By
Around midday on a scorching summer afternoon, Anju, a young homemaker from Jind in Haryana, walked in to Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS) center in Jaipur. This was her third visit in about a decade. The first time she had come here was after losing a leg in a road accident. One moment she was walking on the unpaved road, and the next, a car rushed past her. “My severed foot fell to the side,” she flinches as she recounts the incident. Her brother-in-law, also an amputee, told her to, like him, visit Jaipur to get fitted with the famous Jaipur Foot. Every three or four years, she needs to replace the artificial limb — this time round the process takes all of four hours. And it’s free.
BMVSS is a Jaipur-based nonprofit which made the city’s (many would argue the country’s) greatest social invention accessible to the world. In 1997, Time magazine had noted, “People who live inside the world’s many war zones, from Afghanistan to Rwanda, may never have heard of New York or Paris, but they are likely to know of a town in northern India called Jaipur. Jaipur is famous in strife-torn areas as the birthplace of an extraordinary prosthesis, or artificial limb, known as the Jaipur foot, that has revolutionized life for millions of land-mine amputees.”
It all started in the mid-60s when a doctor and a local craftsman in Jaipur got together: Dr. Pramod Karan Sethi was an orthopedic surgeon at the Sawai Man Singh Hospital in Jaipur; Ram Chandra Sharma was an uneducated sculptor who was teaching persons with leprosy to make handicrafts.
At the hospital, Sethi realized that the solid-ankle-cushion-heel (SACH) foot he was prescribing to his patients was unsuitable for Indians who often sit on the floor and walk bare feet. He reached out to Sharma and briefed him about foot movements and pressure points. They spent two years and experimented with various materials to build the ideal prosthetic. One day, a couple of years later, Sharma was getting the punctured tyre of his bicycle repaired when he had the idea that they could cast a rubber foot.
However, it shredded easily. But rubber hinged to a wooden limb, then wrapped with a lighter rubber, and vulcanized, worked. Sethi formally presented the Jaipur foot to British orthopedic surgeons at Oxford in 1971. But in general, there was skepticism around its efficacy and until 1975, it found only 59 users. In that year, BMVSS was set up by Devendra Raj Mehta, a top bureaucrat who later in his career went on to become the deputy governor of the Reserve Bank of India. The Jaipur foot was making its mark in India when the Soviet-Afghan war broke out in 1979. Russian landmines were injuring thousands of Afghans, many of them children.
“We learnt our first lesson in Afghanistan,” says Dr MK Mathur who has been associated with it since its inception and heads its technical wing. “In Afghanistan, the patient had to negotiate hilly terrain much more than we have to do in India. They told us they had difficulties especially climbing down, they would buckle and fall, so we developed a lock system in the knee-joint to make it more stable,” he says. (BMVSS has since sent multiple teams to the country over the decades and through its many wars, and signed an agreement with Afghanistan’s National Disability Institute providing India-trained experts to make 70 to 100 artificial limbs every month.)
The Jaipur foot, easy to make and adapt worldwide, especially in war-torn regions. Culturally too it was a good fit for Afghans who also sit on the floor.
Halfway across the world, the Sandinista revolution in 1979, had caused more than 2,500 Nicaraguans to suffer major amputations from war-related wounds. The Jaipur foot was introduced in the country in 1990, and became a kind of “a test center for plans to expand the use of the device... to the rest of Latin America and other impoverished regions torn by war and hampered by inadequate medical care,” the New York Times reported.
The Jaipur foot was made to be shared. Its early versions, made of rubber, wood and aluminum could be made in other countries by using locally sourced materials. “In Afghanistan craftsmen hammer the foot together out of spent artillery shells. In Cambodia, where roughly 1 out of every 380 people is a war amputee, part of the foot’s rubber components are scavenged from truck tires,” an article in Time magazine noted.
The Jaipur foot has changed dramatically since it was first conceived. Its central feature is its adaptability. Its technology has been consistently evolving, and worked on by the finest Indian and global research institutions – the Indian Space Research Organisation (ISRO), Stanford University and Massachusetts Institute of Technology (MIT), especially, have made significant contributions. In 2002, ISRO signed an agreement with BMVSS for polyurethrene technology developed by the space agency. The rubber and wood Jaipur foot was replaced by one made of lighter and more durable polyurethane foams.
In 2007, the Center for International Rehabilitation in Chicago developed a new way of fitting the foot. The traditional technique required a plaster-of-Paris cast to be made manually, but the new sand-casting method was able to fit the limb in five minutes. An amputee would put her leg in a bag filled with sand, and a suction device would force all the sand particles to stick around the limb and create a cast. In 2009, the Jaipur Knee, made with oil-filled nylon polymers, was developed at Stanford University. Its four-bar linkage knee joint for above-knee amputees was termed as one of the 50 best inventions of 2009 by Time magazine. Since then, says Mathur, “We have made 20 more changes.” For instance, he says, “in the US, people don’t mind the knee making noise, but here people get disturbed, so we’ve changed the design to buffer the sound. Modifications are constantly going on.”
Most of the work now is done in the two gait labs at the centre. In 2012, with help from NASA, they established a gold-standard gait lab — like those used by top research institutions in the fields — with the help of NASA. In a large room with about 12 high-resolution cameras, the patient is made to walk on a mat which takes all their ground reactions, then the data had to be analyzed.
"It’s a very elaborate process. You have to prepare the patient by putting markers from the hip to the leg, which takes about an hour, and then they’re told how to walk on the mat... we record all the muscles, which ones are working which ones aren’t working, and how is it working, so we can make our limbs as close to the walking limbs for the amputees. It gave us a lot of information and we were able to improve our design further. But we found it gave us much more information than we need.”
This lab has now been relegated to research purposes, and a new lab was purchased last year. The old gait lab would take 3.5 hours per patient but now, says, says Dr Deependra Mehta who heads research at BMVSS, “in 15 minutes our technician can get the information about whether the new limb is as good as the other limb or not.” They can measure hip hiking, the posture, whether the knees are bending equally... corrections can be made immediately.
A young technician at the institute, Balram, first came to BMVSS as a patient when he was a schoolboy in Hardol, Uttar Pradesh. “I was so inspired by their work, I was determined to join them after finishing my studies.” Now, he says, when patients watch him working, which includes carrying molds for the limbs that could be anywhere between three to 10 kilos from one workshop to the other, they seem more at ease about their future.
“It evokes hope in them. When I make their prosthetics, they seem to become more contented, it gives them strength and removes all apprehensions because I’m also an amputee,” he says.
With the Jaipur foot, one can resume all the activities they could before losing their limbs. “I can even climb trees and eat mangoes,” Balram laughs.
