Orthopedic Technology in Brazil: "Officially, the job of an orthopedic technician does not exist"

Interview with Peter Kuhn, Vice President of the ABOTEC Organization (The Brazilian Association for Orthopedic Technology)

People all over the world need prosthetic devices, but the technology and care standards are not the same wherever you go. While orthopedic technology is constantly developing in Germany, the job of an orthopedic technician is not even an accredited profession in Brazil.


Peter Kuhn; © private

Peter Kuhn; © private

COMPAMED.de spoke with Peter Kuhn, Vice President of the ABOTEC Organization (The Brazilian Association for Orthopedic Technology), about the problems in the industry sector and the lack of interest in progress in Brazilian politics.

: Mr. Kuhn, your are Vice President of the ABOTEC Organization, which is committed to the development of orthopedic technology in Brazil. How did this organization originate and what goals does it pursue?

Peter Kuhn: The ABOTEC Organization- Associação Brasileira de Ortopedia Técnica – was founded in 1988. The first President back then was my father Hans Kuhn. At first, it was a small family project, but over the years, ABOTEC has developed into one of the main orthopedic organizations in South America. From the get-go, our goal was to unite manufacturers of orthopedics products and instruments from all over Brazil. The distances between Brazilian towns are often several thousand kilometers, which makes communication and the active exchange between stakeholders in our industry very difficult. This is why ABOTEC serves as a link between stakeholders.

COMPAMED.de: What does the Brazilian orthopedic technology market currently look like?

Kuhn: With 192 million residents, there are several million people with disabilities in Brazil. The need for prosthetics and other orthopedic products is therefore extremely large. Compared with other countries in the world, we are in great shape as it pertains to quality and technological progress in the industry. However, very few Brazilians, who need a prosthetic device, are actually able to afford one that meets the technology standards of Germany for instance.
Photo: man with prothesis

Most people in Brazil are not able to afford a high-tech prothesis. They have to resort to the outdated products that are refunded by the state; © pantherme-
dia.net/Viacheslav Nikolaienko

COMPAMED.de: Are prosthetic devices not funded by health insurance companies or the government?

Kuhn: The publically funded health care system SUS – Sistema Único de Saúde – has a price list for prosthetics and orthotics that has not been updated in over ten years. A very simple, low technology above-knee prosthesis costs about 1,200 dollars and is paid for by the government. Those, who are not able to afford another prosthetic device, then need to revert back to this outdated model by SUS.

The Brazilian National Social Security Institute INSS – Instituto Nacional de Seguro Social – assumes the costs for prostheses that are needed due to a work accident. In such cases, insurance also pays for a modern high-tech prosthetic device. However, the INSS then issues call for tenders and only the company that bids the lowest price gets to manufacture the prosthetic device, even if it is several thousand kilometers away from the patient and he/she would not be able to fly there, if need be.

COMPAMED.de: The Brazilian government appears to have little interest in orthopedic technology.

Kuhn: Compared to other medical fields, the country invests only very little in orthopedic technology. We know for instance that a major hospital in Sao Paulo receives between 15 and 25 million dollars each month to research and treat cancer. Unlike the area of orthopedic technology, where the government only invested about 2.7 million dollars in all of 2012 for research in this field.

COMPAMED.de: Why do you think that is?

Kuhn: This is because politics has no interest in this particular medical field. For many years now, ABOTEC has championed politics to understand the existing problems.

As an orthopedic technician, for me the biggest problem is the fact that my job is not being accredited as such. Officially, the job of an orthopedic technician does not even exist. There are also no state-funded training schools or universities that offer training in this field.
Graphic: Map of Brazil

The distances between Brazilian towns complicate often the provision with orthopedic technologies; © panthermedia.net/Jacqueline B ttcher

COMPAMED: Yet there are several manufacturers of orthopedic products and instruments in Brazil. How do people actually learn their craft?

Kuhn: Most of them pass down their craft from father to son or from boss to colleagues. Others trained abroad – like I did for instance during the 80s in Switzerland.

For a few years now, ABOTEC also offers training courses in orthopedic technology. Every six months an examiner flies in from El Salvador, which has a state-funded training school, and checks on the theoretical and practical skills of our students. Even though they receive a diploma, it is not recognized, because it actually is a certificate by a foreign institution.

COMPAMED: So you can officially train for this job in other Latin American countries?

Kuhn: Based on my knowledge, you can only do this in El Salvador where German investors set up a training center and in Argentina, where two universities have been offering an orthopedic technician training program for the past 20 years. However, the level of development in orthopedic technology is ironically significantly higher in Brazil than it is in these countries.

COMPAMED: How will Brazil and the orthopedic market there further develop in the future?

Kuhn: The most important thing is for the policy makers to recognize the problems in this market. Not much is going to change without the active support by Brazilian politicians. We at ABOTEC are fighting for this every day for the past 15 years and annually organize the largest congress for orthopedic technology in South America, to which we also invite many international industry experts. In doing so, we always hope that this will spark the interest of politicians.
Photo: Michalina Chrzanowska; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Michalina Chrzanowska and translated by Elena O'Meara.