Ronan prosthetist builds new legs for Nicaraguans

Jennifer McBride - Leader Staff

Every other Wednesday, you can find Missoula-based orthotist and prosthetist Larry Williams in Ronan, fitting leg braces to Lake County patients. On other days, you can find Williams in the isolated wilds of Nicaragua, where he is setting up a new clinic for crippled children and their parents.

"It's really third-world," he said. "It's really very primitive. I've seen things there that I've never seen before."

Unlike the United States, where defects like a club foot are treated in infancy, the villagers in Santo Domingo live with their problems uncorrected. The nearest hospital is six hours away by bus, and many people can't afford the fare, much less the doctor's fees.

Williams said babies in Santo Domingo rarely receive prenatal care and are usually born outside hospitals, which could explain the high percentage of children born with physical defects. Children with missing arms and legs regularly walk the streets without benefit of replacements.

Nicaragua is one of the poorest countries in the world. Nicaragua has the third lowest per capita income of any nation in the western hemisphere. Despite a low unemployment rate, 48 percent of the nation's population lives beneath the poverty line. One third of Nicaraguans can't read or write, and its national debt is equivalent to 83.1 percent of its gross domestic product.

Though Nicaragua has cut back on social spending to help reduce debt, Williams said the national government has discussed aiding the clinic. They want to provide a local physical therapist for patients who have to learn to walk all over again.

Williams said he "fell into" the project six months ago. Village leaders in Santo Domingo approached his brother with the idea for a health care center. His brother works at a gold mining company, which will soon become the primary employer for the remote area.

Williams said the company hopes to create several improvements including, eventually, a sewer system. Right now, the outhouses upstream pollutes the village's sole water supply. Though Williams takes a lot of bottled water with him, he's come back from both the visits he's made to Nicaragua sick.

"You can't shower with bottled water," he said.

Despite widespread poverty, Williams said he usually sees a lot of smiles. On his next visit, Williams will start evaluating his first patient for a double leg prothesis. The man, a truck driver for a Santo Domingo business, lost both his legs five inches below the knee. Though he currently has replacements, they don't work very well.

"He has a great sense of humor," Williams said about the Nicaraguan. "He joked that when he gets his truck going down a steep hill, his legs fall off so he can't reach the brakes."

If the man can't drive his truck said, he'll lose his job and he won't be able to feed his family, which is why Williams is making him a priority.

The first step in creating a prosthetic is the evaluation. Williams will look at his patient's medical history and current range of motion. He will hopefully be able to give the truck driver a new prothesis after three visits. Since Williams can't bring his tool shed (complete with grinders, plaster, foam molding and other necessary materials) to Central America, he has to bring the patient's measurements and information home.

After evaluation, Williams creates plastic molds of residual limbs. Though all human beings have similar proportions, subtle details make Williams' job difficult.

"Anatomically, we're all the same," Williams said. "But we're all shaped differently."

After making the mold, Williams fills it with plaster. He wraps the model limb in plastic to create an artificial "test socket." Williams uses the socket to create a preliminary prosthesis, which he'll take back to his patient. Finally, Williams will fine-tune the fit before giving the Nicaraguan truck driver his new pair of legs.

The limbs Williams plans to donate won't be fancy. He said the prosthetics will be similar to ones North Americans used in the 1960s — hard but durable. In the States, people can buy soft, flesh-like sheaves, but Williams said the coverings are expensive and would disintegrate under hard use within a year. Even if the new limbs are primitive, they aren't cheap. Excluding time and travel expenses, the limbs alone normally would cost amputees between $4,500 and $9,000 apiece.

Williams is currently searching for companies that would be willing to donate prosthetic feet, which he said can also be very expensive. For the children, he'll offer another treat — the legs and arms come in several patterns and colors, including pink, purple, and camouflage—which Williams said is one of the favorite patterns of his young patients.

Williams said he wants the new clinic to be able to offer services to families outside of Santo Domingo and so he plans to have three or four rooms with beds and kitchens set aside. Parents will be able to stay close when their kids are treated.

While his trips are important, Williams wants the clinic to become self-sustaining over time. The town has all ready donated land for the project, signaling what Williams hopes will be a long-term commitment.

"I don't want to just build a fancy building in town and just walk away from it," he said. "There's such a tremendous need over there."