 Background
Bolivia is the poorest country in South America. Twenty-nine percent of the population lives on les than 2 dollars a day. With a population of nearly 9 million people, 64% live below the poverty level. Though economically poor, it is a culturally rich country. The majority of the people is of indigenous ethnic groups; mainly Quetchua and Aymarra. They still speak their respective languages, though Spanish is the official national language.
Disabled people in Bolivia make up 15% of the population. They have been and continue to be practically disregarded in mainstream development projects due to a lack of state funds, coupled with a relatively low priority on the part of the government.There is no national medical insurance and private hospital care is expensive relative to the resources of the patients. Though there are local prosthetic technicians who are dedicated and interested in learning, there is no program for formal training nor do they have the economic means to travel abroad for such training. Furthermore, tools, components, and materials are prohibitively expensive to import and the specialized materials are generally unavailable locally.Health care assistance is provided by numerous faith-based and non-governmental organizations, one of which is the Maryknoll Sisters, a Catholic order of missionaries. One of the missionaries, Marilyn belt, is an occupational therapist who has been working in Bolivia for over forty years helping disabled children and adults. Sister Marilyn became acutely aware of challenges in the area of education in prosthetics and orthotics and arranged for Prosthetika to provide critical training workshops and seminars. 
Objectives
The project consisted of three main areas:
- Patient evaluation, casting, and fittings
- Technical training seminars/workshops for orthotists, prosthetists, therapists, and doctors.
- Assessment and planning for future projects
Results
1. Patient evaluation, casting, and fittings
During the course of the project we worked on with children and adults with various disabilities including arm or leg amputation, paraplegia, hemiplegia, cerebral palsy, arthrogryposis, spina bifida, and osteoarthritis. Some of these individuals were already using prosthetic or orthotic devices. We evaluated the fit and function of the devices, made recommendations, and in some cases began work in fabricating new appliances.For those who had no prosthesis yet, we evaluated, cast and measured for the appropriate device. We made made sure all of the work donewas done cooperatively by prosthetists from Prosthetika along with local prosthetists. This insures sustainability and long term results from the project as well as the ability for the patient to have adjustments or replacement done locally in the future.
2. Technical training seminars/workshops
Two full day workshops and two evening workshops were done; one for orthotists and one for prosthetists, one for therapists and one for doctors. The content included lecture presentations, video case presentations with discussions, and actual patient presentations.
The actual patients were evaluated in front of the group, and the goals, conclusions, recommendations, and design considerations were discussed as a group. The workshops were put on a CERECO, a conveniently located rehabilitation center in Cochabamba. Attendees traveled from various cities in Bolivia to attend and were given certificates of completion at the end. 
3. Assessment and planning for future projects
Numerous requests were made for more seminars and more hands on training, both at CERECO and other centers. The main areas to be focused on in future projects will be scoliosis management, hip disarticulation and hemipelvectomy prosthesis, and bilateral transfemoral fitting and training. Many physical therapists and physical therapy students were not able to attend the first workshops so we will expand the physical therapy workshop to a full day with emphasis on evaluation of children in front of the group to discuss goals and prescription criteria.
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