The Jaipur Foot in Lanka: Renewable Energy, Little People, Many Miracles

Michael Roberts, 28 June 2010

This essay could also be entitled “The Jaipur Foot and its Universe of Renewable Being.” As such it is a testimony to that great invention produced in 1971 by Dr. PK Sethi of Jaipur with the aid of an illiterate craftsman named Rām Chandra Sharma.[1] Through tales of its spin-offs and the benefits flowing from the newer-model versions of this artificial limb for amputees in Sri Lanka, this article is an epitaph for Dr Sethi.

As clarified for me by Dr. Susiri Weerasekera, “the foot is referred to as the Jaipur foot or footpiece. The whole prosthesis (artificial limb) is called the Jaipur limb. The Jaipur features are the feet and aluminium shanks with upper end shaped as the aluminium sockets lined with corduroy cloth…. [While] the footpiece is a composite: foam rubber or synthetic foam rubber pieces; composite wooden block and these items wrapped round with tyre cord sheeting, then this whole skeleton foot wrapped round with compound rubber layers; placed within the mould and heated to around 186 degrees C ;  left to cool for some hours.”

 The horrors of war, arising from the injuries inflicted by bombs and land-mines, have of course magnified the number of those disabled in this manner within the island. But people lose one or more limbs from a wide variety of causes, including car and train accidents, diabetes and gangrene. That moment of loss must surelygenerate shock within each person’s body and cause pain of mind if not trauma. Therefore, the work of medical specialists in prosthetics, the technicians who produce artificial limbs, and the physiotherapists who nurture the amputees through their new steps must surely rank high in the field of service to humankind.  My essay will explore the benefits of such enterprise through details of two brother/sister institutions in Sri Lanka, the Colombo Friend-in-Need Society and the Jaipur Foot Centre in Jaffna. Both, I stress, provide free services: the disabled do not spend a cent.

     The Jaffna Jaipur Centre in Jaffna is wholly Sri Lankan Tamil in its composition, though augmented by a German Swiss Australian, a technician who pursues hands-on work with his Tamil counterparts in typical workaday Aussie manner.

      CFINS has a total of 34 paid staff including six office personnel. They are mostly Sinhalese, but there are one or two Muslims and Tamils in its work force. It is also remarkable for its affirmative policy of employing those disabled: out of its total of 17 technicians as many as eight 8 are disabled, including one man who is deaf and dumb, another polio victim and four men who are amputees themselves.

    But our tale must begin with Dr. Sethi (1927-2008). As the New York Times noted in an obituary, “the Jaipur foot has revolutionized lives in war-torn countries;” while its proponents make this specific claims: it has “virtually got the same range of movements which a normal human foot has. It has dorsi-flexion, inversion, eversion, supination, pronation and axial rotation allowing a amputee not only to walk comfortably, but also squat (sitting on hunches), kneeling, crouching, sitting cross legged, walking also on undulated terrain, running, climbing a tree and driving an automobile. In other words, it is an all-functional, all-terrain limb.”[2]

Nadesan Ravindran walking on rough ground … it is Ravindran who is practising ona cycle in our first photo

   Pramod Karan Sethi is a special figure because he refused to take out a patent for his invention. This decision can be read as a critique of capitalism. I stumbled on this statement of intent when I was introduced to one of the work units in Jaffna and its whiz-kid, Mahendrakumar. Mahendrakumar had invented a whole array of wheel chairs for all manner of disabled (see my mouth gaping in amazement!!). The seat on one even came up as a flap to reveal another seat with suitable commode-hole for the disabled person to deposit his waste in some receptacle below.

    This prompted me to suggest the need for the Jaipur Centre and Mahendrakumar to secure patent rights. But when I raised the thought again in Colombo, Dr. Susiri Weerasekera jolted me with the Sethi principle: patents slow the dissemination of Goodness and further improvements in useful techniques. End of thought and argument.

Maheendrakumar, whiz-kid,  with one invention … while Damayanthi’s clarification onf another surprises author

 Friendly Debate

The Colombo and Jaffna branches, brother and sister, are engaged in precisely this activity of refining the original Jaipur foot. It will be no surprise to anyone that there are many types of artificial limbs nowadays, but for Asia and poor countries what matters is a relatively cheap foot.

    On this issue brother and sister in Sri Lanka are locked in friendly debate. Since 1999, with encouragement from the ICRC, the Jaipur Foot Centre in Jaffna began to replace limbs based on an aluminium stump with stumps based on polypropylene. They argue that this material is lighter than aluminium and provides easier alignment, good stability and prevents atrophy, while also being conducive to cosmetic colouring that hides the disability.

    The doctors at Colombo FINS stress that aluminium can bear any weight; it is more durable and, last but not last, it is locally available and cheaper. Their aluminium limb, one should note, is a refinement of the original Jaipur foot because it involves a mix ’n match with a plastic socket (sometimes mediated by an amputee using an aluminium socket for a while)

   Thus, for the standard form of artificial limb below the knee the version based on aluminium costs Rs 8,000, whereas the Jaffna version based on polypropylene costs Rs. 21,000 – a difference of 130 Australian dollars in favour of the Colombo FINS version.

     The footpiece of the Colombo FINS version is more durable.  Herein emerges an important caveat. Artificial limbs are subject to wear and tear. They have to be renewed or replaced. For amputees, therefore, the “renewable energy” provided by their limb (or limbs) has to be regularly replenished. For those who are farmers or fishermen such wholesale or partial replacements may be called for within one two years; in other instances a limb may last up to five years. This limitation renders cost into a critical consideration in what is a free public service. The Jaipur Foot Centre in Jaffna can afford to use the more expensive polypropylene because it has the ICRC as financial prop. CFINS may have got on its feet originally in the period 1985-1992 or so with grants from US Aid, but now has to rely mostly on local philanthropic monies, so the difference in cost is a major factor.

 Another Life, Renewable Energy for Ravindran

For an amputee an artificial limb is a form of renewable energy. I “got another life” said amputee Nadesan Ravindran in speaking to me through a translator in Jaffna. Aged 47 now in 2010, he lost his leg eight years ago in a train accident in Colombo while working as a lorry cleaner for a private firm. Ditched by his employee, the free service provide by the Jaipur Foot Centre has enabled him to sustain a petty trade in plantain leaves and to maintain his wife and 3 children.  Living about 8 kilometres from Jaffna town, he was on his third visit for his third limb when I happened to visit the Jaipur Centre in early June this year. So he was an old hand going through the paces of exercising the limb, walking on rough ground and cycling, so that adjustments could be made. family of three children.

 Thangarāsa Damayānthi

The lass who guided me through the various sections of the Jaffna Jaipur Centre was 35-year old Thangarāsa Damayānthi (Tamil). The daughter of a mason, Damayānthi had been educated at Holy Family Convent and participated in volunteer medical service as a teenager. She had joined the Jaffna Hospital as a physiotherapist in 1998 and had several spells of specialist training, including one year in India in 2003. Competent in English, dynamic, amiable and gregarious, Damayānthi impressed me as a latter-day Florence Nightingale, one who would lighten up any team she worked with. For amputee-patients, as one can imagine, such a lively spirit would be another godsend as they took their first steps on new feet.

     Rather in contrast Hārsini Bandāra (Sinhalese), one of the physiotherapists at CFINS, was from a rural background in Kegalle District and relatively shy and raw; but she was no less committed. Aged 28, she had joined CFINS four years ago after a year-long training course. She had opted for this line of work because her younger sister, Kalpanā, had been born without toes and fingers. Her motivation, I further discovered, was matched by the determination shown by her sister: her disabilities had not prevented Kalpanā from securing a place at Vidyodaya University and completing a Sociology Degree just this year.

    Hārsini Bandāra also told me quietly that she derived satisfaction from her minstrel work: apatath sathutak läbenava — “we too derive satisfaction.” Here she echoed the lively elaborations provided by Damayānthi: “when patients derive satisfaction, then I’m happy…. I get hundred per cent enjoyment.” Injecting an evocative Tamil cultural concept into her English clarification, she said “its thirupthi” (satisfying).

 Little People, Unsung Heroes

Damayānthi and Hārsini, then, are among the unsung heroines and little people who provide a yeomen service through the two welfare institutions that feature in this article. Their work is made possible by the technical work of the male personnel, another body of little people, unsung heroes, who hammer and shape the various raw materials into workaday limbs under the direction of work foreman with considerable technical expertise.

    In invidious manner let me focus on a few individuals as illustrations of this body of personnel. L. Martin Johnson (born 1966) is a Tamil Catholic educated at St. Anthony’s College now attached to the Jaffna Jaipur Centre as an experienced technician. He took to this technical line of work with the Mothers’ Front in the 1980s and has been trained in the Jaipur system in various places and had stints in Vietnam as well as Ethiopia through the good offices of the ICRC. Mohamed Hamseen (a Muslim) is an amputee himself. He joined Colombo FINS in January 1989 and received one year training in India on limb making in 1990-91. He left for the Kandy Workshop afterwards, but re-joined in Sept.2000. Nuwan Prasad, a Sinhala lad, was born in Anuradhapura in 1983, but lost one leg in an accident and received an artificial limb in 1992 and then a Jaipur foot in 2003. He began his technical training in June 2006 and now dwells in Gangodawila near Colombo. Ravi Loganathan is a Tamil from the Colombo area who lost both legs in a train accident in the 1990s and has been attached to CFINS for some time

    In the manner Asian, such personnel are paid less than, say, newly recruited junior lecturers at universities, even though their services to society are far more valuable: putting people on their feet as opposed to a career voicing grievances if one were to present a pithy comparison. In the result Colombo FINS has recently had some trained personnel drwan awayby other institutions such as the Mannar Hospital where the new artificial limb centre-began in Ocotber 2010 with the help of the Colombo Friend In Need Society and Meththa foundation U.K.

filched by private enterprises in the same field.

    If there is any large-scale philanthropist somewhere out there in the universe who is in search of merit, and a better after-life, then s/he could do no better than to fund a salary rise (whether equalised or in scale) for all personnel on the work force of CFINS. In this manner s/he would then be entitled to join all our unsung heroes in the honour roll beneath the epitaph: “Jaipur Foot in the service of Mankind.” Where the LTTE coined the unisex term māvīrar (“great heroes”) to depict its “great heroes, we can cast bronze medals called suluvīrayō (“little heroes”) for every one of the personnel at the Jaffna Jaipur Centre and CFINS in Colombo.

       Martin Johnson clarifies …                       

 

     Mohamed Hamseen at work in CFINS                                                                                 

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Ravi Loganathan at work in aluminium section CFINS  

Senadheera, who is deaf and dumb, has been  given an opportunity to lead a meaningful life as trained technician                                                                                                               

 Felix Trottmann at work in Jaffna

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[1] Dr Sethi first presented his product at a conference in Oxford in 1971. Dr. Ravindran of Sri Lanka was present and he chatted with Sethi and worked out an arrangement for two Sri Lankan trainees with some capacity in Hindi language to be sent to Jaipur for training. But w Dr Ravindran’s efforts to persuade the Ministry of Health to pursue this opportunity were scuttled by senior doctors with their own agenda and personal animosities. In brief, the entry of this design to Sri Lanka was delayed by a decade or so.

[2] http://medgadget.com/archives/2008/01/dr_sethi_and_the_jaipur_foot.html