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Orthopaedic technologies

Appropriate training

by Ursula Schoch
The Tanzania Training Centre for Orthopaedic Technologists (TATCOT) in Moshi is the largest transregional training centre of its kind in Africa. Commissioned by the Tanzanian Ministry of Health, it was built in 1983 with German aid. InWEnt has supported the Centre for years. An evaluation came to the conclusion that the Training Centre has built up a good reputation. Since the beginning of this year, it has to work independently. [ By Ursula Schoch ]

The TATCOT is a beacon in Africa. In the region, there are no comparable training or further education centres for orthopaedic technology. Still, there is not a sufficient number of qualified professionals to meet the demand of people with physical disabilities in terms of prostheses, wheelchairs or orthopaedic assistive devices.

An evaluation conducted in 2007 provides figures showing clearly how the InWEnt Sponsorship Programme has helped the Centre. It also underlines the good reputation that the training courses in orthopaedic technologies have acquired outside of Tanzania.

Between 1996 and 2007, InWEnt was able to support 39 students from the Anglophone African world – some of which have physical disabilities themselves. Several scholarship holders were sent to TATCOT by public institutions or non-governmental institutes. 28 of the participants managed to complete the triennial diploma course. 11 took part in courses such as “Wheelchair Technology” or other classes leading to a Bachelor of Science.

Furthermore, the evaluation took into account the Malawi job careers of InWEnt-supported TATCOT graduates that had obtained the diploma in orthopaedic technology. Apart from the alumni, also workshop managers, directors of hospitals and rehabilitation centres as well as representatives of non-governmental organisations and one representative of the Ministry of Health were interviewed.

Nearly all of the alumni now work in the orthopaedic sector: three of them in public institutions, one at an NGO and one has started his own business. The NGO employee rated his workplace adequate and the equipment good. The alumni employed in the public sector were less satisfied. To some extent even basic things were lacking, especially with regard to work equipment and availability of material. Therefore, one of the alumni had actually left the field of activity.

All regarded themselves as underpaid, yet the NGO was paying considerably more than the other employers. All felt a lack of acknowledgment of their profession – sometimes the profession was even unknown to the public –, moreover they noticed a certain arrogance of doctors and even some nurses. However, it was generally felt that the TATCOT training was appropriate for the institutional practice.

One of the graduates even earned substantially more than he did prior to the TATCOT training. The salary of public sector employees changed only slightly, if it changed at all. Soon, a TATCOT graduate will become head of an orthopaedic workshop in Malawi. With that, also his salary will rise.

The heads of workshops consider the alumni to be very competent and also suitable for superior management positions. All graduates now work directly in the field of patient care; some of them had received considerable job-related support by NGOs.

The directors of institutions with attached orthopaedic workshops think they can benefit from the workshops and consider them to round off the overall supply. Both the directors and other interlocutors knew TATCOT as a training centre and had also heard of the scholarships offered by

The TATCOT training also has a good international reputation. The alumni’s capacities were judged positive by both representatives of the International Committee of the Red Cross in Geneva and Addis Ababa as well as representatives of Handicap International in Brussels, emphasising particularly the medical skills and the “special understanding for the connection between the human being and the orthopaedic product”. The orthopaedic technologists of TATCOT are considered to be competent in their communication with both doctors and patients. They are qualified for management tasks and as supervisors for administrative purposes in OT-workshops. Both the ICRC (International Committee of the Red Cross) and the SFD (Special Funds for Disabled, also Red Cross) intend to employ exclusively TATCOT alumni for direct patient care in Africa.

These statements equally illustrate how highly estimated the TATCOT training actually is. However, the interviewees also pointed out that their attention was drawn to these specialists thanks to the support of InWEnt. Hence – by sponsoring scholarships – InWEnt considerably contributed to consolidating the rehabilitation sector.

The Tanzanian Ministry of Health also emphasised the necessity of rehabilitation. Yet, given the scarcity of financial means in the health care system and the high expenditure, at the present time rehabilitation cannot be granted a higher priority.

Cooperation and change

Back when TATCOT started the training, the major emphasis was on a triennial Diploma Course for Orthopaedic Technology (OT). This diploma is officially recognised by the International Society for Prosthetics and Orthotics (ISPO). In the beginning, InWEnt (back then called DSE) exclusively supported course participation by offering scholarships.

In the 1990s, there was an increasing demand for orthopaedic technology. As a reaction to that, TATCOT was offering specialised training, such as courses focussing on the lower limbs or wheelchair technology. InWEnt supported the advanced training of the teaching staff, just as it did ten years later by enabling some of the tutors and teachers to attend master courses at the German “Bundesfachschule für Orthopädie-Technik (BUFA)”, the Federal College for Orthopaedic Technology in Dortmund. As there was a high demand for professionals, TATCOT was planning to offer a Bachelor Course of Science, but it could not find the highly qualified teaching staff that these courses required. Furthermore, after more than twenty years of training, it had to cope with a generation change of the tutors. Since 2006 TATCOT offers a special training that leads to a Bachelor of Science at the University of Tumaini.

Notwithstanding all these changes, the InWEnt scholarship programmes were carried on for 18 years. Already in 2003, InWEnt slowly withdrew from the well-working programme offering fewer and fewer scholarships. TATCOT had managed to establish itself to such an extent that it was capable of working independently. Due to adverse conditions, projects in other regions became more and more important. Therefore, post-conflict countries like Sierra Leone and the partner countries of the German Federal Ministry for Economic Cooperation and Development, Kenya and Malawi, came to the fore. Rwanda – belonging to both categories – was equally taken into account.

New grounds

When it became clear that the Centre had to act independently by the end of 2008, both institutions cooperated intensively to come up with ideas to make TATCOT fit for the future, because regardless of the high quality, the Centre’s scope is narrow:
- Orthopaedic technologists and NGOs/
workshops/hospitals: they can hardly raise the money for advanced
education. The lobby for people with physical disabilities and their supply with orthopaedic technology is extremely low in their home countries;
- TATCOT: the Tanzanian government provides only scarce means for staff and budget;
- The “eventually benefiting people”, those with physical disabilities, often live on the minimum subsistence level and can hardly ever raise the money for their rehabilitation. At the same time, their need for supply with orthopaedic technology is high.

TATCOT and the workshops/NGOs will have to come up with ideas of how to offer cheaper course rates that are reasonable for all concerned parties without dropping in quality. An attempt to do this is “blended learning” which combines the expensive institute classes – for the practical part – with cheaper e-learning modules for the theoretical part of the training.

TATCOT has been wanting to develop in that direction for quite some time and InWEnt helped to provide equipment and organised trainings and professional coaching. The contents were developed by TATCOT itself and they also arranged the tutorial coaching of the course parti­cipants. Thus – after a pilot module – alumni of the year 2008 were able to attend a specialisation course for spinal conditions. 19 of the 23 participants ma­naged to obtain the course certificate – almost half of them were InWEnt alumni. TATCOT is now making an effort to acquire the ISPO’s official acknowledgment of the course.

Conclusion and perspective

TATCOT is now an international reference and collaboration centre of the World Health Organisation (WHO). Along the way, it had to evolve and re­invent constantly. InWEnt has struggled to support that process, for example by helping to develop the “blended learning course”. Today, this course puts TATCOT in a worldwide leading position – and thus has made the institution fitter for the future.

The longstanding cooperation of both institutions is a fine example of a positive partnership between individual support and the development of the institution and its human resources. However, the success has also brought along new problems: meanwhile, TATCOT personnel are being wooed away. Some Asian countries have a high demand for OT-tutors and these institutions pay higher salaries. This has caused a downright brain drain confronting TATCOT with a real problem – the lack of staff.

In the field of patient care, things could be improved if doctors and nursing staff cooperated better with orthopaedic technologists – for instance when it comes to surgical intervention: the way in which an amputation cut is carried out plays an important role for the subsequent care measures and hence the patient’s long-term quality of life. Yet, many barriers between the different professions are still to be overcome.