Costa Rica is short on long-term rehabilitation facilities for stroke patients. The reality is that many patients end up bedridden at home after discharge.
The Problem of Getting a Brace
A stroke patient who came to the clinic where I worked was still soon after onset, and we expected he would be able to walk on his own with an ankle-foot orthosis (AFO). But under Costa Rica's public insurance, getting a brace takes a very long time. The official orthosis would only arrive eight months after onset. What is the patient supposed to do in the meantime?
So in February 2014, the answer I came up with was making a simple brace ourselves.
A Hand-Made Brace
The materials cost about 8,000 yen total. The trick was the combination.
- Upright support: a custom-ordered metal post
- Sole: a cut-up sandal
- Lower leg (shin): a baseball elbow protector
It was nothing like a proper prosthetic-grade orthosis, but it had enough function to start gait training.
What Changed for the Patient
With the simple brace and continued gait training, the patient achieved independent walking and got back to an active life.
Eight months waiting for an official brace — do nothing, or do what you can? The gap looks small but changes a patient's life. Working in Costa Rica drove that home for me.
Parts of Costa Rica's healthcare system are well developed, but there are still many issues with prosthetics and orthotics. Even so, there are people working to fill the gap. Witnessing that may have been the biggest takeaway from doing this work in Costa Rica.