Artificial Parts, Practical Lives: Modern Histories of Prosthetics

Technology Sits Cross-Legged: Developing the Jaipur Foot Prothesis

12 Technology Sits Cross-Legged Developing the Jaipur Foot Prosthesis Raman Srinivasan The Jaipur Foot is not a foot. . . . not a foot alone. . . . It has become an outlook, a way of looking at the patient both within the world of medicine and in terms of her life beyond the hospital. —P. K. Sethi, 1986 THE TERM “JAIPUR FOOT” is a convenient way of naming a whole class of prosthetic feet developed in the city of Jaipur, India. It refers to a class of handcrafted, multiple-axis prosthetic devices that evoke the human foot exceptionally well in form and function, and yet are cheaper than a pair of Indian shoes. Nonliterate artisans can fit amputees with a rugged, lightweight, skin-colored lower-limb prosthesis in less than an hour. These artisans are usually able to align the prosthesis accurately by visual examination. The amputee learns to use her new machine almost immediately, requiring little or no training. Furthermore , the Jaipur foot prosthesis is waterproof, abrasion-resistant, and durable. It enables an amputee to resume a normal lifestyle more or less quickly. Amputees who currently use the Jaipur foot prosthesis include a celebrated dancer, a professional cricket player, the leader of a much-feared Tamil terrorist faction, tree climbers and toddy tappers, cycle-rickshaw drivers, farmers, and craftsmen. The Jaipur foot prosthesis is a significant advancement in the history of rehabilitation medicine and medical technology, affecting the lives of hundreds of thousands of amputees in the developing nations. It is now used and manufactured in Nicaragua, Sri Lanka, Thailand, Cambodia, Vietnam, Kenya, and India. The Jaipur foot is particularly 327 well suited for developing nations because it is cheap, enduring, and ef- ficient. It is also culturally appropriate, by virtue of its design, as it enables its users to squat, sit cross-legged on the floor, and walk barefoot. Most important, however, the technology for making this prosthetic device requires little in the way of start-up capital or cumbersome machinery , uses locally available materials such as rubber and wood, and provides ample scope for the expression of artistic skills and artisanship . As a consequence, it is not protected by intellectual property regimes, thus making it widely available. The term “Jaipur foot” brings to mind not only the footpiece but also the design and manufacture of lower-limb prosthetics; in fact, it has become a way of talking about a new style of rehabilitation medicine in tropical countries. Dr. Pramod Karan Sethi, professor of orthopedic surgery at the Sawai Man Singh Hospital at Jaipur, is generally recognized as the key individual in the development of the Jaipur foot.1 He began research on the prosthesis in 1966 and continues to improve it, even today. He is unusual in being able to work readily and easily with a wide variety of collaborators, including Indian rocket scientists, volun328 RAMAN SRINIVASAN FIG. 12.1. This woman has customized her Jaipur foot to her liking, with decorative rings and painted toenails. Photograph courtesy of the author. tary agencies, students, journalists, filmmakers, professors in engineering colleges, entrepreneurs, philanthropists, as well as both anonymous Indian craftsmen and medical personnel from the West. Sethi is an inspiringly talented and idealistic orthopedic surgeon , teacher, and entrepreneur. “I grew up hearing about Mahatma Gandhi,” he said, and that made a deep impact on me. Gandhi was an immensely charismatic person. And once you saw him, it left a deep impression on your life; his ideas of ahimsa, nonviolence and Swadeshi, indigentality, became real, practicable, and simple. And you were tempted to follow the Mahatma, just keep walking behind him, singing and dancing, and you met others like yourself, and then you and your friends went from town to hamlet, hamlet to town spreading the message of self-rule, self-reliance, and nonviolence. If you could not follow the Mahatma right away, you, at the very least, tried to use your skills to do something for the downtrodden, the daridranaryaan, god in the guise of the downtrodden. You changed your life to follow the Mahatma. It was so simple. Even though Sethi went to England to study advanced surgery and became a member of the Royal College of Surgeons, he returned to his homeland with a firm resolve to put his knowledge in the service of his fellow Indians. He could have quite easily established a lucrative practice in Delhi or Bombay since, in the years after India gained...