I originally wrote this post for the Global Health Delivery Project in 2014. Just as true today as it was then.

If the golden age of global health has taught us anything, it’s that we must avoid the theory, dimly articulated, of limited good. This theory is predicated on the assumption of scarce resources…but the resource pie is not fixed.
– Paul Farmer et al., Global Health Priorities for the Early Twenty-First Century, Reimagining Global Health

Many incumbents — aka pre-Internet companies — built their businesses based on assumptions of scarcity: scarce information, scarce distribution resources and market reach, or scarce choice and shelf space. Now, though, these factors are abundant, lowering or eliminating barriers to entry, and making entire industries ripe for change.
– Eric Schmidt and Jonathan Rosenberg, How Google Works

It is an unusually cool day in Zacapa, Guatemala, as I walk past our mobile clinic and into the rehab center. Inside, several patients are learning to take their first steps in the parallel bars as physical therapists guide their movements. I enter the workshop and pass Guatemalan technicians cooking copolymer plastic for a prosthetic socket.

Next door in our technology lab (codename: Skunkworks), a Canadian engineer and a Guatemalan technician are designing a pulley system for an upper extremity device; they’ll use the 3D printer to prototype it later today. A mechanical engineer and a prosthetist stand by the carbon fiber lamination area. One evaluates a 3D printed hand, while the other presents an argument for a silicon glove, pigmented to match the patient’s skin color.

I walk out into the dusty parking lot to watch a young firefighter begin to sprint with increasingly deliberate strides. A prosthetist monitors her careful gait with a discerning eye; eventually, she pauses for him to make adjustments. As she wipes her brow, she glances at me and smiles. She told her friends at the firehouse she would run again someday.

At the Range of Motion Project (ROMP), we work hard to ensure that our patients’ only limitations are those that they place on their own ideas of human potential. We aim to provide the very best rehabilitative technology available, regardless of the socioeconomic factors at play.


To do this, most of our time is spent negotiating two competing concepts: mobility and scarcity. Mobility is the goal. It means our patients are empowered to make the best possible choices for themselves, their families, and their communities. Scarcity is the enemy. It means we haven’t been creative enough. Scarcity means we don’t have enough knees in the clinic, or enough information for a follow-up visit, or enough bandwidth to explore a potential partnership. Scarcity means we’ve placed a limitation on our patients.

Despite these constant challenges, I know that mobility is winning. Technology is on our side. Communication is instantaneous and global, and truly impactful resources move effortlessly through the digital ether. At ROMP, ease of information flow is changing the way we archive and understand patient data, educate our staff, meet our revenue goals, communicate with donors, manufacture devices, and, ultimately, deliver world-class prosthetic care based on what the patient needs, not what the patient can afford or access. We are living in a time of increasingly diminishing limitation. And it is the privilege of the global health entrepreneur to bend the arc of this technological change to meet the needs of those who will benefit most.

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