Limbs to go: an Indian lesson

An artisan, squatting on the bare floor, pounds a sheet of aluminum into the shape of a leg and attaches it to the live stump of an amputee.  The patient looks at it, feels it, and smiles. Amputee and artisan work in perfect unison until they get it right.  The new limb is then covered with resin and painted in the color of the patient’s skin. This is a daily scene at Dr. P.K. Sethi’s Jaipur Limb Center in Rajasthan, Northern India.

Just a few hundred miles away, across the border from Pakistan, jet planes are pounding Afghanistan, the world’s most underdeveloped country, with the latest bombs. The U.S. has just deployed a new weapon against the elusive Taliban.  Reports say that it produces the same frightening mushroom cloud as the nuclear bomb, and that the heat it releases penetrates through underground desert sanctuaries and sends shock waves up to about 500 meters. The Americans won’t rest until they get it right. The idea is to be able to wipe out the enemy without having to commit U.S. ground troops.

We have here two examples of the conflicting uses of technology: one that creates and another that destroys.  By some paradox, it has always seemed that more money is spent on the development of war technology than on peaceful technology.  Fortunately, a few creative scientists manage to re-fashion technology originally intended for war into everyday tools beneficial to humanity.  The Internet is a case in point.

Modernity has placed in our hands a large array of devices and appliances that can either support life or end it.  All over the world, technology is changing the way we live in a manner usually not chosen.  It is incredible how we typically sleepwalk through this complex process, allowing technology to alter our relationships and to dictate how we must live.  This is especially so in societies like ours that have become total consumers rather than makers of technology.

This lesson became real for me recently on a visit with Dr. P.K. Sethi, 1981 Magsaysay awardee for community leadership, and the man behind the “Jaipur Foot.”  Sethi’s story is a fascinating illustration of how nations can serve their people, especially the poorest, without being dependent on foreign technology but also without having to supply them with inferior goods.

As a young doctor coming home from postgraduate training in Scotland, Sethi was assigned to organize the orthopedic department of Jaipur’s state hospital.  He soon realized that surgery was useless to patients if they were not also provided with braces and prostheses to help them stand upright and move about.  Most of the patients were polio victims, but a growing number were poor people who had to have their lower limbs amputated as a result of falling off from overcrowded trains.  Imported artificial limbs and braces were beyond their reach.  Sethi needed a workshop in which to make local limbs. The project was hobbled by lack of funds, and he found himself working in abandoned garages.

He and his team of unlettered but highly skilled craftsmen began with molds taken from prostheses imported from the West. They tried wood and experimented with rubber, until they could produce what they thought was a suitable local version. His patients, however, rejected these limbs and kept going back to their crutches.  There was something wrong with the western designs. His patients needed artificial limbs they could use bare, or slip into open sandals, and wash at the end of the day.

Sethi says: “Wearing shoes which were integral to the western designed limbs was uncomfortable in our hot climate.  Our people walk barefoot or in well-ventilated footwear.  We are essentially a floor-sitting people, requiring a range of mobility in our feet and knees which is not needed in the chair-sitting culture of the West.  We should not expect our people to change their lifestyle because of a design we were forcing on them.”

He decided this was not a bio-mechanical problem, but a cultural one. Solving it required paying attention to user-reaction and understanding the everyday world in which his patients moved.  The study that Sethi embarked upon is what we today would call a “phenomenology of technology.”

But more than this, Sethi was conscious that those who most needed these limbs were the very poor.  “This does not imply that we should provide primitive peg legs or substandard limbs to our people.  What we have shown is that it is perfectly feasible to incorporate the latest ideas in science and yet provide an affordable limb.  All frills are cut down to achieve this objective.  Our limbs cost a fraction of otherwise extremely expensive limbs being marketed, and a below-knee artificial limb costs about as much as a pair of good shoes.”

There is an upsurge of interest in Dr. Sethi’s Jaipur limbs because of the sharp rise in the number of victims of land mines in countries ravaged by civil war.  Afghanistan is possibly the most heavily landmined country at present.  Land mines are made to maim rather than kill, and their common victims have been the poor in the countryside – peasants, rural women and children.  Dr. Sethi may soon have to open a workshop in Afghanistan if this nation must walk again.

That is however only the practical side.  At a more philosophical level, Dr. Sethi’s example is a timely reminder that technology with a human face is not only achievable; it is also an imperative in a world that is emptying human activity of all meaning in the name of mass production, profit, and power.


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