An Indian artificial limb charity's work in developing the limb has changed he prospects of thousands of amputees in the country and around the world.
Versatile and inexpensive, Jaipur Foot prosthesis is transforming lives
"Mornings can be depressing here," says Devendra Raj Mehta as dusk falls on the tree-lined grounds outside his Jaipur office. "Many people arrive with nothing, unable to walk. But by evening, everything is very different." Located a few kilometres from the centre of the Rajasthani capital, the Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS) is internationally renowned for its work in the field of amputee care. Most notable is the organisation's pioneering of the Jaipur Foot - a durable, lifelike and inexpensive prosthesis that has already changed more than 400,000 lives.
"That is only the number of people around the world who have been fitted with Jaipur limbs," Mehta explains. "As you will see, we do more than just that.
"We also have centres in other Indian cities, such as Delhi, Mumbai and Chennai, and we take our work to places where it is needed overseas ... In total we have helped approximately 1.25 million people in 25 nations - including Iraq, Afghanistan and Somalia."
Watching Mehta, the 74-year-old founder and chief patron of the BMVSS as he fields calls, dictates letters and answers emails, the operation's reach quickly becomes apparent. On his agenda today are invitations to run clinics in Chad, Mongolia and Cameroon, and a request for his presence at an awards ceremony in Helsinki.
Taking a brief break from this correspondence, Mehta points to a framed picture on the window ledge: "That is from Time magazine," he says. "The Jaipur Knee [a fully jointed plastic prosthesis developed by the BMVSS] was named one of the top 50 inventions of 2009." He then runs through a list of notable sponsors and partner organisations, including national and local government departments, the Indian Space Research Organisation and Michigan Institute of Technology. Further funding for the BMVSS comes from private individuals and public figures, such as Sheikh Nahyan bin Mubarak, the United Arab Emirates Minister of Higher Education and Scientific Research, who provided backing for a recent limb-replacement programme in Pakistan.
Looking at today's high-profile connections, it is easy to forget that the Jaipur Foot began as the handiwork of a local craftsman. Back in 1968, Ram Chandra Sharma, also affectionately known as Masterji, was employed as an occupational therapist by the Sawai Man Singh Hospital in Jaipur. During this time, he found himself frustrated by the expensive and impractical foreign-made prostheses he saw being fitted to amputees.
Masterji was determined to come up with a better alternative. Accordingly, he set himself a number of objectives. Firstly, his invention would be distributed free of charge, and thus needed to be made from cheap, easily obtainable materials. Secondly, it should be strong and flexible enough to withstand the rigours of manual labour. Thirdly, it would be culturally appropriate for its users: able to be worn with or without shoes for visits to temple or mosque, and capable of the full range of motions required by daily prayer.
Like every great innovation, Masterji's solution was simple and elegant. Instead of using costly alloys and polymers, he opted for a core of high-density foam rubber and wood, wrapped in vulcanised rubber. Pressed in a metal mould and heated, these components bound together and took on a shape uncannily close to that of a real human foot. This was then attached to a sturdy wooden leg.
In terms of form and function it was an unqualified success - so much so that it was fully endorsed by Masterji's employers and further research and development would involve a number of doctors from the hospital. Inevitably, word of this work spread among amputees in Rajasthan and beyond. However, for various reasons, only a very modest number of fittings (no more than 50) were carried out in seven years from 1968.
The establishment of the BMVSS changed all that by massively increasing the availability of the Jaipur Foot. Under the stewardship of Mehta and his two brothers, who help to run day-to-day operations, the organisation managed to provide more than 10,000 fittings in the next seven years. The Jaipur Foot itself has also undergone countless revisions. It is now lighter, stronger and attached to a high-density polyethylene leg custom made for each patient. Every day, people from all over India are treated and although these clients come from a relatively wide social spectrum, Mehta is keen to stress the BMVSS's focus on the economically disadvantaged.
"Our main emphasis is always on improving the lives of the poor," he says. This mission was inspired by a painful and very personal epiphany. In 1969, while working in local government, Mehta was involved in a serious motorcycle accident that left one of his legs shattered. "It was broken in more than 40 places. The doctors thought they would have to amputate," he recalls. "I was lucky and received very good care, so that did not happen. But it made me think. I kept my leg and was able to walk again, but there were many people who were not so fortunate. I wanted to find a way to help them."
Already aware of the potential of Masterji's invention, having seen patients queuing for the few fittings provided at SMS hospital, where he was then receiving physiotherapy, Mehta became consumed by the idea that it should be available to as many people as possible. Blessed with a list of influential contacts - the result of a career that has included posts as deputy governor of the Reserve Bank of India and director-general of foreign trade - he spent the next few years securing the premises and funding necessary to take over production of the Jaipur Foot. In doing so, he turned it from a brilliant invention into the foundation of a formidable charitable concern. The BMVSS now comprises a factory, clinic and workshops, and employs 173 people, including doctors, administrative staff and therapists.
However impressive the raw data is, it still fails to do justice to the scale and importance of this organisation. This can only be truly appreciated when one observes the effect it has on the lives of the ordinary individuals who pass through its doors.
Take the case of ML Kabra, a 58-year-old man from a small village near Ajmer. On my first morning at the centre, I see him standing between a set of parallel bars, ready to take his first unaided steps since his right leg was amputated last year, the result of complications related to diabetes.
Kabra's face is knotted in concentration, but it is impossible not to pick up on the happiness of his wife and two sons as they watch him slowly place one foot in front of the other. "Each limb we produce costs only $45," says the factory manager, Om Prakash Sharma. "Other commercial prosthetic companies can charge thousands. But we are a charity and not interested in making profits. That means anyone can come here and be treated."
Not just anyone, but vast numbers, too. While specialist clinics in the West can take weeks to develop a single custom-built prosthesis, Sharma and his team fabricate and fit several new limbs a day.
Immediately after one fitting, I witness a man sprinting from one end of the centre's grounds to another, climbing trees and then jumping back down. It's a striking demonstration of how just versatile and hard-wearing the Jaipur Foot is. However, the most memorable patient of all is Sushil Lalmeena. Just three years old and accompanied by his father Prabhu, this little boy underwent a double amputation in 2009 after suffering horrific burns to his feet in a house fire. He has never walked at all, yet after several hours of work constructing two tiny limbs and plenty of gentle coaxing, he is able to take the first steps of his life.
Sharma looks on, plainly delighted, but such moments are all in a day's work for him. A meticulous man with a welcoming smile, he proudly shows off the laser-alignment system that helps to ensure every limb is made to precisely the correct dimensions for each patient. "This is a very important part of the process. Some of these people travel a long way to see us, so we have to make sure that each fitting is perfect before they leave," he says, pointing to the sharp red beams now describing the contours of Santosh Vajpeyi's left leg.
Vajypeyi, 30, is a second-time visitor to the BMVSS. Like many who find their way here, he is a victim of India's chaotic roads; mown down four years ago by a speeding truck in rural Uttar Pradesh. Indicating that all is well with his new prosthesis, he steps down from the platform and confidently walks through the waiting area, then sits as further measurements are taken for the leather straps that will secure it to his knee. "Many people we see are coming here for their second or third time," says Sharma. "Each leg we produce lasts between two and five years. This depends on how heavily it is used. If a patient uses their leg in hard manual labour, it will not last as well as one used by someone who doesn't, but most are good for around three years before they have to be replaced." In terms of basic mechanics, this is remarkable enough. However, do a little mental arithmetic and the numbers quickly become extraordinary.
With each limb weighing in at an average cost of $45, this lifespan means that the clinic has figured out a way to enable amputees to walk again for around $15 per year. This is achieved by working in volume and by rigorous control of almost every stage of production. Not only are Jaipur limbs made at the centre, so are many of the raw materials, right down to the rubber strips that eventually form the foot's protective coating.
The first time I arrive at the BMVSS, a sharply featured silver-haired man stands outside, dressed in a frayed dhoti. Propping himself up on a makeshift crutch, he looks over, points towards the gate and tells me that I am visiting a "very famous place". He's absolutely right and given that many of the organisation's clients are people with little formal education, this grassroots recognition has also been carefully engineered.
As Mehta explains: "We do not advertise at all. We rely on word of mouth to reach people. That is important because we want our work to be accessible to everyone. Now a person can travel across the country and arrive in Jaipur with no knowledge of the city, not even knowing our address. If they are an amputee or unable to walk, every rickshaw driver will automatically know exactly where to take them."
It also leads to an ever-expanding remit. Over recent years the BMVSS has grown exponentially, not just in size but in terms of the services it provides. "Our work is never done. Whenever we solve one problem, we turn our attention to another," says Mehta, whose position at the centre is undertaken on an entirely voluntary basis. "We began with the Jaipur Foot. Now we manufacture callipers, hand tricycles for people who cannot use artificial limbs, crutches, artificial arms and hands, and recently we added a physiotherapy department."
Returning to the topic of the overseas camps run by the organisation, he adds: "We are hoping to be able to work in Libya soon. Many places where we have set up temporary clinics, people have warned us against it, saying that what we were planning was too dangerous. But what we do is not connected with politics. It is about humanitarian aid. In my experience when you go to a conflict zone like Iraq as a human being, with the intention of doing good for others, the response you receive is generally very positive."
The responsibilities of the centre now also extend far beyond medical care, domestic or foreign. The grounds serve as a hub of the local community, a quiet space where students come to pore over their books. Training is provided in a number of different disciplines and an additional programme exists to enhance the economic position of many of the organisation's clients. This last initiative is one of which Mehta appears justifiably proud. "Often the solution it is not just a matter of giving someone an artificial leg and then sending them away," he says. "We address the physical problem but we also have a duty to address their social problems: helping them to earn money and be self-sufficient when they leave." This is accomplished by providing equipment that allows previously unemployed patients to establish small businesses of their own.
Later in the day, all the utensils necessary to set up chai and snack stalls are laid out on the ground nearby and a group of patients who have recently been fitted with new prostheses assembles around us. Among them is Raju Jaiswal, a slightly built 36 year old man from Uttar Pradesh.
Soon, he takes a seat and begins to carefully relate the circumstances that brought him here. He has travelled all the way from Varanasi - a distance of nearly 800 kilometres. Since losing both legs just below the knee in a traffic accident two years ago he has been immobile and unable to hold down a job.
It's an all-too-common story. Many of the centre's clients arrive with only a couple of rupees to their name. However, Jaiswal's disability has been particularly devastating.
As a result of his reduced capacity to provide for his family, his wife has left him and he has not seen his two young children for several months. He doesn't appear to blame anyone for his situation, but the deep lines that score his prematurely aged face speak to a life of considerable hardship. Now, though, the future looks a little brighter. "I can walk again," he says, roughly translated by Mehta. "And now I'll be able to work. If I can make money to look after my family, I hope they will come back to me."
Mehta smiles, places a hand on Jaiswal's shoulder and wishes him luck. "You see in that one man everything we are trying to do," he says. "First, you have the physical rehabilitation. Secondly, you have the economic empowerment. And in his case we may even be able to bring about the reunion of a husband and wife." As the next person in line takes their seat, I can't help but wonder what will happen to Jaiswal. Will he make a success of his new business opportunity? Will he return to Varanasi and regain his family? None of this is guaranteed, but as he strides off into the fading light, one thing is certain: this evening, for him, everything is very different.
Dave Stelfox is a journalist and photographer based in London. His work has appeared in The Guardian, The Independent and The Daily Telegraph.