February 8, 2012

India group's prosthetic device a boon for thousands of amputeesMakers of India's Jaipur Foot rapidly craft low-cost customized prosthetic devices that have changed the lives of hundreds of thousands of impoverished amputees.

A craftsman in the western Indian city of Jaipur puts finishing touches on the Jaipur Foot. The artificial limb costs about $40 for materials, or $150 with labor and overhead, compared with thousands of dollars for similar prosthetic devices in the West. (Mark Magnier / Los Angeles Times)

By Mark Magnier, Los Angeles Times (Reporting from Jaipur, India)

Shopkeeper Mauji Lal was boarding a train four years ago when the crowd pushed him onto the tracks and he was run over. Doctors amputated his right leg and four toes on his left foot. Hobbling on a walker, he got back on a train last month for the 20-hour trip across India to this western city.

He was fitted with an artificial limb and got meals and rudimentary therapy, all free.

"The limb is good," the 72-year-old Lal said. "I feel some pain and it's still difficult to walk on it for more than an hour, but I'm getting used to it."

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Lal is one of hundreds of patients each week who arrive leaning on sticks, hobbling on crutches or carried by relatives, a near-biblical scene, at the gates of a white three-story building. For three decades, a civic group here has been changing lives with the "Jaipur Foot," a low-cost prosthetic device that can be attached to an artificial leg of any length, depending on where the amputation occurred.

Devendra Raj Mehta, a retired civil servant and the charity's founder, said he got the idea after his leg was broken in 43 places in 1969. His leg was saved, but during his five months recovering in a hospital, he was struck by how many impoverished Indian lives were destroyed by amputations.

Six years later, he started Bhagwan Mahavir Viklang Sahayata Samiti, better known as Jaipur Foot.

In the first seven years, the group produced fewer than 50 artificial limbs. But by the 1980s, it was gaining traction and now produces customized legs of wood, plastic, rubber and aluminum in rapid succession for about $40 in materials, or $150, including labor and overhead, compared with thousands of dollars in the United States.

Producing the flexible, waterproof prosthesis at such low cost has involved cutting some rather ingenious corners. The leg's exterior, for example, is made of beige plastic irrigation piping melted to fit. "See how strong it is?" Mehta said, banging a just-cooled limb against a table edge. "And with our design, people can kneel, squat, climb trees, which isn't possible with other designs."

The Jaipur Foot was invented in the 1960s by an orthopedic surgeon and a craftsman with a fourth-grade education who taught crafts to patients in a hospital. The two stopped speaking to each other before the doctor's recent death, Mehta said, in part over who deserved credit for the invention.

The foot is heavier than many Western prosthetics and has no attached shoe, allowing it to work better in mud, rice fields and on uneven ground. And its flexibility works with Asian squat toilets, sitting cross-legged or bowing in prayer.

To date, the group has handed out 1.2 million limbs.

The group, which also operates internationally, gets about a third of its funding from the Indian government — New Delhi supports projects abroad as part of "soft power" initiatives — and two-thirds from grants and donations.

Over the years, the group has set up camps or permanent clinics in Africa, Latin America, throughout India and across Asia, including Cambodia, Afghanistan and Pakistan. (The Jaipur Foot is not available in the U.S. because it lacks FDA approval.)

Energetic and committed, with a hint of the hauteur sometimes found in senior Indian bureaucrats, Mehta breezes through the clinic here as patients entreat him for train fare or the wheelchair cycles reserved for those who've lost both legs.

Patients sit on long rows of plastic chairs beneath posters of Hindu gods, Islam's holy site of Mecca and Jesus, underscoring the group's nondenominational approach. Once registered, amputees are measured and a custom-made cast is heated to 350 degrees and attached to one of several sizes of artificial feet. Voila.

John Craig, a Texas-based prosthetist who has visited Jaipur Foot camps in Honduras, Uganda, Tanzania and India to assess the system for USAID funding, praises the technology, the cost and the Jaipur center's counseling and holistic approach.

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But in some of the field camps he visited, he said, those making and fitting devices may be poorly trained. And often there was limited follow-up, he said, which led some patients to reject the limb when a small adjustment could have changed their lives.

"If you just fit the prosthesis and send them away without training the amputee or follow-up, you're doing these people a disservice," he said. "They'll stop using it because it's hurting."

Jaipur Foot staff members dismiss the criticism, saying they're constantly working on improvements. "People will find faults in everything," said workshop manager Om Prakash. "We produce the most legs in the world, and our competitors are jealous."

There's little doubt that the Jaipur Foot has changed many lives. One of the most prominent users is Sudha Chandran, a professional dancer in India, who got the prosthesis after a car accident when she was 17. Three years later, she was able to resume dancing with a specially modified version of the device, which she continues to use even though she could afford a more expensive model.

"The Jaipur Foot meets India's culture — the West is more of a chair culture — as we go barefoot in the temple a lot and it looks almost like a normal leg," she said. "I keep telling people, it's more than just individual rehabilitation. We have to rehabilitate society's views. That will take some time."

mark.magnier@latimes.com

Tanvi Sharma of The Times' New Delhi bureau contributed to this report.

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