Astronaut Neil Armstrong’s historic words, ‘That’s one small step for a man, one giant leap for mankind’ could well apply to the tentative first step taken by the initial recipient of the Jaipur foot. It signalled the arrival of a prosthesis that would revolutionise the world of the differently-abled.
Being differently-abled is difficult for both the well off and the poor. Apart from physical discomfort, it also takes an emotional toll on them as they become dependent on others for even basic bodily functions. But the poor have it worse as they lose their ability to earn and drain family finances for treatment.
Prostheses: an expensive beginning
Prostheses in use before the 1970s were expensive and of the solid-ankle cushioned-heel (SACH) variety, which were meant to go with shoes and gave the wearers no mobility option other than sitting on chairs.
In 1966, Pramod Karan Sethi, an orthopaedic surgeon at the Sawai Man Singh (SMS) Medical College, Jaipur, conceived the fundamentals of an inexpensive, easy-to-use prosthetic. He was aided by Dr SC Kasliwal and Dr Mahesh Udawat. Craftsman Pandit Ram Chandra Sharma gave the prosthetic limb shape and design — the initial one resembled a human foot and even had toes!
Sethi and Sharma took into account not only the necessity of providing artificial limbs that would help the wearers return to normal life, but also the specific needs of Indians: the prostheses should help the users squat, walk barefoot, climb trees, cycle, work in muddy fields, visit places of worship, prostrate or sit cross legged, and run. Different terrains and uneven road surfaces had to be taken into account as well.
After experimenting with several materials, they zeroed in on vulcanised rubber and lightweight wood. A cycle repairman named Chugga Bai is said to have helped them cast the rubber to prepare the first Jaipur foot (so named because it was invented in Jaipur). The natural foot’s dorsiflexion action (backward bending) — so necessary for sitting cross-legged on the floor during pooja s — was incorporated into the artificial limb.
In 1968, an amputee received the first prosthetic Jaipur foot. The excitement this created brought many hopeful patients to the city. Despite the initial euphoria, however, over the next seven years, only about 50 patients were fitted with the prosthetic.
Taking off
The Jaipur Foot took off only after 1975. The story behind this is touching.
In 1969, a young man named Devendra Raj Mehta was serving as the Collector of Jaisalmer. A near-fatal road accident saw him almost lose a leg and rendered him bedridden for five months. When he recovered and went for rehabilitation and physiotherapy to Sawai Man Singh Hospital, he witnessed first-hand the suffering of amputees who thronged the hospital for artificial limbs.
Almost all of them were in dire poverty and struggled with registration, and food and stay issues, waiting and hoping that their turn for fitment would come soon.
Mehta had had plenty of time for introspection over the five months he was laid up: what if he had lost a leg? What if he had been too poor to afford treatment? When he returned to active service, these thoughts — and the scenes he had witnessed at the hospital — never quite went away. In 1975, when the Indian government decided to celebrate the 2500th birthday of Mahavira, Mehta (a Jain himself) suggested setting up an organisation that would make the Jaipur foot easily and freely available to poor people.
The broken-down ambulance garage inside the SMS hospital premises was converted into Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS), which was registered as a society on March 29, 1975. Mehta set about his mission of making BMVSS ‘patient-centric’. The treatment was completely free.
Free walk-ins
Right from the beginning, patients were allowed to walk in at any time of the day and get registered. Their boarding and lodging was provided for and, after a doctor’s examination and advice on the type of prosthesis needed, fitment was done as quickly as possible.
Once the patient had been trained and was confident of walking independently, a return fare would be provided and, in many cases, even a means of livelihood.
Depending on the type of usage, a Jaipur Foot can last for about four years. Patients then return for another fitment. If children are fitted with prostheses, they return for new fitments at every growth phase.
The growth of BMVSS was rapid, despite the fact that it never advertised. Within the next year, due to the streamlining of the admission procedures and the assembly-line fabrication process, it was able to complete 59 fittings. Now, about 16,000 artificial limbs are fitted every year.
Today, the Jaipur foot is the most widely-used prosthetic in the world, as it can be used with all levels of amputations. It is lightweight, shock absorbent, flexible, reasonably priced and offers the wearer a firm grip.
Growth and tech
The organisation has grown to become the world’s largest centre equipping the differently-abled, providing not just artificial limbs but also callipers, crutches, hand-operated tricycles, wheelchairs, hearing aids and other appliances. More than 1.55 million persons have been rehabilitated to date. Twenty-three branches across the country handle Indian patients while camps, associate centres, joint ventures and others take care of patients in about 27 countries abroad.
What sets BMVSS apart is its open-door policy, free services, and efficient fitment that sometimes take place within a day. The prostheses offered include below knee, above knee and artificial hands. In collaboration with Stanford, an oil-filled, self-lubricating ‘Stanford/Jaipur knee’ was introduced in 2009 (considered one of the 50 best inventions in the world by Time magazine). There are even artificial limbs for amputee cows!
The basic technology, despite changes in materials, has remained the same. First wood, then aluminium and later HDPE (high density polyethylene) pipe was used. Today, skin-coloured HDPE pipes are manufactured specifically for BMVSS.
An in-house R&D lab and technological and scientific collaborations help make the foot more lightweight and durable. Facilities include a first-of-its-kind Gait and Movement Analysis Lab System, and 3D printed prosthetics are planned for the future.
BMVSS has entered into research and development collaborations with IIT-Bombay, IIT-Delhi, Stanford University, the Massachusetts Institute of Technology and even the Indian Space Research Organisation to improve the Jaipur Foot.
Financing
Because it offers its services for free, the organisation depends completely on donations for its operations. A third of its funding comes from the Indian government, while the rest is provided by corporate and private donors like the Rural Electrification Corporation Ltd. (RECL), Paul Hamlyn Foundation, Glenmark Pharmaceuticals Group, and others.
About 96 per cent of the funds are used for the patients; only 4 per cent is used for other expenditures. To reserve every paisa for the patients’ welfare, Mehta and his co-workers do not serve even basic refreshments such as tea and water.
BMVSS believes that empowering the poor is many times better than just offering sympathy. This is why it refuses to patent its technology. It has reportedly transferred the same to more than 30 institutions in the country and trained their personnel in the artificial limb-fitting procedures.
Questions were raised about whether the free-of-cost model could endure in the future (it will, says Mehta), whether BMVSS would continue to be equally efficient after Mehta (a successor has already been appointed) and whether the Jaipur foot was biodegradable (still under study).
Awards and recognition
The organisation received two national awards (in 1982 and 1998). Other awards include the Sat Paul Mittal National award, Mahavir Award, CNBC-TV18 Social Enterprise of the Year Award and SR Jindal award. The men behind the Jaipur Foot were also lauded: Dr PK Sethi received the Magsaysay award and the Padma Shri, Ram Chandra Sharma got the Diwali-Ben award, and Mehta was awarded the Padma Bhushan.
More importantly, in recognition of its services, BMVSS has been given Special Consultative Status with the Economic and Social Council of the United Nations Organisation.