PO Paraguay|Asunción, Paraguay| July 2021

Chapter Spotlight also available in Google Docs

Table of Contents

Site & Community

Active chapter since 2014
Based in Asunción, Paraguay
Almost 400 devices delivered to 300 device users

In 2014, as 3D print technologies were first arriving in Paraguay, a group of three university students studying medicine and engineering joined e-NABLE’s Google+ community when it still had less than 100 people. They were inspired by the recent ‘Project: Daniel’ from Not Impossible Labs and were eager to explore how they could make an impact locally. They were already involved with organizing a national online community of 3D printers, so they took over a workshop shed in a grandparent’s garden where they met a few times every week.

Po Paraguay applied for a few grants, and eventually won the Premios Conecta competition, which awarded the team a co-work space where they set up shop and continue working today. Po means hand in Guarani, a local language familiar to the people they serve in Paraguay. They use this term for their devices as an alternative to ‘prosthetic’, which has helped people become more comfortable with the new technology and designs.

They work with many children experiencing congenital limb differences, but the majority of their device users are adults, mostly males, with work-related accidents. Those requesting devices for lower limb differences include many who are adapting after motorcycle accidents. Because of this, Po Paraguay has become involved with prevention campaigns for safety regulations in the workplace and on the road.

Tech & Specs

2 Flash Forge Guiders 2S
1 Flash Forge Finder
Ultimaker (frankenstein) ‘Inutilmaker’
Flash Forge Dreamer
Form 2 (resin from Form labs)
Flash Forge Adventure 3
Flash Forge Creator Pro (4 years non-stop!)
FlashForge Foto 8.9 Resin 3D Printer

The team has also tried DIY Prusas with the size of the printer bed and frame adapted. Workspaces and equipment are organized between spaces for lower limbs and upper limbs. They had laser cutters and hydrographic painting in an old workspace but now collaborate with other workshops for these needs. They have been using 3D scanners adapted from Kinect technology using Skanect software for the past 5 years.

For design software, they use Autodesk Fusion 360, and Simplify 3D as a slicer (with free licenses thanks to guidance from Jeremy Simon many years ago). Their workshop also includes a range of finishing tools.

Team & Specialities

Eric Dijkhuis | Co-founder, strategic planning, finance
Fernando Vallese | Co-founder, planning, finance
Mateo Acosta | Co-founder, engineering operations, full-time project manager

Fernanda | Full-time industrial 3D designer
Leticia | Full-time administrator for finances
Noellia | Full Time user liaison staff
Carolina | Full-time marketing and fundraising
Luciana | Full-time 3D printing engineer

Luis | Contract prothetician (production team)
Mariella | Contract 3D designer
Paula | Contract 3D designer
Tiziana | Volunteer graphic designer

Po Paraguay continues with their three original co-founders. Their organization has six full-time office staff (defined above), and an additional community of four contract designers (three specialize in 3D designing of devices they developed, and one serves as a graphic designer). Most of the team started as volunteers or paid interns for a few years before becoming employed. It is noteworthy that Po Paraguay continues collaborations with ex-employees on projects, some of whom live out of the country and overseas.

The full-time ‘User Liaison Staff’ is an interesting position, involving scheduling with device users for measurements, fitting of prosthetics, and feedback sessions. Being responsible for ‘user success’, the duties include social media and a variety of follow-up activities (see Design and Process below) as well as the coordination for their device subsidy program (see Projects & Collaborations).

The team manages 60-70 volunteers each year (perhaps over 500 altogether) who join from schools, professional careers, and event competitions. Educational volunteers account for about half of this number, but only contribute for a few months at a time. For schools and universities, they have provided more than 100 certificates for students through hundreds of class events. International volunteers have joined from the US, Germany, Costa Rica, Ireland, and France.

Design & Process

When the founders began, they printed an early adapted Flexy Hand (from designer Steve Woods) for Ellias, their very first device user. He became a design partner and explored a variety of adapters, including one for the violin which he learned to play. He continues to be involved today, testing several new devices each year.

Word of mouth spread nationally through family & contacts, the press, and through competitions. Today, device users are referred by doctors, companies, and formal institutions as well.

Measurements are preferred in person, especially for above elbow and lower limb, with a pre-consult from a doctor.

Because so many people reach out through social media, device users sometimes begin working with Po Paraguay by sending pictures and videos of their residual limbs along with forms through Facebook, Whatsapp, Instagram. Feedback is collected by the User Liaison (see Team & Specialities) after the first week, first month, and every following 6 months through the Official Facebook and Whatsapp accounts in a one-to-one meeting. Feedback is documented regarding user challenges, activities, and frequency of use. The data collection system regarding usage was developed between 2017-2019, and today continues systematically for all participants.

In addition, they have hosted holiday events in person to observe use and provide support. Whatsapp groups with local organizers developed independent of the chapter activities, along with localized house gatherings for device users to share strategies for daily activities and device experiences. The chapter does not curate these but engages as needed, encouraging from the sidelines. It has become a sustainable model for a community resource that can feel more localized and private while also being connected to wider community relationships.

Device Development
The Flexy hand has been redesigned 10-15 times by their team, resulting in the development of a fleet of upper limb prosthetics devices (including the Po, Po arm, and PO Guata). They have explored extended wrist disarticulation (OneHandred80 can move 180 degrees), adapters, and transhumeral devices. In a collaboration with teams in Colombia, they redesigned the RIT arm, and co-founder Mateo’s graduate thesis was on a unique myoelectric arm. Each device follows standard protocols, with the open source files shared on Thingiverse (and MyMiniFactory, which allows tracking those who download devices which encourages new partnerships). Some designs include STL files, some include source files (CAD). There have been thousands and thousands of downloads.

Projects & Collaborations

Subsidy Program

Po Paraguay found that providing devices for free became problematic. Devices were seen as gifts to the poor, favors, or borrowed equipment. Charging something changed the dynamics into something owned, and a mutual investment between the chapter and device user. They found that establishing a clear monetary value parallel to a commercial product helped increase value in the devices. Additionally, community food fairs (common local fundraisers within the culture that bring families together for unique expenses) are often organized to pay for Po devices.

The team developed a subsidy program to support those with limited incomes to participate while continuing to provide them for free to those who had no means of income (no one is turned away). An optional questionnaire is given collecting information about income, family size and dependants, home-ownership, mobility and transportation, and healthcare. Photo and invoice evidence is suggested, along with details regarding the home bathroom and kitchen. Their model is based on standard practices in the national healthcare system to evaluate social economical status and vulnerabilities, but has been adapted along the way. The information also provides the team with a better understanding of the living circumstances, needs, and priorities of their device user community.

Po Paraguay continues to cover repairs (including shipping) and provides free upgrades for all devices. They have found device users feel more empowered, take care of the devices, follow up when things break, and show interest in device improvements with this program.

PU Project

PU in the local Guaraní language means ‘sound’. The team developed open source accessories for their prostheses to play guitar and violin. This project was part of a social media campaign with 10’s of thousands of views.

Lower Limb

Beginning in 2017, the team took one year to develop a lower limb device (for below the knee) with a full-time industrial designer who had studied in Germany, along with 2 consulting prosthetists.They chose 10 users with 3 different amputation levels (chopart, symes, and transtibial) to test the prototypes. They ended up 3D printing the sockets, which are laminated with fiberglass to reinforce and inlaid with a padded surface to serve as an interface between the prosthesis and the person. Covers were also 3D printed for the metallic tube leg. They have successfully set an open source precedent to follow; the first 3D printed regulation device recommended by the government. It is a basic modular design, which they aim to develop into a system that meets safety needs and medical standards. Next, they hope to support above the knee devices and custom feet! See Public Presence for links to devices.

Recycled Devices

In a partnership with Coca Cola (making Paraguay’s soft drinks), the team explored reusing excess PET from industrial production of bottles. The process included cleaning, shredding, producing pellets, and extruding into filament. Maintaining quality was a challenge, as well as dealing with dust and temperature regulation. The project was intense and several engineers resigned, but they did create hands of a lower quality. It was decided that the process was not easily replicable. They also explored recycled devices with disassembled pieces being reused.

Campaigns & Competitions

The team led 60 students from the design school of Universidad nacional de Asunción in a marketing competition for packaging. They also collaborated with a chain of local convenience stores (Biggie Express) in a campaign event across 40 sites, all run by volunteers.

Research

Po Paraguay partners with several universities including National University of Asunción, Catholic University, and Uni Norte. They have supported 10-15 university theses in industrial design, physiotherapy, marketing, and electrical engineering. Chapter co-founder Mateo Acosta’s thesis as an example.

Funding

The team was a volunteer effort until the end of 2015, when they created a crowdfunding project through the Generosity platform. They collected $30k from the campaign and $40k more in related partnerships. This was the big break that allowed them to hire a team full-time and support a stream of incoming interns. They also were able to acquire a sustainable base of software, hardware, equipment, and materials for the project.

For a time, they created their own co-working space as a business model, but moved back to a shared space October 2020 due in part to pandemic concerns. While Po Paraguay does officially charge for their devices, the subsidy program is not a significant funding source and was created to increase value in the devices (see Projects & Collaborations).

The chapter’s annual budget goals are around 80k, but the true budget continues to change year to year. They coordinate sponsorships with private companies, and have moved from individual project support to one focused on R&D development. A device is only a few hundred dollars, while device design can involve a team working together for months. They have also developed relationships with corporations like mobile phone companies, banks, family foundations, and individual donors without competing with large organizations like Teleton and Techo.

The team makes a point to communicate to partners that they are not a start-up oriented around profit. An increase in devices could imply more accidents and birth defects which they hope can be avoided in the future. They work as a non-profit aimed to diminish the need of prosthetics, but provide the best available for those in need.