Last updated: Saturday, November 24, 2007

Rotary and the LN-4 Prosthetic Hand
in Amman, Jordan

November 12-20, 2007                              Douna, future prosthetics doctorMy young friend, Douna, and her father.

Victor Georgiou, representing the Rotary Club of Danville,  and Chau and I, representing the Rotary Club of Walnut Creek Sunrise, traveled to Amman, Jordan in November to provide LN-4 training and to fit LN-4 prosthetics as needed.

Victor's slide show

Victor Chau and I returned to SFO and home about 3PM on Tuesday November 20 – all is well. We had a very good trip and experience the the Al Hussein Society Rehabilitation Center. 

Here is a short, summary report - I could have made it longer!.

Overall this was a wonderful and productive trip – I expect the Al Hussein Society, with their dedicated staff, will be a strong partner in the future for more LN-4 projects, in Amman, in other places in Jordan and the region.

Michael Mendonca provided me with 80 LN-4 prosthetics, and parts, to take to the Al Hussein Society in Amman, Jordan. I actually carried only 60 hands after a last minute telephone call with Annie Abu Hanna, the Executive Director at the center.

We traveled from SFO to Amman, ( 6PM on 11/12 in SFO-3AM 11/14 in Amman) in about  23 hours); after a short day of introductions and getting acquainted on on Wednesday, we conducted 2 days of LN-4 clinic, training and fitting,  at the Prosthetics Workshop within the center, then went with a mobile clinic all day Saturday – total of 14 hours of training and fittings. We visited and attended one regular meeting of the Rotary Club of Amman Cosmopolitan – a largely English speaking Rotary Club that works with the Al Hussein Society regularly and frequently. After brief wrap-up reports, we left Amman and returned to SFO on Monday 11/20.

We saw 24 potential recipients, who were pre-registered, and we were able to fit 13 people with the new LN-4 prosthetic. About 7 of the people whom we could not fit with a prosthetic have scheduled a re-visit to the center to get a custom rigid foam extension for their residual limb. Then the center staff will provide a LN-4 hand from the supply of LN-4 hands we left in their custody. This extension is new idea and has potential to increase the number of people we can help with the LN-4.

We saw children and adults. Many recipient's missing hand was congenital and a number had lost their limb due to an infection that turned to gangrene and was then amputated. Only two were explosions or war related in anyway. Nearly all we long time amputations. The major reason for not fitting a hand was a short residual.

Our experience with the new hand was great; while there are some details to share and some things to learn from our experience, the new production hand looks better and is easier to fit and use for our LN-4 recipients. 

I brought only 30 hands, plus parts, to the center for the clinics as only about 10 people were scheduled each day. Since this is a workshop and clinic environment these numbers were about right - more would have been too crowded and a storage issue.

We brought back 7 failed LN-4 hands for further study (See Victor's notes for more detail). It appears two there are two problems with the assembly - both related to the small rubber tubes used to push the brass toggles against the ratchet teeth. We had never experienced any LN-4 failures during a clinic before.

We had a slight issue demonstration with the new LN-4 hand; these hands are early production and appear to be slight differences in the details of the moveable fingers. As a result demonstration and use of the hand becomes slightly different than the old hand. We did not carry demonstration items with us, and what we used for our demonstrations of the LN-4, locally available items, did not always demo well – pencils and pens fell out when the hand should have gripped them. Also the wrist release did not work as expected with smooth, smaller diameter items. Still, overall a great experience of fitting hands in a new location and with new friends - everyone simple spent a little extra time in training and looking or ways to use the LN-4. For example, one recipient found that he couple open a cabinet door while carrying something - we have a video clip. The simple design and installation of the LN-4 was effective.

Regarding our experience at the Al Hussein Society - the staff at the center is very serious and dedicated. The director of the center met us the first day and had everything organized and pre-arranged. The manager of the prosthetics workshop was our main contact and we conducted 14 hours of “hands on” clinic with her staff and 3 professionals from the Jordanian Ministry of Health. Everyone in the training completed a supervised evaluation, hand fitting and training session. The manager and her administrative assistant were responsible for the registration of recipients and used our forms and process.

I am thrilled at the level of compassion among the staff when working with recipients – I don’t think these particular people normally work directly with arm amputees and especially with children regularly, so this was a challenge and everyone participated extremely well. I provided temporary certificates of completion for the staff – 14 hours of training in LN-4 fitting procedures – and I want to make an official LN-4 Training Certificate and send to the center for distribution as soon as feasible,

The Al Hussein Society will be a good representative and strong partner for us and may actually drive us forward. The 3 prosthetic professionals from the Jordanian Ministry of Health worked very well also. The manager of the prosthetics work shop took one LN-4 to a Land Mine conference which occurred last weekend, and she felt they got a very good reception with LN-4 and feels strongly that they will get many more requests for LN-4s as a result. She clearly sees the value in the LN-4 now that was not so clear before this visit.

The Executive Director of the Center and several Board Members of the center told us the first day that they were disappointed on seeing the LN-4 prosthetic (poor cosmetics and lack of functions) so we were concerned. After our clinics and training began, everything changed quickly. Everyone only had good things to say – about the team of Victor, Chau and Jim (of course!!) and especially about the LN-4. The Executive Director and the Workshop Manager requested (strongly) that we leave a supply with them. We left them with 37 hands and supplies and instructions for handling any additional broken hands. Additional potential recipients are already scheduled for the days after we left the center.

The Basra Prosthetics projects, a large Rotary sponsored prosthetics effort to help people in Iraq, is based at the Al Hussein Society. Assuming things go well as we continue to develop our LN-4 work in Jordan, LN-4 hands may get included in Basra Prosthetics efforts.

The Executive Director of the Center and several Board Members (the Chair of the Board is a princess!) see now how well the LN-4 can be presented to Rotary Clubs and others for fund raising and other promotional purposes - this is important and essential too. The Workshop Manager and her staff see the “hands-on” benefits and have been very creative in finding ways to not turn anyone away as far as possible.

Everyone at the center who worked with us and with the LN-4 said this: the LN-4 is functional, light-weight, quick to fit and maintenance free (just replace it). These key features of the LN-4 may not be appreciated at first review, but are strongly appreciated after our 3 days of clinic, and after seeing how we work directly with our recipients. In addition an LN-4 is always provided to recipients at no cost .

One request was made by the Prosthetics Workshop staff - a larger LN-4 for adults. There was also a perceived need for hand extensions and stockinet, neither of which I brought. The color of the LN-4 was not mentioned as a problem, and no other specific issues or problems were raised. Of course everyone involved, at some time, wishes for a more cosmetic LN-4.

One LN-4 recipient stood out from the others for me. A little girl, Douna, about 10 years old, with a congenital, left arm below elbow residual limb. She is always smiling and came to our mobile clinic with her older father – she is the youngest of his 5 children. She announced that she is going to be a “prosthetics doctor” and that is why she has a missing hand. Her father and family were/are of course sad about the missing hand, but they are very supportive of Douna. We were able to fit her with an LN-4.

We, on the LN-4 team, appreciate working with the frank, professional and dedicated people at the Al Hussein Society and the Jordanian Ministry of Health. We are grateful to all the LN-4 recipients we met and worked with, for their trust and patience. We had a wonderful experience and are all very happy to have had this opportunity to do this Rotary work; we are grateful to meet and work with the wonderful people that came into our lives during the past 10 days.


Three amigos enjoying lunch in Amman.

Victor and Jim exchanging Rotary club flags at the Amman Cosmopolitan Rotary Club

At the Al Hussein Society (Annie Abu Hanna, Executive Director is 2nd from the left)

Front of the Al Hussein Society Rehabilitation Center

Jim giving the LN-4 talk and initial demonstration to a few recipients

The Prosthetics Workshop team

The Workshop team during mobile clinic

One of the vans used by the Al Hussein Society

One ot the group sessions - red chairs seem to be from the Wheelchair foundation - another Rotary sponsored initiative

Some of the staff learning about the LN-4

Several staff of the center with the LN-4

In the computer training room

physical therapy pool

a huge slection of shoes for a variety of needs

Demonstration of how to evaluate a residual limb for fitting the LN-4

Victor monitoring

Douna and her father, new friends