# HVP-Gatagara and ORTHOLAB: An Introduction --- For more pictures from HVP-Gatagara and ORTHOLAB, [check out the gallery](https://hub.e-nable.org/u/kreeser1/gallery/custom-gallery/view?openGalleryId=79#.jpeg). --- ### HVP-Gatagara  ###### Sign: *Home of the Virgin of the Poor Gatagara, orthopedic workshop* --- [HVP-Gatagara](http://hvpgatagara.org/) (Home of the Virgin of the Poor - Gatagara) is a hospital and educational institution located in Gatagara village, roughly 10 km from [Nyanza](https://en.wikipedia.org/wiki/Nyanza,_Rwanda), [Rwanda](https://en.wikipedia.org/wiki/Rwanda). Founded in 1962 by Belgian priest Father Joseph Fraipont, HVP-Gatagara was the first center for medical care and education for the disabled in Rwanda. Today, Rwandans travel from all over the country to be treated at the facility. Gatagara village is situated in the beautiful [Southern Rwandan](https://en.wikipedia.org/wiki/Southern_Province,_Rwanda) countryside surrounded by hills and farms. Originally settled by the [Batwa Pygmies](https://en.wikipedia.org/wiki/Twa), the original potters of Rwanda, Gatagara is known for the traditional pottery that has been made in the region for generations.  ###### A view of the countryside from Gatagara village, Southern Rwanda. --- Gatagara village has a roughly 2 km dirt road running through it, connected to the main, paved road. At the opposite (dead) end is the HVP-Gatagara facility campus. HVP-Gatagara is similar to [Lake Victoria Disability Centre](https://hub.e-nable.org/u/kreeser1/wiki/page/view?title=Lake+Victoria+Disability+Centre "Lake Victoria Disability Centre") in that it is much more than a hospital. In addition to the health care facility, the HVP-Gatagara campus contains the school for the children of Gatagara village, the local church, a farm for produce and livestock, and a living quarters for staff, [religious brothers](https://en.wikipedia.org/wiki/Brother_(Christian)#Religious_brothers_today), and volunteer visitors.  ###### The entrance to the HVP-Gatagara facility. --- ### Hospital Facility HVP-Gatagara is first and foremost an institution that provides the following services: * [Orthopedic surgery](https://en.wikipedia.org/wiki/Orthopedic_surgery) * [Medical Imaging](https://en.wikipedia.org/wiki/Medical_imaging) * Prosthetics and Orthotics * Care for the Disabled * [Physiotherapy](https://en.wikipedia.org/wiki/Physical_therapy) * [Occupational Therapy](https://en.wikipedia.org/wiki/Occupational_therapy) * [Special Education](https://en.wikipedia.org/wiki/Special_education) * [Inclusive Education](https://en.wikipedia.org/wiki/Inclusion_(education)) * [Clinical Psychology](https://en.wikipedia.org/wiki/Clinical_psychology) * Nutrition Services This is a for-profit hospital system, but the cost burden of care is based on the patient’s income level. Much of the day-to-day operations at HVP-Gatagara are overseen by an order of Christian religious brothers, under the direction of Brother Kizito Misago. ### Education The school for children from Gatagara village is part of HVP-Gatagara, with several buildings within the facility dedicated to education between ages 7-18. Schoolchildren bring their lunch or return home to eat during their lunch breaks as the school does not provide food. During recess, students can be seen in adjacent fields playing ball sports.  ###### Schoolchildren at HVP-Gatagara playing during recess. --- HVP-Gatagara additionally provides education and reintegration services for adults with disabilities to become productive members of society. ### Farming and Livestock Animals are raised on the HVP-Gatagara facility campus as well, both as a source of meat for staff and in-patient residents, and to be sold at local markets as a secondary source of income to keep the facility running. Among the animals raised are: cows, goats, sheep, pigs, rabbits, chickens, and guinea pigs. There is also a small banana farm at the facility as well.  ###### HVP-Gatagara raises livestock both for staff meals and to sell at the local market as an income source. --- ### Prosthetics and Orthotics Department In the aftermath of the [Rwandan Genocide in 1994](https://en.wikipedia.org/wiki/Rwandan_genocide) during which more than 800,000 people were killed, the country was left with a high number of people with amputations. The HVP-Gatagara facility has a dedicated workshop for creating custom, traditionally-made prosthetic and orthotic devices. A detailed look at the creation of [plaster casts](https://en.wikipedia.org/wiki/Plaster_cast) of residual limbs and soft sockets in the facility will be detailed in [another write up](https://hub.e-nable.org/u/kreeser1/wiki/page/view?title=Creating+Soft+Sockets+and+3D+Scans+from+Plaster+Casts#null "Creating Soft Sockets and 3D Scans from Plaster Casts").  ###### A sign directing visitors to the prosthetics and orthotics workshop and counseling center. ---  ###### Exterior of the prosthetics and orthotics workshop. --- The P&O department consists of a main workshop, two side rooms for molding and shaping plaster casts, another side room for welding and building wheelchairs and crutches, and several consultation rooms and offices. Workers in the department make both lower and upper limb prosthetics and orthotics, as well as custom-made assistive devices.  ###### Interior of the prosthetics and orthotics workshop. --- ### Accommodations Certain staff, several religious brothers, and volunteer visitors can pay for room and board at HVP-Gatagara. Approximately 20 single rooms are available. Each day the religious brothers meet for lunch and dinner in the community center, and are often joined by volunteer visitors to discuss the day’s events and the overall state of the HVP-Gatagara facility.  ###### Left: A view of a building with rooms to rent for staff and volunteer visitors. Right: A table set for a staff lunch in the community center. Similar buildings offer rooms for patients to rent, sometimes for days or months as they receive in-patient care. Often whole families stay in these rooms at HVP-Gatagara, with mother’s making food in a communal kitchen and children playing in the courtyard. --- ### ORTHOLAB The Belgian organization [Humanitarian Prosthetists and Orthotists](https://fr.hpo-lab.org/) (HP&O) was founded by prosthetist Roberto Postelmans, and has worked since 2012 to establish 3D printed prosthetic device clinics called ORTHOLABs in Belgium and several other countries in Africa. The Rwandan ORTHOLAB project is hosted by HVP-Gatagara. By this partnership, HVP-Gatagara provides ORTHOLAB space to manufacture patient-specific prostheses using 3D scanning and additive manufacturing technologies.  ###### A sign directing visitors to ORTHOLAB. --- The technicians in the ORTHOLAB are clinicians and machinists from HVP-Gatagara’s P&O workshop who are trained by Roberto to include additive manufacturing technologies into their device construction. All donations to ORTHOLAB go directly toward providing valuable help to the poorest in need. ORTHOLAB developed in parallel with e-NABLE. Roberto Postelmans reportedly reached out to e-NABLE in the early days, but the connection was never consummated. Postelmans, a certified prosthetist, has developed several [innovative 3D-printable designs](wiki:/u/kreeser1/wiki/A+Design+for+a+3D+Printed+Lower+Limb+Prosthetic+Device "A Design for a 3D Printed Lower Limb Prosthetic Device") for lower as well as upper limb prosthetics. ORTHOLAB has taken an independent yet parallel track to e-NABLE in the development of 3D printed prosthetic devices due to the sequestration of the work due to geography and language (Roberto primarily speaks French and has little time to spend advertising his work or fundraising).  ###### Kyle Reeser, sitting with two patients undergoing physiotherapy at HVP-Gatagara --- When Roberto opens a new ORTHOLAB, he works closely with a potential host facility to ensure that there is a need and appreciation for 3D printed prosthetic and orthotic devices in the area. He purchases 3D printers, 3D scanners, tools, and materials as a loan to the host facility and embarks on a mission to set up the ORTHOLAB and train technicians to use the technology to create custom prosthetics and orthotics. Roberto requires that any devices that are created using ORTHOLAB equipment and material be given to the patient free of charge. He works closely with technicians at all of his ORTHOLABs ([Benin](https://en.wikipedia.org/wiki/Benin), [Burkina Faso](https://en.wikipedia.org/wiki/Burkina_Faso), Rwanda, and [Togo](https://en.wikipedia.org/wiki/Togo)), providing technical support as well as 3D modeling services. Roberto visits his ORTHOLABs on periodic missions to each country, making sure that the host facility is using the loaned machines and materials to his standards. He loans these machines and materials to the host facility for a period of four years, at which point the facility ‘graduates’, and he releases them to the host facility to operate independently from his direction.  ###### The interior of the ORTHOLAB at HVP-Gatagara. --- The ORTHOLAB-Gatagara currently operates with the following equipment: * (1) Modix3D Big 60 large format 3D printer * (2) Witbox 2 3D printers * (1) Creatbot DE Plus * (1) Hephestos 2 3D printer * (1) Sense 3D Scanner * Assorted hand tools and electric tools Due to constant power fluctuations, the 3D printers need to be plugged into an [uninterruptable power supply](https://en.wikipedia.org/wiki/Uninterruptible_power_supply) (UPS).  ###### Left: Roberto Postelmans stands next to the Modix3D Big 60 large format 3D printer inside the ORTHOLAB. Right: Roberto creating a digital model of a plaster cast of a patient’s residual limb with a Sense 3D scanner. --- ### Takeaways My experience at HVP-Gatagara, as well as my experience at Lake Victoria Disability Centre in Tanzania, introduced me to a style of care facility that I had never seen before. The idea that whole families would move into a small room at HVP-Gatagara while a member is undergoing in-patient treatment was new to me. I had never heard of a hospital that also raises and sells produce and livestock as a secondary source of income, but it works really well. Finally, and perhaps most importantly, schoolchildren seeing and interacting with hundreds of differently abled individuals throughout the school year seems to be a great means of empathy-building. ### e-NABLE Community Call to Action If you would like more information on donating to or volunteering at HVP-Gatagara, [visit their website](http://hvpgatagara.org/donate.html) or contact Brother Kizito Misago. For more information about ORTHOLAB, visit the website of [Humanitarian Prosthetists & Orthotists](https://fr.hpo-lab.org/).