The document summarizes a study abroad program organized by Santiago Muñoz, CPO, for orthotics and prosthetics students from the University of Pittsburgh. The program involved students traveling to Ecuador to treat patients and attend an international O&P conference. While there, the students gained hands-on experience fitting devices for patients, including a toddler who took her first steps with prosthetics. They also learned about different materials and healthcare challenges in other countries. Attending the conference allowed the students to network with international O&P professionals and gain a broader perspective on common issues faced globally in the field. The experience of working with diverse patients and practitioners abroad provided valuable lessons for the students' professional development.

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STUDY
ABROAD
PROGRAM
SERVICELEARNINGWITHANO&P
By Maria St. Louis-Sanchez

2. 53JUNE 2015 www.oandp.com/edge
The new study abroad
program at the univer-
sity came about due
to student requests.
Students Sara Lustusky
and Amanda Gilarski
approached Santiago
Muñoz, CPO, the Pitt
MSPO orthotic coordi-
nator and an orthotic
and prosthetic instruc-
tor, and co-owner of
an O&P practice in
Ecuador, with their
idea. Lustusky and
Gilarski say their
instructor loved the
idea. Lustusky says that
although they didn’t
know what shape the
program would take,
they thought that with
Muñoz’s international
connections he would
be a good person to
approach with the idea.
“He was all for it, was
really enthusiastic, and
immediately he said,
‘All right, let’s do this.’”
Muñoz says it makes
sense for O&P students
to learn more about
the profession abroad
and the patients served.
“Right now we are
living in a world with
the globalization of
everything,” he says.
“Our students in O&P
should not only be
looking at issues here,
but they should be
thinking about global
issues and conditions
as well.”
Muñoz immediately
began developing a
program. Since he was
already organizing a
Latin American forum
for the International
Society for Prosthet-
ics and Orthotics
(ISPO)—the 6th Unit-
ing Frontiers Forum
in October 2014—he
decided to arrange
the study abroad trip
around the forum so
the students could talk
with practitioners from
around the world. He
also thought it would
be important for the
students to put their
skills to the test. He
contacted his practice
in Ecuador and asked
people there to be on
the lookout for patients
who needed help. With
the plan in hand, he
submitted the proposal
to the university.
“The project was
approved by the
university, and it was
considered an official
study abroad program,”
Muñoz says. He and
six students planned to
go to Ecuador, spend a
week treating patients,
and attend four days
of the conference.
As an official study
abroad program, the
students were indi-
vidually evaluated on
their application of
key elements of the
MSPO program, which
included ethical issues
in healthcare, evidence-
based practice, clinical
pathology, biomechan-
ics, materials, equip-
ment, and fabrication,
to earn college credits.
An Unfamiliar
Country and
Language
For many of the stu-
dents, a big part of the
challenge was simply
being surrounded by
another culture; even a
trip to the grocery store
was a culture shock
for Gilarski, as it was
her first time traveling
outside of the United
States. Translators were
available to help the
students bridge the lan-
guage barrier, and yet it
could still be difficult to
figure out exactly what
their patients were
thinking and feeling,
SometimesthebestlessonsintheO&Pprofessioncan’t
belearnedinthecomfortof yourowncountry.That’swhat
studentsintheUniversityof Pittsburgh(Pitt),Schoolof
HealthandRehabilitationSciences,Masterof Science
inProstheticsandOrthotics(MSPO)programsayafter
treatingpatientsandattendingaprofessionalconferencein
Ecuador. AndtheysaythattheyhopeotherO&Pstudents
findwaystotesttheircomfortlevelsbyworkingincultures
thataredifferentfromtheirown.

3. 54JUNE 2015 www.oandp.com/edge
the students say.
“We learned how to
use our intuition a lot,
and you really had to
challenge yourself to
figure out what was go-
ing on,” Lustusky says.
“We had translators,
but diagnostically, you
had to use your powers
of observation.”
While it was a chal-
lenge, it was also the
point of the trip, says
Leah Wolfe, another
MSPO student.
“[I] went on the trip
because I thought it
would be an excellent
opportunity to hone my
patient skills,” she says.
“I wanted to learn how
to address people from
different cultures and
help them to the best of
my ability.”
Another lesson the
students took away
was the difference in
materials used by the
O&P professionals in
Ecuador. “It costs them
too much to import the
plastics [we use in the
United States], so they
have to use different
fabrication techniques,”
Gilarski says.
The Patients
Muñoz used his con-
tacts to line up patients
in Ecuador for the
students to assist—
patients who were not
able to get O&P care
otherwise. They helped
a marathon runner find
a better running solu-
tion, they helped cast a
patient with a hip dis-
articulation, and they
fitted three patients
with cerebral palsy with
six orthoses. There were
also two other patients,
however, who the
students say made the
biggest impact on them.
The case that was
the most emotional for
many of the students
was an 18-month-old
girl with a congenital
condition that kept her
from developing knees
and legs beyond her
femurs. Lustusky says
that the girl was falling
a lot but was unable to
receive basic prostheses
from the government
because her physician
decided she wouldn’t
need assistive devices
until she was 15 years
old.
“That kind of blew
us away, and we didn’t
really understand the
reasoning,” Lustusky
says. “Basically her
parents went online
and sought help. They
weren’t going to take no
for an answer.”
The students casted
the girl for stubbies
and fitted her residual
limbs with pediatric
gel liners. At first,
the child screamed
because she didn’t
understand what was
going on, says Wolfe.
The parents became
worried because of her
reaction, and Muñoz
had to calm them. He
reassured them that she
was crying because she
was confused and had
never had this experi-
ence before, Wolfe says,
not because she was in
pain.
In the end, it worked
out. The students were
all there when the tod-
dler stood on her own
for the first time.
“Her mom cried
when she saw her stand
for the first time; it was
a beautiful moment,”
Lustusky says. By the
end of the week, the
girl was crying when
“Rightnowwearelivinginaworldwith
theglobalizationof everything.Our
studentsinO&Pshouldnotonlybe
lookingatissueshere,buttheyshould
bethinkingaboutglobalissuesand
conditionsaswell.” — SANTIAGO MUÑOZ, CPO
Left: Wolfe and
Lustusky assess a
patient with polio as
part of the study abroad
program.
Right: From left, Briana
Suppes, Kelly Harkins,
Wolfe, Lustusky, David
Ortiz, and Gilarski pose
with a patient athlete.
Photographs courtesy of Santiago Muñoz.

4. 56JUNE 2015 www.oandp.com/edge
she wasn’t wearing the
prostheses, Wolfe says,
and was asking for her
zapatos, her shoes.
Another case that af-
fected the students was
helping to improve the
life of a polio survivor.
When he arrived, the
56-year-old man was
using bilateral forearm
crutches to walk.
The students observed
his knees bending
backward, measur-
ing between 40 to 45
degrees.
“He was an active
person, but walking for
him was exhausting,”
Lustusky says.
The students say they
were challenged by
the case. In the United
States, polio has been
eradicated for so long
that patients with those
kinds of mobility issues
are rare. To help him,
the students fabricated
bilateral KAFOs and
adapted the braces to
accommodate for his
plantarflexion contrac-
tures.
They weren’t there
for his final fittings but
watched by video as he
tried on his new braces
and walked down a
hallway. A later video
showed how he had
progressed to walking
with just the aid of a
cane.
“His quality of life
has improved signifi-
cantly,” Lustusky says.
“It’s incredible that
something we made
was able to do that for
this gentleman.”
Overall, the students
say that working with
patients abroad brought
home the overall
process of what their
jobs would be like. For
one of the first times,
they got to see a patient
through the entire
process.
“We had a fantastic
setting in which we
could accomplish a lot
in a short amount of
time,” Lustusky says.
“In clinicals, you see
snippets of a patient’s
life. But because we
were with the same
patients almost every
day for a week, we got
to see everything from
start to finish….”
The hands-on experi-
ence was so impactful
that Lustusky, with
the support of David
Ortiz and the rest of the
students, submitted the
polio patient experience
as a case-study abstract
that was approved as
a poster presentation
for the ISPO 2015
World Congress in
Lyon, France, later this
month.
The ISPO
Conference
Helping patients was
just part of the pro-
gram. Muñoz also
wanted the students
to learn from interna-
tional O&P profession-
als. “My intention was
to expose them to the
challenges of practi-
tioners from other parts
of the world,” he says.
Wolfe says she real-
izes that even though
some things were
different, O&P profes-
sionals in the United
States and Ecuador
share many of the same
challenges.
“We are all hav-
ing problems being
recognized as medical
professionals instead
of as durable medical
equipment suppliers,”
she says. “I was able
to talk with a lot of
“Welearnedhowtouseourintuitionalot,
andyoureallyhadtochallengeyourself
tofigureoutwhatwasgoingon.Wehad
translators,butdiagnostically,youhadtouse
yourpowersof observation.” — SARA LUSTUSKY
Left: An 18-month-
old girl with bilateral
congenital conditions
was treated by the Pitt
MSPO students.
Right: David Ortiz,
second from left,
evaluates a patient
with cerebral palsy in a
physical therapy center
in Ecuador as others
assist.

5. 58JUNE 2015 www.oandp.com/edge
different practitioners
and hear that they were all
pretty much on the same
page. I was glad to see that
we are all looking to the
future of our field and [how
to] make it better for our
patients. It was an invalu-
able experience for me.”
Gilarski says she saw
that even though the
healthcare systems of the
United States and South
America are different,
there are still a lot of
similarities. “They had a
different kind of healthcare
system…but just talking
to them showed me how
passionate they were to get
a high standard of care for
their patients, which really
inspired me.”
Lustusky says that talk-
ing with the professionals
helped her learn about
how she wants to ap-
proach her career. She sees
herself continuing to give
aid abroad, but convers-
ing with the professionals
helped her realize that this
assistance can be provided
in an inappropriate man-
ner, no matter how well-
intentioned it might be.
“What I learned from the
conference was to be aware
and conscious of the ethics
when you go about helping
out cultures you might not
understand,” Lustusky says.
“It’s not about going in and
making yourself feel good.
Because I don’t live there,
part of my job will be to
make sure [that] the soci-
ety will be able to sustain
itself so eventually they
won’t need outside aid.”
A New Way of
Thinking
Beyond the learning expe-
rience and helping others,
the students and their
instructor say one of the
best things they got from
the experience was their
problem-solving skills.
Student Briana Suppes
says she has already put
her new skills to work. At
an externship she went
to after the program, she
chose to use a specific joint
on a KAFO in the same
way she had seen it used
in Ecuador. “They [asked],
‘How did you think to
make it like that?’” she
says. “We learned how to
do things that we wouldn’t
have thought of originally.”
She says that she and
many of the other students
plan to return and hope
to see their patients again,
especially the toddler. “We
have every intention of go-
ing back and seeing those
patients again and again,”
she says. “We’ll get to see
how the little girl grows up
through the years.”
Experiences like these
are the beauty of such
programs, Muñoz says.
“By studying abroad, it
led [the students] to
think about other possible
treatments and other
solutions that they may
have never realized oth-
erwise. It will help them
grow into well-rounded
practitioners.” O&P EDGE
Maria St. Louis-Sanchez can be
reached at msantray@yahoo.com.
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