An Open Letter To The Enable Community Foundation From Enable International Haiti
All these scenes and the work invested to bring them to fruition are still vivid in our minds, These are the scenes that we, the Enable International Haiti (EIH) team, will personally take from our on-the-ground work in Haiti.
Since its inception in 2014, EIH has been working to provide a culturally appropriate, cost-effective upper-limb prosthetic option to Haiti, and to develop a model to implement the process elsewhere. After nearly two years together, we three co-founders are excited to share a few thoughts from our journey as we prepare to pass the torch to the new generation of leadership. And we can’t help but remember how it started…
Our Genesis
When Dante Varotsis first solicited members from the e-NABLE movement in the spring of 2014 to submit a proposal for an international venture, we could not have anticipated the challenging, rewarding, and shape-shifting journey ahead.
Thrown together via the e-NABLE Google group, we were an unlikely motley crew, yet representative of the e-NABLE movement: spanning all ages, both coasts and abroad, and with skills ranging from technical, business, and writing. We came together idealistic, creative and determined. Beginning fitfully, in ways typical to start-ups and volunteer enterprises, we started to learn… mostly about how much we had to learn!
In the summer of 2015 we went to Haiti fresh from winning the Genesis Generation Grant, to present e-NABLE 3D printed prosthetic and assistive devices as well as our business plan to medical professionals, business people, patients and even strangers. There, we quickly came face-to-face with our first, misguided assumption. Designs that had been successful in the US did not meet the Haitian needs. Haitians were far less concerned with fun, colorful robotic “superhero hands,” and much more interested in subtle, anthropomorphic devices. The samples we brought were seen as “Zombie Hands.”
Moreover, being hands when the majority of upper-limb amputees globally are near-elbow amputations, they were hardly relevant! Arms necessitated a major rethink of our plan…
How do would we make what patients need, instead of make our existing devices suit them? How do we engage prosthetists and physical therapists to ensure safe use? How can we encourage a production and distribution plan despite our limited time on the ground?
On top of this, we discovered that our first group of partners and collaborators were not easily charmed by our vision, nor were they able to collaboratively translate our ideas into reality with minimal oversight as we thought. Even those who were enthusiastic about our mission struggled with the difficulties of merely doing business in Port Au Prince.
Defining Buzzwords in Real Time and Learning from Failure
Sustainability, adaptability, pivoting — three concepts we learned to fully embrace, both in our external operations as well as our internal team dynamics. With partners going out of business, volunteers detoured by other commitments, and a political climate out of our control, sustainability became an increasingly elusive goal. This meant figuring out how to plan for long-term success, while struggling to stay afloat short-term.
Adaptability meant perpetually answering, Now what? And pivoting, we can tell you, was as much about personal reflection on our roles and how to make them most viable and effective as it was about reconfiguring goals of the project.
In January of 2016, Dante and Caitlin shared their findings and challenges in Haiti with a group of O&P professionals, designers, and technical advisors at the Enable Community Foundation (ECF) 2016 Design Summit. In doing so, they made a significant contribution to ECF strategic thinking about the realities of current designs in global settings, and were able to compare their experience with that of other teams working in Jordan, Turkey, and Nepal. Perhaps even more critical, EIH’s participation reaffirmed ECF’s commitment to supporting, and eventually taking on, the project, which, naturally, helped morale as we hunkered down to problem-solve.
Eventually, through numerous iterations with partners, we conceived a new plan: a streamlined educational program focused on getting clinical buy-in and training the next generation of Haitian prosthetists. This June marked the project’s culmination with a two-week prosthetist training course, considered by all parties a great success. The project also hired short-term trainees to seed longer-term, sustainable printing at our partner clinics in Port Au Prince and Jeremie, and focus on refining arm designs based on patient feedback.
To implement the new plan, we sought additional contracting instructors to lead the course. This took us to Victoria Hand Project (VHP), a pioneering group working to bring 3D printed prosthetics to the developing world. VHP not only contributed Josh Coutts, an experienced, talented instructor and engineer, but they also generously shared their ingenious design and hard-won knowledge about building viable, sustainable operations abroad. It was, for both EIH and ECF, a golden lesson in the fruits of collaboration.
Final Thoughts & Next Steps
Throughout these challenges, every member of the team wondered countless times: “Or do we just call it quits now?” And in fact, during the project many team members understandably quit. However, those who hung in came to realize and appreciate how we truly represent and are inspired by the e-NABLE movement aspiring and the work the Enable Community Foundation (ECF) is doing to be the most prolific, innovative and, yes, responsible group of online social entrepreneurs!
We salute the volunteers of the e-NABLE movement and their goals, which is why we hope they will appreciate one final cautionary note based on what we saw early on in our work when we stayed at Haiti Communitere (HC), a fascinating hostel/incubator/maker space in Port au Prince.
HC is located just off a main boulevard, on a chalky, rubble-filled road. Behind the tall guarded gates that front so many businesses in the city are several buildings with accommodations, meeting rooms, storage and workshops, but there is also one notable, ruinous structure. It is a half-completed “sustainable house” that HC leaves standing as a reminder of the many volunteers who, despite the best intentions, quit when the going got tough, leaving their broken promises behind.
EIH we know has deeply informed other international projects now underway by the Enable Community Foundation. With continued involvement and support of those who have been involved in the Haiti project in the past, ECF will continue to develop and nurture partnerships and discover key insights in this area. We are excited for all you will learn and do in the coming months. Those of us who have been involved will always treasure the privilege of being part of this meaningful, groundbreaking project and know you will too.
We three are so proud and humbled to have been able to blaze the trail, and we are grateful that such a talented group of Haitian prosthetists and volunteers are committed to continuing the work.
We know the Haiti project would never have been able to realize its mission to this point without help from certain individuals and institutions. These folks (acknowledged below) will not hesitate to help again.
With Warmest Regards and Encouragement,
The EIH Team: Dante Varotsis, Elinor Meeks, and Caitlin McDonnell
Acknowledgments:
A big thanks to helping us mind, body, and soul throughout the project:
Prior EIH Members
Mohit Chaudhary; Roland Mokuolu; Dheeraj Duggineni; Caroline Lutkins
Key Advisors
Jon Schull and Grace Mastalli
Continuing EIH Members
Joe Fairley and Eli Stein
Enable Community Foundation
Andreas Bastian; Jeff Erenstone; Peter Larson; Tyler Bray; Joe Fairley
e-NABLE Movement Volunteers
Peter Binkley; Adam Arabian; Skip Meetze
Victoria Hand Project
Josh Coutts and Nick Dechev
Genesis Generation
Ali Rose; Ilya Oshman; Michael Bloomberg
Haiti
Katie Wolf; Cherlie Severs; Gail Buck; Jhonson Alcide; Deke Bowman; Dara Dotz; Sam Bloch; Cornelia Koehler; Ralf Jungblut; Evelyn Bernard; Pascal Kodjo; Rachelle LaCroix; Philippe Armand; Our students; Our patients
Other
Albert Chi of Johns Hopkins School of Medicine; Ethan Zohn of Grassroots Soccer; Kara Tanaka and USC 3D; Maggie Zhang and UCB Team; Annie Hess of Ottobock
