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In Atlanta at AAOP's Thursday morning session, Ethical Considerations in Global Orthotics and Prosthetics, provided a look into the complex ethical dilemmas faced in delivering orthotic and prosthetic services worldwide. Led by a distinguished panel of Dr. Cody McDonald, John Brinkmann, Eddy Fuentes, and Aarti Deshpande, the discussion centered on how global health inequities, colonial histories, and funding models shape the landscape of O&P care in low-resource settings. The speakers expressed the need for a sustainable, culturally competent approach that respects local expertise rather than perpetuating a “white savior” mentality.
Dr. McDonald framed the conversation by highlighting the historical context of colonialism in global health, referencing Paul Farmer’s Reimagining Global Health. “We can’t talk about global health without talking about colonialism,” she stated, pointing out that many low-income countries still suffer from healthcare systems weakened by colonial extraction. She also criticized the donor-driven model, where Western organizations dictate funding priorities, often prioritizing diseases that may impact wealthier nations over non-communicable diseases like stroke or rehabilitation. “Sixty percent of the global disease burden is from non-communicable diseases,” she noted, “but only 2.3% of global health funding goes toward them.”
Brinkmann took a philosophical approach, using an analogy from Friends—a debate between Joey and Phoebe about whether truly selfless good deeds exist. He argued that while humanitarian efforts in O&P often come from a place of goodwill, they can unintentionally cause harm. He shared a case study of a well-intentioned prosthetist who brought high-tech prosthetic components to a remote African village. “The components were completely unsustainable,” he explained, “with no plan for maintenance or follow-up.” The lack of local infrastructure meant the prosthetics quickly became unusable, highlighting the ethical failure of one-time, feel-good interventions that lack long-term planning.
Fuentes, drawing from decades of experience in Latin America, criticized foreign NGOs that provide free prosthetics but fail to support local providers. “I moved back to Guatemala to help,” he recalled, “but I didn’t anticipate the competition from international charities.” These organizations, while seemingly altruistic, often undermine local businesses, making it impossible for local practitioners to sustain a practice. He pointed out that many nonprofits receive tax exemptions and donated materials, allowing them to provide "free" devices while sometimes secretly charging patients. "If you're a charity, act like one," he stated bluntly, questioning whether nonprofits should be allowed to compete against local for-profit businesses without regulation.
Deshpande addressed service-learning trips and the ethical concerns surrounding student involvement in global health. She emphasized that training programs should be bi-directional, ensuring that visiting students and local providers both benefit from the exchange. “Service-learning should not be about parachuting in and taking over,” she stated. She outlined five core ethical principles: solidarity, humility, cultural sensitivity, sustainability, and shared accountability. She warned against students engaging in hands-on patient care beyond their competency levels, which can lead to unintended harm. “Students must remember,” she emphasized, “that their learning should not come at the expense of patient well-being.”
During the Q&A, the session speakers tackled tough questions about prioritizing funding in global health and ethical partnerships. Dr. McDonald stressed the importance of health system strengthening over short-term interventions, advocating for approaches that support local governance and long-term sustainability. “If we’re truly committed to ethical global health,” she stated, “we need to build up local infrastructure, not just drop in and deliver care.”
Overall, the panelists agreed that ethical global O&P work requires a shift from charitable giving to capacity building, ensuring that interventions empower local professionals rather than create dependency. As Brinkmann summarized: "Doing good isn’t enough—we must do good well."
