Partnering with COPE to help amputees.

April 9, 2009

Miss Monivahn is the first Lao female graduate of the Cambodian School of Prosthetics and Orthotics. In the interview below she describes her work with victims of cluster bomblets and other ordnance.


Lao Peoples Democratic Republic

Time and again, when I encounter accident victims in need of surgery or a prosthesis, I turn to my friends at COPE (Cooperative Orthotics and Prosthetics Enterprise) a non-governmental organization providing supportive services to patients at the National Rehabilitation Center in Vientiane.

Recently I returned to Boualapha District in Khammuan Province to continue documenting the involvement of children and teens in the local scrap trade.  (In my August 27, 2008 journal entry I described the nature of the trade and shared details of the accident that claimed two young lives.)

During this recent visit, I met Yoth, a 22 year-old man who two years ago lost his lower leg in an accident involving an old cluster bomblet. The surgery to amputate Yoth’s damaged leg so impoverished his family that neither he nor any of his relatives could afford the subsequent purchase of an artificial limb.

Fortunately, Dr. Dan Evans, a veterinarian in Canton, Ohio and a personal friend of mine for nearly fifty years, had sent me off to Laos with the promise of financial help for the next amputee I met.  From past experience, I knew that the good people at COPE would welcome Yoth with open arms and do everything they could to restore mobility to him.  Thanks to Dr. Evans and the staff at COPE, Yoth should have his new leg in time for the upcoming rice-planting season.

In this journal entry I would like to introduce readers to Miss Monivahn, a young woman who has the distinction of being the first female from Laos to graduate from the Cambodian School of Prosthetics and Orthotics, a challenging program conducted in English and requiring three years of classroom instruction and clinical training.

In the interview presented below, Miss Monivahn describes her motivation for seeking a career in this field and shares insight into the nature of her work.

Interview With Miss Monivahn, the First Lao Female Graduate of the Cambodian School of Prosthetics and Orthotics.

What is your name?

Miss Monivahn.

How old are you?

I am 24 years old.

Where do you live?

I live in Luang Prabang Province.

In a village or in the city?

In the city of Luang Prabang.

Did you go to a big school or a small school?

I think it was quite small.

Where did you learn to speak English?

I learned in secondary school and in my high school.  In high school I studied English two hours a week.  Then [after high school] I took evening classes and studied by myself.

How did you learn to make artificial limbs?  Did you study in Laos, or did you have to go to another country?

I went to a school in Cambodia.  The Cambodian School of Prosthetics and Orthotics. We had lectures, readings and also practice working.  Theory and practice together!

How long did you have to study?

For three years.

Did you study year-round or did you have school vacations?

Every year we had a school vacation for three weeks.

Why did you want this job?

After I finished high school, I was looking for something for my future life.  During that time I saw the COPE [Cooperative Orthotic and Prosthetic Enterprise] advertisement in the newspaper and radio.  I was interested in trying to attend.

Were there many high school students and others who wanted to go to Cambodia?

When I asked for information, not so many were interested in prosthetics and orthotics at that time.

Your family must have been nervous sending their daughter off to another country to study.  Were they supportive?

They said, “It’s no problem!  Study as hard as you can”.

What are artificial arms and legs made of?

We use polypropylene.  In Cambodia we used other plastics, but here in Laos we use mostly polypropylene.

Where do the materials and parts come from?

India, Vietnam.  Some parts from Cambodia.  Some from the United Kingdom.

Which countries make the best parts?

It depends how we compare.  We can’t say which country makes the “best.”  It depends on which item can perform the most functions for the patient.  [The best leg for a rice farmer might not be the best leg for a city person.]

Why is the school in Cambodia?

I asked my teachers that!  Because Cambodia has so many amputees and disabled people.  That’s why they built it there.

Has anyone in your family ever needed an artificial arm or leg?

No.  But I do have a friend who had polio and cannot walk.  When he got orthotics he could stand and walk some steps.

Did you know your friend with polio before you got trained in Cambodia?

Yes.  Before Cambodia.  At that time Orthotics were not made in Laos.  Maybe someone sent him the orthotics from the United Kingdom.  During that time there were no orthotics in Laos.

What do you need to know, in order to be good in your job?

For the prosthetics and orthotics job, language is important because we need to get [accurate] information from the patient.  And math. And psychology, as well, because we need to read the patient.  What the patient needs.

Are some patients angry over their accident or illness?

Some patients are quite angry.  Some are frightened when they first come here.

Do all of your patients speak Lao, or do they speak other languages, too?

Mostly Lao.  Some Hmong.  But most of the Hmong patients they give to the male prosthesis and orthotics workers.  That’s because of Hmong beliefs.  As a female, I should not be touching a Hmong male.  Hmong women, it’s okay, but not Hmong men.

Are people happy when they get their new artificial limbs?

Yes!  Sure!  Because, before they could only walk with crutches.  When they can walk freely without crutches and wear long trousers so no one can see that they’ve lost their leg, they are so happy!

What do they say?  When they get their prosthesis?

We have so many types of patients.  Some are excited.  Some patients cry.  Some patients laugh.  They are so thankful to us.

When you help someone get a new limb, how does that make you feel?

When we can help a person walk, we also feel happy that we could help.  We think, “Our work is successful!”

Does it make you feel proud?

Yes, proud!

How many patients do you see in a year?

I just started here two months ago.  I’ve seen about 100 already, in two months.

How do people loose a limb?  What kinds of illnesses and accidents?

The most are from UXO [Unexploded Ordinance].  Second, are tumors.  Other causes are snakebite, car accidents, falls from trees.

When you see injuries from UXO, is it usually arms or legs?

In Cambodia, usually legs.  But here in Laos, I think the arm as well, because they have been trying to handle the bomb.  Sometimes touching the bomb.  They don’t know whether they’ll explode or not.

When a bombie explodes in their hand, don’t they also get injured in the face and body?

Yes, some people get injured in the eyes, face, and body as well.

Do you ever see children injured by UXO?

So far, during my two months here, I have only seen adults.

Where does the National Rehabilitation Center get its financial support?

From the NGO’s [Non Governmental Organizations] like COPE.

Does the Laos government give help with materials and supplies?

I don’t know the answer… how they [the NGO’s and the government] work in cooperation with each other.

Are you a volunteer, or do you get paid?

A volunteer, and some pay as well.  In Laos, normally, we can be Lao government staff.  But now, I’m not yet staff.  I am a volunteer for the government but I’m paid by COPE, an NGO.

When you were a student at the school in Cambodia, were you paid?

Yes, we were paid a salary.

How much salary are you paid for doing your work now?

Thirty-five dollars a month.

Can you live on thirty-five dollars a month?

If we try to live on our salary [alone], it’s probably impossible.

Do workers like you take second jobs?

We might try another job, but our major job is prosthetics and orthotics.

What about the new graduates?  The younger workers here?

The new graduates? No.

Because they still have a lot to learn here?


Do you have a second job?

Not yet but, I’ll try!

Do you enjoy your work?


Do you have a husband?

Not yet.

When you get married, will you continue to do this work?

If possible, yes.  I want to continue but it depends on the salary.  For me, I want to improve my study about prosthetics and Orthotics.  I already have the basics of this work, so it’s easier to continue than to start a new career.

How many people in Laos have artificial limbs?

I don’t know.  [laughs]  I have been concentrating on training and don’t have time to read!

How long does it take to make a leg?

If we need to finish everything by ourselves, without any [outside assistance] one leg would be about three or four days.  Start to finish.  That’s if the person is a “primary” patient.

What is a “primary” patient?

A primary patient is a patient who has never worn prosthesis before.  An amputee. But, has never worn a prosthesis.  The first time for them.

If the person is a primary patient we need more time for training in walking and balancing.

Do some people go many years without getting an artificial limb?

Yes!  Some people live far away from the city.  They don’t know what to do or where to go.

I met a man in a village who had a home made artificial leg for 28 years.  I told him about the work of COPE at the Rehabilitation Center.  I encouraged him to come to Vientiane to be fitted with a proper prosthesis.

Yes.  Good.

The man I saw didn’t seem to be moving around much on his homemade leg. What problems do people typically have with a homemade prosthesis?

They don’t know the biomechanics.  They don’t know what makes a good prosthesis.  If they make it by themselves [a bad fit] may destroy their stump.  Also, the homemade prosthesis might not walk nicely.  They fall down or are unstable.

Are most people satisfied with their new prosthesis?  Do they throw the old one away?

In Cambodia, they destroy it.  But here, I see some people do not want to throw the old one away.  They want to keep it.  They say, “It’s the same as when we buy new clothes.  We need to keep the old ones.”

Just in case.  Like a spare?

Yes! [Laughter]

How do you feel after you see a person walk with their new prosthesis?

I am happy with them!  I feel like a god, making them walk!

Have your parents visited the Rehabilitation Center here in the capitol, to see the work that you do?

No.  They haven’t come here, but they went to the workshop in Luang Prabang.

What happens to children who have an amputation?  As they grow, do they need additional surgeries?

As they grow?  No.  They won’t need additional surgeries as long as the stump is well made.  If the stump is not well made, if it is difficult for them to wear the artificial limb, or they have some infection, some may need an operation to make it nice.  So they can wear their prosthesis easily.

When a patient comes here, how long do they stay?

A new patient, about one month.

Do they need to bring a family member with them to help?

In some cases a patient comes here and maybe needs the help of an assistant.

Do they cook their own food, or is the food cooked for them?

COPE pays for their meals.

How many hours a week do you work?

Eight hours a day; five days a week.  Forty hours.  Eight to four are the normal working hours but sometimes we have work that is not finished, and then sometimes overtime is okay.

Is your work ever frustrating?

Sometimes it’s frustrating when we cannot do something successfully.  Sometimes we try to fit the artificial limb and it doesn’t fit well.  Okay.  We try again and. “Oh!”… We still don’t have it”.  But, we keep making it until it’s a good fit.

For the National Rehabilitation Center to be successful, what is your greatest need?

When they send people to study, they need good professionals.  Very responsible.  Good workers!

If an American or a Lao student wanted to do this kind of work, what advice would you give them?

Try to study hard.  Try to learn the program.  The most important thing is psychology because it is relevant to our work.  When we know psychology, the needs of people, we are more effective in our work!

One Response to “ Partnering with COPE to help amputees. ”

  1. Isobel on July 31, 2013 at 9:09 am

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