International Assistance

Jaipur, India

Background

India, with its large population of indigent people, presents special challenges in designing and fitting prostheses. The hot climate, the common use of sandals or bare feet, and having very limited resources, makes Western designed prosthetic components inappropriate for most Indian amputees. In 1968 a prosthetist, Ram Chandra Sharma and an orthopedic surgeon, Dr P. K. Sethi, designed the "Jaipur foot". This low cost, durable, flexible, natural, waterproof bare foot, became one of the most significant developments in the prosthetics industry. It put Jaipur, India on the map of prosthetic centers of the world. To date, the foot has been fit to over 900,000 amputees in India and other developing countries, including Afghanistan, Bangladesh, Dominican Republic, Honduras, Indonesia, Malawi, Nigeria, Nepal, Nairobi, Panama, Philippines, Papua New Guinea, Rwanda, Somalia, Trinidad, Vietnam, Zimbabwe, Sudan.

Garrett Hurley, CPO (ProsthetiKa) Provides Help

In April, 2008, prosthetist Garrett Hurley represented ProsthetiKa in visiting Jaipur to evaluate the Jaipur foot technology and to assess its appropriateness for other ProsthetiKa projects. He was invited to observe the fitting techniques and to make recommendations as to how the sockets could be made more comfortable and functional.

In Garrett's report to the Jaipur Foot Prosthetics Center, he began, "I would like to start by saying that the work that is being done here is great work. The international field of Prosthetics and Orthotics can learn a lot from your approach of making high quality artificial limbs and braces in very high numbers to a poor population that need them". Garrett went on to propose that the techniques used in Jaipur used as a model for training prosthetists who wish to fit amputees in developing counties with similar needs.

As far as specific technical suggestions, Garrett suggested a slight change in the heel of the foot when used for above-the-knee amputees. This change would reduce the forces on the heel and would thus, result in a more stable prosthetic knee.

He also suggested that they investigate a more skin-friendly socket liner to improve comfort. The liner Garrett suggested would utilize a fabrication technique now used by ProsthetiKa prosthetists in the U.S., but we would adapt the system to utilize materials which are readily available in India.

If Jaipur responds enthusiastically to this recommendation, ProsthetiKa is prepared to assist them in developing the technology.

Finally, Garrett noted the problem in providing follow-up which is critical in prosthetics as the amputee's residual limb undergoes physical changes, and the prosthesis begins to wear out. Long distances and difficult travel make such follow up challenging. Garrett suggested setting up "mobile clinics" or working with community based rehabilitation projects.

Garrett concluded ProsthetiKa's project in Jaipur was an excellent example of mutual respect and "true exchange of information"

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