-da, you're done. So then we don't focus on making the custom solution for everyone. We just say like, okay, with these hundred sizes of each part, the hundred sizes, foot, hundred sizes, brace, hundred sizes, whatever, we get 30% of people and we just need to take some simple measurements and then these are the easiest low hanging for dudes and we just help them. Yeah.
Speaker 1:Well and I think that's what you can do with a trans femoral or above the knee prosthesis, because you're only dealing with one bone right, and typically it's a fairly easy surgery and such, and so there's a lot of truth to that is you could have a small, medium and large left and right and be good to go. So I think that is definitely a really important option for that. For the trans tibials, you know, especially in the developing world, it's a whole nother thing because you have traumatic amputees, congenital amputees, these patients that have had diabetes really terrible, you know, amputee Like. If there's so much variability in the below the knee, I think it makes it more difficult Now, with that being said, though, is you could have some dimensions, and then there's materials now, like, I think, like a part A, part B foam, where you can pour it together, have them put their leg in there, and it kind of expands around their leg, and now it's custom.
Speaker 2:You can do that with polycarpylactamide as well. To call it a polycarpylactamide heat fits to you and these foams as well, but that's yeah. Okay, you could do that as well and then also like latex like materials for the outside. That could be interesting yeah.
Speaker 1:So I think and there's there was one group that did that, something similar. But here's the other cool thing and with the shapes and such, I believe that if you have the right lattice structure, bladder size or say, if some of that's modular and you can kind of almost you know how you can put the dots and the crocs, the little the, in the holes of the crocs shoes. You know, you put the little thing. You could do something very similar to that and get things to fit and you could do that with FDM and that would be very interesting. So I think yes.
Speaker 1:But what would be great is to have a company take some of their application engineers. They make this little passion project for them like a company, like you know, a bigger one that has a bunch of resources, and they take it on as a passion project and say, hey, for the next two years. This is what the results do we want to be? We're going to work on this we're going to do a couple things, and then you're off to the races.
Speaker 2:There was a solution that I'm glad you mentioned, because that's something we almost didn't can. We've gone like kind of the NGO route and looked at this as a technological problem, right, but I remember at one point but enable there were people selling this when enables like donating these hands and stuff like this, there were people selling the enable hands in Mexico for a couple hundred bucks. So how about? This is a business opportunity, right? How about somebody saying we are actually a startup that is going to bring prosthetics of the development world? Do you believe in that kind of model? Like a pure commercial model? Somebody's just saying, like you know, we're going to have like my first prosthetic or something like low cost prosthetic, or we're going to open a whole bunch of clinics everywhere. Do you believe in that kind of thing?
Speaker 1:I do Like, I believe in definitely, entrepreneurship, and you know, I think this is where it gets interesting and the semantics get very interesting. You have these NGOs that you know. A lot of them will say, hey, you can pay for your device and it will go, and that money will go back into the business, essentially, and then somebody else will walk. Or you have this thing I mean a lot of people will call it like a social enterprise type of thing where they're not trying to really make a profit, they're trying to cover their costs, but they're backed by, say, some investors. To me it's one and the same. I mean, yes, it is commercial and that sort of thing, but investors, donors the reality is a lot of these people do not have the money to pay full price for these things. So they're going to be subsidized in some sort of way.
Speaker 1:And that's just from what I've seen, right. I don't want that to be true. I'd love for it to be completely self-sufficient, but I don't want to be naive enough to also on the same thing and say, oh, this is going to be self-sufficient because the people that are missing limbs and such, these are not the people that are the wealthy of the wealth, they can fly to the US and go to the best prosthetist and get their stuff the way they need to, which I don't necessarily agree with either, because they're going to have the same problem once they get back in. They're going to change in size and such and sustain local is very important.
Speaker 1:So I think really the answer lies in somewhere in between. There's a hybrid model of like you have somebody skilled enough that can take care of these super high-end things, or maybe you do a clinic once a month or whatever, where you bring in a prosthetist from out of town or whatever that allows you to help you learn and be on this journey of being coming a better prosthetist. But you take care of the high end the well. You know things that can be paid they're self-funded, that sort of thing and use some of that money then to pay for or subsidize these prostheses that are low cost, say sub $500 or so but you give somebody a job, you give multiple people a job learning this trade. So I think you can do that through the NGO. I think you can do it through a social enterprise. I think you just have to be super honest about what is actually going on in the back end. Right, and sometimes it's like going back to the photo ops and stuff.
Speaker 1:Well, we had this team come in. You know there were 15 of them that came in and they stayed at the best hotel and they flew first class and all that. You know it cost them $60,000 to get here. Well, that $60,000 goes a long way in providing prostheses to people, right, and they didn't really even have to come. So I think there's a balance with any of that, but I love the idea of entrepreneurship and making it happen. I think one thing that what we've had issues with with life enabled and this is, you know, I talk to a bunch of people, but especially like in the area that we go, which is the jungle of Guatemala, it's not, there's not a lot of people that love being up there. It's hot all the time, I mean, and Dusty there's has its own challenges with when the rain and all that stuff comes.
Speaker 1:Everybody wants to go live in the city where it's, you know, the land of eternal spring. The coffee is amazing. You get up and it's 65 degrees and it may get to 80 degrees, like that is the life right, and you have malls and Walmart and all that stuff, and so one difficult thing that we've had problem with is when you give somebody a skill, that is in that other people want right, they will leave and follow the money We've had two clinicians that we've trained and such that, move to the city.
Speaker 1:I don't blame them for doing that. Luckily we've had other ones coming behind them. But now they're in a situation where they're talented, they're good enough and they're making good money, but they've left the people they were serving for money itself. That's a difficult thing and I don't fault them for doing it, but I think we also have to have a little bit of a reality check-in. These skills are very valuable and they will be able to level up, and there's a chance that you will lose them.
Speaker 2:I think that's a good point. The other approach which we also haven't considered, is the exoskeleton approach. I'm going to call it the exoskeleton approach. Imagine the exoskeleton just becomes a product. So we get a productized technological solution for all the workers in the world to be able to work harder, because everybody gets an exoskeleton, something like that. But there's other things that could do with this. We can see this happening with robotics. We saw how quickly all these robotized vehicles are conquering or these electric vehicles are conquering, the road, not the cars, but all these other wheeled vehicles and cars and little bicycles and stuff like that. Do you believe there's maybe a technological solution that competes with that whole kind of charity slash orthotox-driven stack, if you will? There's going to be some product by this thing now.
Speaker 1:One interesting thing is and now that you brought this up and we've kind of foreshadowed a little bit but in the northern part of Guatemala where we go, the hospital, which is a not-for-profit hospital they will also let private surgeons come in and use their OR suite because they have endoscopy equipment, so a specialized equipment, right and so these doctors are there pretty frequently because they're able to do these jobs very well. So it would be interesting to have something very similar in that sense of, say, it's a non-profit organization, it allows a prosthetist or whatever, or they could be a traveling prosthist or what have you. Hey, we have this lab that's set up and you know for you to come and use it. You can come see your patient, but at the same time we want you to see 10 of our patients.
Speaker 1:I don't know, maybe that's the way that, where you barter some of that skill or what have you and it allows them access to technology that they would otherwise not have and it gives us access to their skill that we would not otherwise have. I think it's a very interesting thought on that. And then how do we find those medical professionals that are going to stay in the area that have?
Speaker 1:family in the area that are well-established, that have an established practice. How do we get them to incorporate this into their clinics and take care of people? I think that's very interesting.
Speaker 2:Or there's another model which is kind of analogous to this. This is kind of closest Imagine we do in Guatemala in the jungle. We have a central fab right and the central fab makes stuff for America. These guys are getting paid well for Guatemala, the laughing. They'll stay because they're getting much higher salaries than they get in the city and the jungle. The living there costs peanuts, whatever. So they're staying. They're doing all the manual labor stuff that the fabricator people do and that gives us a cost advantage by shipping these things to America. And then meanwhile, with all you know, two days a week, we're making low cost prosthetics for Guatemalans for free. So then we have a hybrid, as in we're doing the fabrication in a low-income country or lower-income country and then we're using that to actually like make you know skill people a product for America as well.
Speaker 1:So, and I, oh man, I love that idea and I think I think that's great. I had not considered that aspect of like. Okay. So how do you make it? If they're following the money? Well, how do you get them to follow the money to stay home? Essentially so and I think we've talked about this before is the real key to any of this is design. So, if you can, if they have an internet connection, and you say you set up some computers somewhere that you know they all have haptic devices and what have you? And you set up central design right there in northern Guatemala. I think that you're onto something there, because now they can help me design the stuff that I need for the US. They're also designing low cost prostheses for you know the jungle of Guatemala and you know Belize and Honduras and all the surrounding countries, and and they're getting paid well to do- it.
Speaker 1:I think it's great.
Speaker 2:I like these kind of things because then you're like engineering a solution. It's not something like mega breakthrough, we don't have to change the world, we just have to give the right people the right incentives and then all of a sudden magically to work right, maybe for whatever two times minimum wage. The guy wants to, but four times he will. And then it all of a sudden makes sense for us and also for him. It's like you know he's laughing. All of a sudden, the four times minimum wage and jungle. Then he's like you know, whatever, I'll buy a house with a pool.
Speaker 1:Fine, you know maybe I don't know, yeah, yeah. Yeah. Yeah, oh, 100%. I really like that. I like that a lot, yours.
Speaker 2:Yeah, I think that's. That's an interesting exploration as well. But, um, and then the other thing is like, okay, we're looking at funding, right, so we haven't really considered funding because either NGO or commercial or some kind of mixed mash thing of. But how about? Okay, the first one. I've always thought about this. I think everyone's thought of this. We sponsor them. Your knee is brought to you by Coca-Cola and it says Coca-Cola on the knee. Yeah, is that going to work? I mean, companies get involved with this, but they seem to be. You said me, someone told me before, like I think it was offline. You told me, like I'm about, like they're more interested in the pictures, like you know, you know, do you think of that? Like, like you know, lockheed makes 1000 knees possible in in some country. Do you think that is something? Or do you think that's not going to be a sustainable thing? Or we really need a commitment from one organization or whatever?
Speaker 1:I think it would be interesting you know, I think it and if you could get enough of these corporates to take on specific parts of it, like, like Coca-Cola, coca-cola is everywhere, right? So if they have Coca-Cola on their knee and it does, you know, it's bright, red or whatever and it's got Coca-Cola. I mean that's good branding, advertising, all that stuff, and they're doing good things for people. I think the, you know. I think another thing that would be very interesting is you get some. It's one of the Polymer companies or what have you to?
Speaker 1:be, involved in the socket stuff and then you have this, you know whole complete system. Essentially, that is brought to you by corporations and I think that's very interesting. I love, I love that model and, I think, touching on this idea of sustainability too, like a lot of these companies have, like endowment funds or trust funds or what have you, where you know they're donating based on the interest coming in. So if you can get a commitment long term, I don't care. That's sustainable, that's as sustainable as having you know investors invest.
Speaker 1:You know a million dollars in the middle of you know Uganda or something, but when that money runs out, it runs out. At least you've got a little bit of a runway you know, with something like that. I like that a lot.
Speaker 2:Okay, all right. I think I would always worry about how long is their commitment? What do they want out of it? Will it fit, you know? Are they just going to suddenly say buy, or are we going to do it four years and up to fifth? I think that would really worry me. I think in that sense They'd be easy. Like I said, I think it's a good idea, the Polymer idea, like I could imagine if you get a BASF or somebody to keep donating one metric ton of this stuff, they're just going to do it forever because, like for them, whatever this is great, great marketing, whatever you know. But if they need to keep finding the cash somewhere, I think maybe at one point you might be a little bit yeah, you might have a little bit of a budgeting problem.
Speaker 1:Yeah, well, this is where I think it would be interesting for a company to pick it up and do the kind of the initial project, like scope of project and then where they're only, and then you know the end result is how do we make sure that all we're doing is we're not giving cash anymore, we're actually just donating material or something to that effect? I think that would be very interesting.
Speaker 2:The other model I think I think you thought of this before is like this idea of like you get a leg, you get like a plus one leg or something. So you tell like your person it's like, hey, pay 500 bucks extra and then we'll give you a person, a leg to a person, and go on a mountain. That kind of idea of like I know people that Tom's trying to do this, there's people trying to do this for shoes and all sorts of other things. Can we do this for prosthetics as well? Where you just say to people like you know, for this amount, this other person will also get something, or something like that, another person in the same situation as you, or I think yeah, I think I would say that I mean, especially in the US, that probably already happens.
Speaker 1:I would say most people probably go ahead and donate that. I think. What's interesting and that's what's happened most recently, though, is some of these companies and we've talked to some companies that have had some pretty significant consolidation sessions, so they have some clinicians that they're willing to give time, you know, to go somewhere or be a part of a project, and so, like we have a group going to the Ivory Coast, and Bionic Sagar and we had Sagar and Tony on said, hey, we've got two clinicians that would love to go with you guys and we're going to take care of their vacation time, we'll pay them while they're gone. You know that sort of thing, and that is super cool. You know, you get another company kind of behind you and they're going to donate some components, and that sort of thing. I think that sort of kind of social commitment where these companies are saying, hey, you can take the time, whether it's, you know, here, local or if you want to actually travel somewhere and then that becomes sustainable, where you can build some of these teams, even design teams.
Speaker 1:You know that, because there's sometimes where I will take a file and be like you know what. I am so busy right now I cannot crank this out. Can I send it over to you? And they're like, yeah, no problem, I'll fit it into my schedule. And then I get this file back and I haven't had to touch it. They feel good because they've helped. It's a great thing.
Speaker 2:Okay, this is the one I think I've been saying for the last time. I think you're having at least enthusiastic about it. But look, we have the AI based super scanning Autobot prosthetist. You know, we take the prosthetist out of the loop. I could just scan using my phone and then, magical, the algorithms, all those super busy algorithms will design and maybe print or partially print this whole thing in the automotive art. Yeah, I don't know if that's desirable, right, I think? I think you know, with alignment back issues, whatever we want to be, but you know, surely someone is gonna do that eventually, something like this yeah, I mean.
Speaker 1:So MIT had a project a while ago. They had this like fitting thing that had these like spring-loaded things that came down and evaluated the tissue underneath and all that stuff.
Speaker 1:And you know it was super cool, right, I forget how much it cost. I mean it died. I mean the thing is like there is a way to over complicate the prosthetic stuff. So I think you can maybe focus in the software side of things. But the bottom line is there has to be At least right now there has to be some sort of human interaction that can turn the screws, put stuff together, cut stuff, grind stuff, that sort of thing To to really make it go at it. But you know, when I say all that, but the way some of this TPU stuff is going, maybe not it's, maybe it's more like a shoe and some flaps and some Strings, you know that go together and kind of pull everything together, I think I think that's going to be Something worthwhile looking at okay.
Speaker 2:Well, I thought this is really great discussion. I think it was really wonderful. I hope we Uh, it was. Why are people to think about this stuff in a broader way? I think I hope that that was the thing. That's what I think would be nice for people to think about these angles and these different ways of thinking about this stuff, and you know, it'd be really valuable, I think I.
Speaker 1:Think so too. I think this is a great discussion, as I opening for me, you know, on some of this stuff and I, and I hope you know we can continue the discussion. I think the thing that we can agree on is it's a fragmented Industry, which is kind of silly to me, like you've got different people All over the world doing it different ways and they won't talk to each other. Yeah, we got it. We got to stop that.
Speaker 2:That's a good idea. It's generally like figuring out best practices from everywhere and then everybody getting together on the same page on at least, or finding other people that are doing the same approach. But even if it be valuable, everyone is a pure NGO people that only want to make wood lathe prosthetics. Right, if those guys all 20 of them or something got together and so we're gonna make it all out of local hardwood or whatever, because that's how we are and they learn from each other, I think that would be really valuable as well. If all those little different groups and factions go together, you know, let alone everyone agreeing on like one approach or one thing or one solution.
Speaker 1:Yeah, well, I think that's important and I think you know, if you took all the NGOs Everywhere in the world, I Bet you that they didn't deliver 10,000 prosthetics last year really I have no idea and there are over 35 million apts, yeah. So All that to say is we've got to be better, right, if we, if we choose a?
Speaker 2:million. Even though I did a million, that I wouldn't really address the problem, because then, like, by the time you got the problem, like yeah yeah, so everybody is fighting over whose whose idea is the best, and we didn't even touch 1% of people.
Speaker 1:We didn't even touch point 1% probably and and so that is where I think the discussion needs to be is how Do we get all these people on the same page? And that includes me, and you know, you know I was, I was, you know, very much in the blind or mode, thinking that I'm doing things the right way, and. But now I'm definitely much more open to it, and I think 3d printing Software and all that is going to be part of this. I just don't know what part.
Speaker 2:I mean, I think it's really interesting space. It's really great. It was a wonderful conversation and I hope you enjoyed it very much for listening to us, and this is another prosthetics and orthotics podcast with Brent Wright in yours fields. Have a great day you.