On September 7, Fundashon Alton Paas turns 14 years old. Two days after the world came to a standstill on World Spinal Cord Injury Day, last September 5th. The theme of the tenth edition of World Spinal Cord Injury Day was “From Awareness to Action: Ten Years Advancing Dwarslesi Prevention”.
Fundashon Alton Paas did not plan the calendar in this way. But those forty-eight hours describe our work more precisely than any mission statement we’ve written. For one day we ask the world to move from awareness to action as prevention. Two days later, we mark fourteen years of a kind of prevention that is hardly seen or given the value it deserves.
The half of prevention nobody counts
When people hear “spinal cord injury prevention”, they picture the moment before impact. Seatbelts. Speed limits. Grab bars in the bathroom. Safe scaffolding. Caution in the sea. All of it matters, and Fundashon Alton Paas has run initiatives in that space over the years.
But prevention does not end when the injury happens. It changes shape.
From the day of the injury onward, a second set of entirely preventable outcomes begins:
- A person stops leaving the house. Not because they cannot, but because getting out requires a vehicle that does not come, a building that will not admit them, and a level of effort that eventually exhausts anyone. Withdrawal is not a symptom of spinal cord injury. It is a symptom of an environment.
- Secondary medical complications. Pressure injuries. Urinary tract infections. Loss of muscle mass and bone density. Joint contractures. Cardiovascular and metabolic decline. These are among the most common and most costly consequences of spinal cord injury — and they are largely preventable through sustained movement, monitoring, and access to care.
- The slow loss of function, strength, and independence that a person had after rehabilitation, and no longer has two years later, because nothing existed to maintain it.
None of these are the injury. All of them are preventable. And every one of them is what our fourteen years have actually been spent on.
What that looks like on an ordinary week
At the AP Center, prevention means specialized guided exercise and continued support after formal rehabilitation ends. Not a program with a discharge date — a place to keep coming back to, so that the function a person fought for in rehabilitation is still there in five years. We support an average of 35 clients a month.
At Wheelee, prevention means a vehicle that arrives. Every month we complete more than 500 rides — to clinics, classrooms, trainings, workplaces, birthdays, funerals. Each one is a person who did not miss a medical appointment, did not drop out of a course, did not disappear from their own community. Accessible transport is not a convenience. It is one of the most effective anti-isolation interventions available on this island.
“Prevention is usually understood as everything we do before an injury. We have spent fourteen years on the part that comes after. Preventing isolation, preventing secondary medical complications, preventing deterioration. Those outcomes are not inevitable. They are the result of choices a society makes, or fails to make, in the years after somebody’s life changes.”
– Alton Paas, founder, Fundashon Alton Paas
Why this framing matters for Curaçao
Primary prevention reduces the number of people who sustain a spinal cord injury. Secondary prevention determines what happens to the people who already have one, and on a small island, that group does not shrink. It grows, and it ages.
Treating the two as separate agendas is how a health system ends up funding emergency care generously and everything afterwards barely. The costs do not disappear when the ambulance leaves. They reappear years later as readmissions, complications, lost employment, and lost participation. Every one of them more expensive than the support that would have prevented them.
Fourteen years in, this is the argument we would most like to see accepted: the prevention agenda does not close at the hospital door.
What we are asking for
To healthcare providers: the handover from rehabilitation into daily life is where people are lost. We would like to build that bridge with you, not beside you.
To the public sector: fund the after. It is prevention, it is cheaper than the alternative, and it currently sits almost entirely outside the prevention budget.
To employers, schools, and community organisations: accessibility is what makes participation possible. Without it, isolation is not a personal outcome — it is a design decision.
To everyone else on this island: 35 people a month, more than 500 rides a month. Behind those numbers are neighbours who intend to stay part of this community, and who need it to be built so that they can.
Fourteen years
Fundashon Alton Paas was founded on 7 September 2012, with the conviction that a person’s mobility should never decide the size of their life.
Two days ago, the world asked for action on prevention.
We have been doing the second half of it for fourteen years, and we are not finished.