“What one could do in case he/she needs a bionic arm, leg or other body parts?” and “Why do foundations raise funds?”…

"The state covers 100% of the cost of prosthetics!", "Why doesn't the state support prosthetics for the military?", "There is no need to raise funds for prosthetics!", "Why do foundations raise funds?"…

Such questions and comments are becoming more and more frequent these days. The team of the Citizen Foundation, the Foundation's ambassadors and leading experts in the field of prosthetics will tell you what myths are there and what is real.
We would like to start from the fact that the intensity of hostilities and a wide range of heavy weapons used by the enemy leads to an increase in the number of wounded and to more severe injuries. The exact statistics will not be disclosed until our complete victory. However, we can draw a conclusion based on open data.
According to a statement by the President of Ukraine, 500 Ukrainian defenders are wounded every day. Officially, in the first half of 2023 alone, 58,852 people applied for prosthetics at the state expense.
Vadym Svyrydenko, the Citizen Charitable Foundation ambassador and Presidential Commissioner for Rehabilitation of Combatants, commented: "Nowadays, soldiers are being treated for such severe amputations that have never been seen before. This includes, for example, amputation of three limbs or loss of vision and loss of limbs. These people need new rehabilitation and recovery approaches."

*The photo shows Oleksandr Vykhruk, a participant in the Cyborgs program, a soldier from the 10th Mountain Assault Brigade. Oleksandr suffered amputation of 3 limbs as a result of enemy shelling near the settlement of Berestove. Within the framework of the Cyborgs program, he was provided with an electric chin-controlled wheelchair. Oleksandr is going to face a lengthy and expensive rehabilitation and prosthetics. The amount of expenses will significantly exceed the amount of funds provided by the state program. In addition, Oleksandr, like other patients with such injuries, needs devices that will facilitate his daily routine and everyday life (to use a computer or tablet to be able to read or watch videos). Therefore, such injuries necessitate charitable assistance at every stage of treatment and recovery.

"Is there a state program ensuring prosthetics in Ukraine and does it fully cover the cost of existing prosthetic devices?" – this is perhaps the most frequently asked question. Since the launch of the Cyborgs program, staff of the Citizen Charity Foundation are obliged to be mentioning the state prosthetics program almost every day. We faced the fact that half of the military, as well as military doctors, had no idea about the existence of the state program, and another half of them did not believe in state prosthetics. According to our internal statistics, we referred 50% of the applications to state institutions and they were successfully fitted with prosthetics without additional charitable funds.

What documents currently regulate the prosthetics procedure in Ukraine?

Resolutions of the Cabinet of Ministers of Ukraine No. 321 dated 05 April 2012 and No. 518 dated 1 October 2014 establish the right of combatants to get free prosthetics at the expense of the state budget. Prosthetics may be provided within the maximum cost limits set by the Ministry of Social Policy.

The amount of funds allocated by the state depends on the extent of the amputation and the specifics of the prosthetic device. However, there are still cases when state funds are not sufficient for a patient to receive a desired prosthesis. In such situations, the additional payment is made at the expense of charitable foundations.

AN EXAMPLE OF CO-FINANCING FROM THE STATE BUDGET AND CHARITABLE ASSISTANCE
The Citizen Foundation helped a military medic Vadym, call sign VATUTIN, to receive a prosthetic shoulder with an external power source and a Taska wrist.
In case of such an amputation, the state allocates UAH 543,451.00 for primary prosthetics (Order of the Ministry of Social Policy of Ukraine No. 1208 dated 06 August 2019). At the same time, the cost of a prosthesis with a functional Taska hand is approximately USD 40,000 (depending on the configuration). 

For physiological and medical reasons, a simpler prosthesis would not have been able to meet all the patient's needs. "There are obvious differences between a bionic shoulder prosthesis and a mechanical one. And each patient decides for himself which prosthesis is better for a particular use. A bionic prosthesis grips an object stronger, the hand has more functionality, greater number of grips, and can be used in a wider range of applications. In addition, the chosen Taska wrist is waterproof, protected from dust and dirt," says a prosthetics engineer Oleksandr Stetsenko.
In this case, the Citizen Charitable Foundation made an additional payment of UAH 946,091.69. As a result, the beneficiary received one of the most modern prostheses in the world.

In the cases of lower limb prosthetics, an additional payment is usually required for amputations with hip disarticulation, bilateral amputations and other cases to increase the functionality and comfort of using the prosthesis.

The Foundation paid additional UAH 67,669.86 for a prosthesis after disarticulation of the hip joint of the 3rd mobility level for Oleksii, call sign Pizhon. As the state funds were insufficient for the necessary configuration. On this subject, prosthetics engineer Oleksandr Stetsenko said:

"The configuration of any prosthesis depends on its elements. As for Oleksii, we chose some of the best components: the Triton carbon foot, which accumulates energy and then releases it, making it easier for the patient to take steps. The 3R60 hydraulic knee assembly, which ensures stability when moving, even if there is an uneven surface, such assembly will secure the patient. And the 7E9 hip joint, which provides additional cushioning in the support phase and also adjusts the stride length, which is very important when there is no hip joint and it is difficult for the patient to take a step with a prosthesis. And this mechanism improves gait biomechanics. All these three elements help the patient to use less energy and move more safely with such a prosthesis. This means that the better the components, the more expensive they are. Unfortunately, even the threefold cost provided by the state did not cover the prosthetics in full. Therefore, it was necessary to get extra money from charitable funds to pay for it."

Oleksandr Stetsenko, prosthetics engineer, certified prosthetist-orthoticist (over 30 years of experience)

PROSTHESES FOR THE MOST ACTIVE
For each type of human motor activity (walking, swimming in the sea, river or pool, hiking, or doing sports), prosthetic manufacturers develop a separate product. Moreover, even prostheses for running are divided into long and short distance running prostheses.

Roman Kashpur, an ambassador of the Cyborgs program, an active serviceman wearing a prosthesis and a record holder, said: "In each of the prostheses, the design engineer incorporates a certain degree of stiffness and functionality of the prosthesis. That is, in simple terms, for a normal full life, a person needs at least 2 prostheses: one for everyday life (also suitable for athletics, gym, fitness - amateur active sports) and the second prosthesis for swimming! The third prosthesis, namely a sports prosthesis, should be provided to people leading an extremely active lifestyle (athletes)...".

Firstly, assistance with sports prostheses has a positive individual impact. It increases the capabilities and potential of a particular person. Secondly, sports achievements motivate and set a good example for other wounded that an active life with a prosthesis is possible.

Those defenders who return to service despite amputation are also in need of financial assistance in purchasing additional prosthetic devices. This is due to several reasons: excessive load on the prosthesis, the need for a replacement prosthesis, changes in the physiological parameters of the stump...

In this regard, the Foundation provides the military with additional prostheses. In particular, we provided assistance to soldier Alim, call sign Tatarin. Alim needed an additional sports prosthesis to return to the army and effectively perform combat missions. Thus, the Foundation paid UAH 195,529.39 for a modular 4th mobility prosthetic leg with increased functionality for sports.

"A man who is fighting on a prosthesis broke his prosthesis because he is fighting, which means he is protecting us all, which means there should be no room for bureaucratic talks or procrastination, it should simply be done quickly and efficiently!" – says Roman Kashpur, ambassador of the Cyborgs program, an active duty soldier wearing a prosthesis and a record holder.

COMPONENTS THAT ARE NOT COVERED BY THE STATE PROGRAM

The Ukrainian national legislation regulates the number of prosthetic devices and their components that can be obtained free of charge.

However, defenders and veterans wearing prostheses have a constant need for liners, special socks, knee pads, etc. This need is especially acute when the patient's weight changes. Since changes in body weight directly affect the size of the stump. At the same time, such components (liners, socks) make the use of the prosthesis more comfortable and safe. The Citizen charitable foundation does its best to ensure that our defenders do not have unmet needs and are provided with everything they need.

"Basically, it's a regular sock without seams. They are used when the stump loses weight, which can even be due to weather reasons, and compensate for the difference in thickness. Without them, wearing a prosthesis is at the very least painful, and often impossible at all." – says Andrii Holopapa, a soldier and participant in the Cyborgs program.

QUALITY OF PROSTHETICS IN UKRAINE
The level of domestic prosthetics was quite high even before the full-scale invasion, and since 2022, national specialists have been forced to master new technologies and today show an even higher level, successfully making prostheses even in extremely difficult cases. Ukrainian prosthetists work with the world's best technologies. Prostheses with components from Ottobock and Ossur are available in Ukraine free of charge. Today, there are more than 80 prosthesis manufacturers in Ukraine.

According to a sociological survey conducted by Protez Hub, 88.9% of people were satisfied with the quality and comfort of their product.

As part of the support for the domestic prosthetics industry, professional trainings and exchanges of experience with the world's best prosthetists are constantly taking place. Ukraine receives the most advanced technologies and imports the best equipment in the field of prosthetics.

In early 2023, thanks to the financial support of the CANADIAN-UKRAINIAN FOUNDATION, 2 Ottobock thermal cabinets were purchased for the Ukrainian Institute of Prosthetics, Prosthetics Engineering and Rehabilitation. This equipment has accelerated the production of prostheses ("stump receivers") by almost 300%.

However, there are still many challenges remaining! We must start working now to ensure that there are no veterans with disabilities left after the war is over. To achieve this, we need to work together to take care of the wounded veterans. "Prosthetics and rehabilitation of defenders is a joint task of the state and civil society" - President of the Citizen Charitable Foundation Olena Schmidt.

Support prosthetics of the wounded defenders: https://ctzn24.com/en/heroes

Link to the publication of the material in the BLOGS section of Censor.NET

https://m.censor.net/ua/blogs/3451685/scho_robiti_koli_potrbn_bonchn_ruki_nogi_ta_nsh_chastini_tla