Jaipur Foot is near-perfect


India: Craftsmen create a sturdy, low-tech prosthesis, and a clinic gives it to anyone who needs it.

January 21, 2003|By Claudia Kolker | Claudia Kolker,SPECIAL TO THE SUN

JAIPUR, India - In a cobbled courtyard in a city famed for its artisans, a team of craftsmen taps and carves to make an object coveted throughout Asia.

It's not a statue, or necklace, or fixture for one of Jaipur's palatial hotels.

It's a foot - a plain, prosthetic foot, fashioned out of rubber. The Jaipur Foot, it's called, and it is so cheap, flexible and suited for the East that it eclipses limbs made in the West, many doctors say.

"The Jaipur Foot is a unique and well-designed approach to the needs of its community," says Dr. Richard Haynes, an orthopedist and the chief of staff at Shriners Hospital for Children in Houston. "Its ingenuity is spectacular."

Costing just $28 to make, the Jaipur Foot and its hardware allow movements that are difficult and usually unneeded with prostheses in the West, experts say.

A Jaipur Foot wearer can trudge barefoot down an unpaved road, squat comfortably through a long conversation or weed a wet rice paddy. He can scale a palm tree, ride a bike or cobble sandals, for which craftsmen use their toes and feet.

To an Indian disabled by a train or an Afghan maimed by a land mine, this means a chance to participate in life again.

"There's going to be disbelief that someone in the boondocks in Jaipur can innovate something so far ahead of what they do here in the United States technologically," says C.K. Prahalad, a University of Michigan business professor and a leading management expert.

To see the technology - or lack of it - that most disabled Indians endure, just look outside Jaipur's BMVSS Limb Center, the clinic where amputees wait for their free Jaipur Foot.

A bent man with one leg leans on a crude, hand-carved crutch, while a muscular younger man hops nearby on his lone foot. Unable to stand at all, an adolescent boy heaves past on hands tucked into plastic shower shoes.

It was while watching such people working, chatting and navigating fields and roads that Jaipur Foot co-creator Pramod Sethi first saw the flaws of Western prostheses.

Thirty-five years ago, when Sethi was a young orthopedic surgeon, India's government asked him to start an artificial-limb clinic in Jaipur. The tourist city of 1.8 million had about 300,000 people then; Sethi sometimes spotted former patients.

"I'd see someone on crutches. I'd say: `But we fitted a limb. Why is he not using it?'"

Western prostheses, his patients said gently, work well enough if you're wearing shoes and walking on a sidewalk. But many Indians go barefoot and often use their feet in different ways than Westerners use theirs.

Western feet, made of sophisticated plastics and foams, disintegrated in wet rice fields, he says. Stripped of their protective shoe, they also looked alarmingly blocklike.

And those were the complaints of people who were lucky enough to get them. Most disabled Indians live below the poverty line, including the estimated 1 million who need prosthetic limbs. Getting prostheses for these amputees required rethinking how such limbs were to be made and marketed.

Educated in India and Europe's elite institutions, Sethi could analyze the problem crisply. But it took a semiliterate craftsman, Ram Chandra Sharma, to solve it practically.

With no formal education, Sharma, now 82, was a master at his family trade, carving statues of the Hindu gods. He was one of the craftsmen for whom Jaipur was renowned. In the mid-1960s, when Sharma started teaching his skills to disabled children, he met Sethi and came to share the doctor's quest.

"When I started this work, I saw that amputees were very depressed and frustrated," he says. "In some cases, their own families had rejected them. Others were distraught because they had to travel so far and pay so much for their prostheses."

Sharma and other craftsmen began to work with Sethi on a better, cheaper foot. One day, pulling his bicycle to a tire-patching stall, Sharma realized that vulcanized rubber - cheap, waterproof and familiar to Indian craftsmen - was the perfect material. Between the artisan and doctor, the Jaipur Foot took shape.

Its simplicity and flexibility remain revolutionary. A hinged wooden core swathed in waterproof rubber, each foot is hand-molded and tinted for its wearer. As the patient sits nearby, a tinsmith clangs on an anvil to customize an aluminum socket and fix the limb to an artificial ankle or leg.

The process takes less than an hour. The cheap material - and Jaipur's skilled, inexpensive craftsmen - keep production costs at a miraculous $28.

Crafted from high-tech materials, Western prostheses typically are made to be covered with a shoe. Though there's little demand, American companies could conceivably make limbs like the Jaipur Foot, says orthopedist Haynes. What Westerners can't do, he says, is duplicate the price: "The major cost of a prosthesis is the labor."

In the United States, Haynes says, a prosthesis, including the connecting hardware, costs from $6,000 to $9,000.

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