Silicone Liners and Clinical Education in Nepal

Written by Malena Rapaport

In October 2019, I was fortunate enough to travel to Nepal with a group of health care professionals in a trip organized by Operation Namaste.

Operation Namaste is a not-for-profit organization striving to improve access and quality of prosthetic and orthotic services, primarily in Nepal. Their mission is to achieve this by providing tools and support to Orthotic and Prosthetic practitioners in Nepal, and beyond.

Most recently, they have developed a sustainable and cost-effective system for fabricating prosthetic silicone liners. A prosthetic liner is the interface between an amputee and the prosthesis. The material and quality of this interface greatly affects the users’ comfort and mobility. Silicone prosthetic liners have been shown to improve comfort, decrease pain, lower frequency of skin issues, and improve overall walking function (Baars & Geerstzen, 2005). This translates into amputees’ ability to walk longer, maintain employment, and live their lives to their fullest potential.

In North America, the use of prosthetic liners made of gels, such as silicone, has become the stand of care for many decades. However, this is not the case in countries such as Nepal, due to their high cost. SILC (Silicone Interface Liner Comfort) Solutions is Operation Namaste’s system for fabricating silicone liners locally, in standard sizes (e.g. small, medium, large and extra-large) using CAD-designed, 3D-printed molds. This allows Nepali prosthetists access to high-quality, medical-grade silicone liners for less than $50 USD, as opposed to the current cost of $200 USD.

Access to prosthetic liners and cost are not the only barriers to use. Prosthetists need to know and understand common practices and skills to use silicone liners with patients effectively, but most importantly, safely. This is was one of the main goals of this year’s trip. I, with a team of prosthetists, physiotherapists, and a peer-support amputee/patient liaison, presented at the 2019 Operation Namaste’s Education Summit aimed to enhance knowledge and skills pertaining to silicone prosthetic liner use in amputee care for both physiotherapists and prosthetists. Held in Kathmandu, this inter-disciplinary education conference was extremely well-attended, allowing participants the opportunity to gain hands-on experience with patients while accessing our collective expertise and knowledge. Through this collaboration, we also developed relationships with prosthetists and physiotherapists in Nepal, and various places in North America, helping to establish the beginnings of a global network of clinicians and experts.

During this trip, we also visited a number of rehabilitation hospitals and met many prosthetists and physiotherapists working with amputees of all ages and amputation levels. Through these visits, we were able to further expand this global network and learn about questions, concerns and desires of prosthetists with regards to silicone prosthetic liners. An amazing and rewarding experience, to say the least!

The vision is to improve prosthetic care and, in turn, quality of life of amputees in the world, starting in Nepal, by introducing silicone liners, supporting education, and ongoing clinical help. Thank you to Operation Namaste for the invitation, C.A.R.E. Society for supporting my travels, and to Barber Prosthetics for allowing me the opportunity and freedom to help Operation Namaste’s vision.

Reference: Baars, E. C. T., & Geertzen, J. H. B. (2005). Literature review of the possible advantages of silicon liner socket use in trans-tibial prostheses. Prosthetics and orthotics international, 29(1), 27-37.