Quelhas and his team have been collecting historical O&P pieces, which they display at a museum within their facility. some reimbursement from the government. They are fitted according to prescriptions from the hospital’s doctors, which means that they have a basic prosthesis or orthosis. In addition, thanks to a special partnership we have with an individual in France, we do a lot of work making silicone prostheses, mainly for partial amputations: very cosmetic, nonfunctional, and very expensive. O&P ALMANAC: How are the devices
you provide paid for?
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OCTOBER 2017 | O&P ALMANAC
O&P ALMANAC: Describe your
educational background and any certifications you have. How do you keep your skills sharp?
QUELHAS: My formal education was in chemistry, and all the [O&P] skills acquired were throughout the years, in several places; there were no schools at the time. To keep my skills in place, I try to [work on] those more challenging cases, those that require an innovative solution. I love those challenges, such as children with congenital problems that an ordinary prosthesis does not solve—these cases keep me alive and useful.
O&P ALMANAC: What’s the biggest
challenge you face as a practitioner, and how do you deal with it?
QUELHAS: The biggest challenge is that
we cannot do our work as we should; our profession is considered as inferior, and the fact that we must quote for every work we do, without seeing the patient, is the proof that, sometimes, we are not making a prosthesis but just building up components that someone said should be applied. To have qualified people [providing prostheses and orthoses] is expensive, and that is not taken into consideration. In my group, I have three CPOs, one biomedical engineer, and one mechanical engineer, and, to take advantage of their skills, I would need to have freedom to work and that is not the case. We do not have the space to develop and try new solutions. On the other side, we are forced to use silicone liners for almost every patient, which is very expensive and, in my opinion, completely wrong as they only serve, in most cases, to mask a socket’s problems. With the money spent in liners, we could do much better work in the socket or knee. O&P ALMANAC: Describe any chari-
table work you or your organization does. QUELHAS: We have done, from time to time, some devices for people who cannot be included in any of the installed systems. Our charity, if you want to call it that, is to develop, at our expense, new solutions for people and apply them, not receiving for that any money.
PHOTOS: Carlos Quelhas
QUELHAS: Private patients pay for everything. Afterwards, they include the costs in their [tax] declarations. All others have some kind of reimbursement, in a rather complicated system that works more or less like this: • The military patients will not pay anything; the government pays 100 percent of the cost. • Patients sent by insurance companies do not pay for anything; insurance takes care of everything. However, if patients want more expensive items, they must go to court against the company; they usually win. • Public servants will have a partial reimbursement system that will pay more or less for 80 percent of the cost of the device, and this is not bad, considering that the reimbursement charts are updated at least every two years. • Members of the general population, only covered by the National Security System, also have the right to be reimbursed; the problem is
that for them, the reimbursement table was made in 1979, I believe, and as far as I know, never updated; this means that in many cases, the reimbursement, nowadays, is not enough to pay for their trips to the workshop. • There is a very small niche of people, working, who are able to prove, with a doctor’s report, that they could be more efficient if they had a better prosthesis; for those, once again, the reimbursement is 100 percent. The major complication of the system is that most of the paying institutions ask, before making the order, for three different quotations from three different workshops. The institutions then select a workshop not by the quality, but by the price. Thus, in many cases, we are not able to fit what we think we should but what is possible, within the previously given budget.