This connection between a sense of completeness, vivacity and vicissitude has been brought about by a simple concept of design sensibility that has emerged to influence the life of many practically and provide a platform of self-expression.
Prosthetics, it is, that has primarily focused on improving the lives of the disabled through innovative devices and techniques and has managed to garner a huge response for people suffering from amputations, limb loss, as well as lifestyle-related joint problems. In India, there’s a new effort under way to bring mobility and feeling far beyond that is generally experienced by people with traditional prosthetics.
The story dates back to 1981 when the United Nations General Assembly declared it as the “International Year of Disabled Persons.” It called for a plan of action at the national, regional and international levels, with an emphasis on equalisation of opportunities, rehabilitation and prevention of disabilities. The theme focused on “full participation and equality”, defined as the right of persons with disabilities to take part fully in the life and development of their societies, enjoy living conditions equal to those of other citizens, and have an equal share in improved conditions resulting from socio-economic development.
Increasing public awareness; understanding and acceptance of persons who are disabled; encouraging those with disabilities to form organisations through which they could express their views and promote action to improve their situation were the other principal objectives of the year.
It was during this time that the Indian government woke up to the cause and decided to come forward to help the disabled. The Artificial Limb Centre in Pune, established in 1944 under the command of Lt Col DS Vohra, began work with renewed vigour. The centre was set up to provide artificial limb, appliances and deliver rehabilitative care to the gallant soldiers of the Indian Army, who had lost their limbs in combat. Some technicians and surgeons were sent to England for training.
Although initially, ALC was raised with the primary objective of meeting the prosthetic and orthotic requirements of disabled personnel of the armed forces, the facilities were gradually extended to civilians as well. Renowned orthopaedic surgeon Dr Balu Sankaran, who was formerly Director General of Health Services and Director of the World Health Organisation in Geneva, expanded his research and work in reconstruction surgery and played a pivotal role in establishing the Artificial Limbs Manufacturing Corporation of India at Kanpur in 1972, of which he was chairman, and the National Institute of Rehabilitation Training and Research in Cuttack.
Individual components of the artificial limbs used to be assembled at the outlet in Kanpur and would be custom-made according to the requirements of particular patients.
Devendra Raj Mehta, the founder and chief patron of Bhagwan Mahaveer Viklang Sahayata Samiti, the organisation known the world over for affordable artificial Jaipur Foot, has made all-out efforts to provide assistance, including artificial limbs, calipers and other aids and appliances totally free of charge to the disabled.
He elaborates: “The disabled after losing the limb and after being treated in hospitals come to us. Number of such treated persons who come to us after surgery is about 100 per day at Jaipur Centre and about 100 a day in other 21 centres of BMVSS at Srinagar, Delhi, Mumbai, Hyderabad, Chennai, Bangalore, Ahmadabad, Gauhati, Patna respectively.” Speaking on why the Jaipur Foot has been such a huge success, he says: “Jaipur Foot is the most versatile limb. Functionally, it is closest to the human limb.”
Dr S K Varma, former Superintendant of AIIMS (All India Institutes of Medical Sciences), gives us a new insight into the initiatives taken by his team in bringing about a change in lifestyle for the amputees. Sitting in his sun-lit, cozy drawing room, he elaborates: “Energetic IAS officers and collectors, who were also representatives of the Red Cross, came forward and offered to open camps and provide financial assistance to those with disability. Even NGOs came forward to help.
One such Collector in Madhya Pradesh observed that a lot of people, who eventually suffered from disabilities resulting from accidents or even diseases, came back to their villagers and became dependent on their family members or relatives for support. Camps were opened and massive efforts were undertaken to rehabilitate the specially-abled. “Doctors and technicians from AIIMS organised a camp in Vidisha. People with disabilities gathered for the camp, casts were taken for assemblage and all the cost was borne by the Red Cross. The team went back with all the components. They were properly fitted and the patients were trained to walk with that. Steps were taken to make such patients self-reliant and independent so that they could earn their own livelihood.”
Gradually, small wings were opened in medical colleges where students were trained in prosthetics. The ministry came up with various schemes for the specially-abled. Research was facilitated in the field and several camps were organised in the neighbouring countries as well, like Afghanistan, Bhutan and Cambodia. Several foreign firms came down to India and began to manufacture artificial limbs.
Dr Varma goes on to say: “Literacy has made people wake up to the new modalities of life. There are many stories of sheer will-power and grit that have brought about considerable changes to the lifestyle of the disabled in India. I remember a case where a man, walking on tree trunks, reached AIIMS and got his limbs amputated. These days, the foreign firms have brought about a lot of difference and have managed to minimise the disability factor.” Loss of a body part is very unfortunate which can affect a person functionally, cosmetically or psychologically. Most common and visible part of the body is face and when that gets affected, an entire individual’s life can change forever. The pain is insurmountable and inconceivable. Facial defects are the most obvious ones compared to any part of the body. It causes extreme cosmetic blemish, dissatisfaction, loss of self-esteem, social stigma and loss of confidence, depression, which in turn affects their personal and professional life.
Congenital condition is where the child is born with a defect, such as anophthalmia, microphtalmia, microtia, atresia; and the acquired conditions are developed during the ongoing journey of life, which include injury, infection or cancer. A lot of work and research is being done at the International Prosthetic Eye Centre in Hyderabad. Kuldeep Raizada, Director of the institute says: “Ocular prosthesis is fitted to the patients following eye removal surgery and disfigured or shrunken eyes.
Those born with these defects (microphtalmia/anophthalmia) should be started with the treatment as early as possible. This enables normal growth of the socket. The longer they delay the treatment, more compromised the results will be, and sometimes there can be a permanent damage.”
He goes on to say: “New modalities such as custom-designed ocular or facial prosthesis can do wonders in improving their appearance. It is a gift that completely changes their life, giving them feeling of a normal person and boosts their confidence levels. In this technique, each and every prosthesis is tailor-made to camouflage the defect and match perfectly to the contralateral side. This is important to give a natural life-like aesthetic appearance. A well-fitting and aesthetically pleasing prosthesis tremendously improves the quality of life in these patients enabling them to lead a normal life, and improves their self-esteem. They can reach any heights in their education and profession; disability won’t be a barrier anymore. It give hope to live life for the patients who are psychologically affected. These cases have been very well managed at the International Prosthetic Eye Center using hi-tech rapid prototyping (CAD-CAM) technology. This has been a great asset in the medical field. It made so much difference in the treatment of many complicated conditions like cancers.”
Physical models can be built layer-by-layer in a 3D printer by using images on computer softwares. CT and MRI scans of any part of the body can be reformatted as 3D images, and study model can be built. Surgeries can be well planned on these models. Customised implants to replace the lost bone (for example after cancer treatment) can be fabricated and made available even before scheduling for the surgery. In the prosthetics field, placement of craniofacial implants in the correct location is crucial to achieve successful results with the prosthesis fitting. Using this technology, surgical templates can be produced to guide implant placement in the desired location. All these factors upgraded the outcome of the surgery to a much different level.
Prosthetist’s skill and experience along with use of technology are two most important factors in achieving successful results in this work. At present, the kind of treatment that International Prosthetic Eye Centre is rendering is simply remarkable and is not available in most parts of the country; as a result of which people travel to other countries to get the services.
Dr Raizada explains: “A change in the life of the affected individuals is clearly visible. We have seen many patients who are doing great after receiving the prosthesis. Many of our patients have gone for higher studies and some even topped. There are no hindrances to marriage as well. They are more social now, and do not carry a sympathetic attraction anymore.”
For Asha Khetan (name changed), the world around her changed when she was operated upon in Hyderabad and got a cosmic eye. She went back to her state, sat for her board exams and came out with flying colours. She say: “My life changed after that day. There was no sympathy, no ridicule and I felt that I was at par with each and every single individual in this world who doesn’t have any kind of disability.”
Two years back, Arunima Sinha (28) successfully completed her Everest Summit. After Tom Whittaker, she is the first Indian disable mountaineer to reach the world’s tallest peak. We have several such real-life heroes around us from whom there are ample reasons to draw inspiration and look at life differently. People, suffering from some kind of disability, have often shown immense courage and grit that have brought about a difference not only in their lives but also to those who surround them. And prosthetics has proved to be a boon for them. From minor surgeries to complicated amputations, it has constantly brought about vital changes to those suffering from disability. One who always feels that disability has withheld the pleasures of human experience from him, it is time to rise and act for as noted author Charles Dickens says: “Try not to associate bodily defect with mental, my good friend, except for a solid reason.”