Surprising many people, the number one cause of amputation world-wide is due to complications from disease …specifically, diabetes. All that said, most of the children and young adults we treat lose limbs from injuries . Standing With Hope founder, Gracie Rosenberger, lost her limbs as a result of a car accident. Landmines and war certainly create large numbers of amputees, as well, but limbs with poor circulation due to diabetes create all types of problems for patients …and sadly often end in amputation–particularly in developing countries where medical services are limited.

Taking into consideration the work and living environments in developing countries, Standing With Hope teaches prosthetic technicians how to build below-the-knee, endoskeleton acrylic resin sockets with a pylon and SACH (Solid Ankle Cushion Heel) foot (or similar type foot). We also developed training clinics for above the knee limbs.

A prosthesis built more like a human skeleton with support and components on the inside and a cosmetic cover on the outside. This type of socket allows for easy maintenance, adjustment, replacement of feet, etc. Gracie uses this type of prosthesis.

A prosthesis that is hollow on the inside with a hard outer surface to bear weight.

A socket is the portion of prosthesis that fits around the amputated or residual limb (commonly called a “stump”). Prosthetic components are attached to the socket. There are many ways to make a socket, including using materials such as wood, polyester resin, acrylic, and thermoplastics. Each of those methods and materials has its own benefits and detractors. For example, a socket carved from a piece of wood is inexpensive but very heavy and usually poor fitting. A thermoplastic socket can be made quickly and for relatively low costs, but requires specialty equipment such as an oven. Thermoplastics are also not as strong and long lasting.

We use acrylic resin due to its strength and ease to use. Gracie wears an acrylic resin socket, and hers last for many years. They are lightweight, but durable and can withstand the often-extreme conditions in developing countries. They can also be made in a low-tech environment. Standing With Hope uses non-toxic acrylic resins that create better working conditions (no fumes) and “set up: well in Ghana’s humidity. Three pieces of machinery are required to make this type of socket: A vacuum pump, a cast saw, and a socket grinder/sander. The clinic in Ghana has all three, and replacements can be provided quickly if necessary. We also have two complete electrical systems (110 and 220) in the event that Ghana’s electrical power is interrupted (happens often). We can quickly utilize the 110 generator provided by Standing With Hope that remains onsite at the clinic …and be back in business within minutes. This model avoids using the large ovens needed for thermoplastic sockets. Those ovens are expensive …and if one breaks, they are not easy to repair or replace.

The workers in the National Prosthetic Center in Ghana can now create a below-the knee prosthesis in less than six hours. (That is down from the two weeks it took to carve a wooden leg when Standing With Hope arrived in Ghana). We only will make a limb that quickly if the patient has traveled from a long distance and has limited resources for a lengthy stay in Accra. Normally the turn around time for each patient is within a week.

Yes. For example, in the USA, computers and machines are used to make the sockets relatively quickly. Computer aided design (CAD) and manufacturing has been successfully used in prosthetic applications since 1980s. The principle of socket design, however, has been around for a long time. Due to the lack of hi-tech machines in developing countries, Standing With Hope trains workers to build sockets by hand in a low-tech environment. It is a little more labor-intensive, but there are benefits. The technicians learn a skill that has been around for decades rather than depend upon machines. Devices such as ovens to make thermoplastic sockets, and CAD machines that quickly create sockets are helpful and wonderful … but they are very expensive to purchase and costly to maintain. Taking a different approach that does not rely on technology that is frequently unavailable, Standing With Hope trains workers in time tested principles of socket modification, design, and alignment … in a low-tech environment. Gracie requires an expert eye and skill-set in order to properly fit her prostheses, and through ongoing training provided by our experts, we are imparting those skill sets to technicians in Ghana.

After giving up both of my legs following my car accident, I knew that God impressed upon my heart to reach others who didn’t have access to prosthetic limbs. As great as our health care system is here in America, there are amputees who can’t afford a limb …and so for a while I served on the board of directors for Oklahoma-based Limbs for Life. Wanting to reach even more amputees, my heart was pulled beyond our borders to developing countries …where not only were limbs unaffordable for most, but in many places there aren’t even prosthetic services being offered.I shared my with our friends at Wheels for the World, a ministry started by my dear friend, Joni Eareckson-Tada …and they suggested we start in Ghana.  Gulping (actually Peter nearly had a cow at the thought of taking me to West Africa), we trusted Joni’s team …and more importantly Christ …and we launched our prosthetic limb outreach in Ghana. (You have to read the whole story in my new book …it will make you laugh and rejoice!)

A limb created by the technicians in Africa, using the supplies and training provided by Standing With Hope, will be amazingly similar to limbs costing $7,000 or more in the US. Each limb is developed utilizing the same technique and materials that Gracie herself uses. The greatest emphasis is placed on the socket and alignment. A proper fitting socket ensures comfort, a better walking gait, and less stress on other body parts to compensate. With the advancement of high tech components or conversely less expensive components, the emphasis is often placed on the foot itself i.e. a cheaper foot would be advantageous to developing country. Standing With Hope primarily uses a SACH foot, which has been a long time industry standard with its functionality and ease to repair. In addition to leaders of international prosthetic organizations and suppliers, Standing With Hope relies on the counsel of certified prosthetists who are well respected in international circles. Standing With Hope also leans heavily on Gracie Rosenberger’s own experience as double-amputee herself.

Standing With Hope recruits US certified prosthetists (CP) to train local workers on building these devices. Most team-leader prosthetists traveling with us have at least twenty years of experience. Our senior prosthetic advisor, James S. McElhiney, has nearly fifty years of experience as a prosthetist. Mr. McElhiney has served as Gracie’s personal prosthetist since she lost her right leg in 1991, and Mr. McElhiney lost his own leg many years ago. In addition to Mr. McElhiney’s vast experience, our standards reflect Gracie’s and Mr. McElhiney’s personal understanding of limb-loss.

At the start, it cost nearly $700, but through training, shipping consolidation, and growth, we’ve been able to cut the cost in half to approximately $350 to provide a limb to an amputee in Ghana. This includes all parts (foot, pylon, etc.), materials for fabricating the limb (resin, carbon fiber, stockinet, adaptors, etc.), and manufacturing costs such as equipment, shipping, and labor. In addition, this cost includes high performance liners and sleeves that below the knee amputees wear. These sleeves and liners are exactly what Gracie herself wears with her prosthetic limbs. For above knee amputees, we also provide hi-quality knee units and belt systems. There are many ways to make a prosthetic limb, and several of them are cheaper. We feel a responsibility to make high-quality limbs that will last and perform well in the often-difficult conditions of developing countries. As Christians, we are putting this leg on in order to reflect the Gospel. We want to provide the very best we can. We cannot accept placing a limb on an amputee that we know will not last and perform for the patient. The patients used in training receive a limb for free, and their maintenance is free as well. For all other patients, the government subsidizes the limbs, and a nominal fee for labor is charged to the patient. That fee comes to approximately $100 for a below knee limb. Many can afford that fee. For those who cannot, the clinic director in Ghana coordinates with Standing With Hope for us to underwrite the costs for the patients …ensuring that no qualified patient is turned away. Our focus is on children and active adults who can return to the work force. The fee is simply for labor of the technicians who work for Ghana Health Services.

Many can afford that fee (See previous FAQ). That is a fee that the ministry of health charges, and it goes towards their own expenses. It does not come to Standing With Hope, but instead helps sustain Ghana Health Services’ clinic …so that they can treat more patients. If the patient cannot afford that fee, then Ghana Health Services submits a request to Standing With Hope to subsidize the limb. Each case is reviewed individually …and the priority goes to children. How long does the socket/limb last? Each socket is designed to last for a minimum of five years for a fully-grown adult. To date, Gracie’s own prostheses have lasted her for more than six years. Simple maintenance for such things as foot replacement, alignment, etc. is done at no costs to the patient after the socket is made.

Certainly through financial contributions …but don’t underestimate the value of sharing this ministry with your friends, Facebook, Twitter, church, school …or at your office. We depend upon the donation of used prosthetics to recycle them components and parts. Help us get the word out!