September Issue 2009
One Small Step
In January, Qasim was admitted to the National Medical Centre, at Kala Pul, for a bypass. Unfortunately, after removing a vein from his right leg to replace a clogged vessel in his heart, he lost his leg altogether due to a surgical slipup. “They fixed my heart,” says Qasim, “but I paid the price with my leg.” The Artificial Limb Centre (ALC) helped recover what he lost. “The bypass operation cost me four lakh rupees. But I haven’t paid a single penny for my artificial leg,” he added.
Mr Iqbal found his way to the ALC after he heard of it from a shopkeeper who runs a store across the road from the centre. He had lost his left leg in a road accident while trying to catch a bus. “I could not believe, at first, that they provided free treatment,” he says, “but I thought it was worth looking into. I had enquired about artificial limbs earlier and it was costing me Rs 20,000 — Rs 10,000 in advance and then Rs 10,000 on receipt. Once I arrived, I realised it really was true. They took the measurements in the morning when I came in and by evening I had the prosthetic leg. My life changed within a day.”
Mr Iqbal now works at the ALC workshop. He says, “I had not been working for the past 16 years (since I lost my leg) but now, 17 years later, I have a job. I am capable of working and earning a living.”
The Artificial Limb Centre, located in Gulistan-e-Johar, is basic. Devoid of the state-of-the-art dÃ©cor and polished marble floors found in even small clinics nowadays, the ALC building is smaller than you’d imagine. It literally comprises four rooms in a row, in the centre of a clean, airy and spacious veranda. Though unassuming in appearance, this set-up offers life-changing treatment to lower-limb amputees and those disabled by post-polio deformity.
It is headed by Dr Feroz Ismail, president of the Healthcare and Social Welfare Association (HASWA), who has been running the ALC for the past six years.
The ALC is a wholly charity-run, non-profit organisation, with the purpose of providing prostheses and callipers for free. Dr Ismail, along with a group of Pakistani-Americans who ran an NGO in Houston, had been involved in providing treatment to children with post-burn deformities. A team from Houston, including a plastic surgeon, came to Karachi about six or seven years back for research. While they were here, they initiated a programme to send children with post-burn deformities to the US for treatment. HASWA would arrange for the visas and passports of the children and send them off from this end, and in the US, the American team members received the children and kept them in their own homes for the duration of their medical treatment. This programme continues to date.
But then came the case of a small girl who had lost her leg in an accident. Dr Ismail says when he went around trying to identify a place that makes artificial limbs and he could not — as those who were making limbs were asking for too much, or were not competent enough to make it — the Americans, who were visiting Pakistan suggested taking the little girl to the US with them. So he sent her to the US where she got an artificial leg and returned home. But during that period people started telling him that they should have their own set-up for prostheses, so he asked the Americans to help him.
Both the Civil Hospital and Jinnah Hospital in Karachi have a prosthetics department but the cost of acquiring an artificial limb from there is not affordable for most. It can cost anywhere between Rs 50,000 to two lakh rupees. Also, Dr Ismail found the staff to be largely untrained in the art of making limbs; they were competent enough to manage the simple, straight-forward procedures, but where the case got even slightly complicated, the patient would suffer much at the hands of the unskilled staff. Locally, aside from the Pakistan Institute of Prosthetic and Orthotic Science, Peshawar, and now Dow Medical College, there is a stark absence of departments in medical schools that offer degrees in prosthetics and orthotics (the science that deals with the use of specialised mechanical devices to support or supplement weakened or abnormal joints or limbs).
The journey of bringing this facility to those in need in Karachi began in Jaipur. In their quest to overcome more hurdles in relieving the needy of their health and welfare impediments, the NGO workers from the US suggested that Dr Ismail go to Jaipur, India, the home of Bhagwan Mahaveer Viklang Sahayata Samiti (BMVSS), the biggest centre for artificial limbs in the world. Set up in 1975 by D.R. Mehta, the BMVSS treat the needy free of charge and have developed their own system of making limbs. Recognised by Stanford and Cambridge, and by Time magazine for one of the inventions of the century, the BMVSS uses the Jaipur foot technology in its 22 branches worldwide. Upon request, four of their workers came to Karachi for the purpose of training, bringing all their machinery in a container. The leader of the delegation was Areeza Khan, a prosthetist and orthotist. Their only condition was that upon the transfer of technology, the treatment must continue to be free in Pakistan as well.
Click on any image to begin the slideshow
The ALC uses the Jaipur foot, which has been produced in India for the last 35 years. It is imported in all sizes, for children, men and women, in as broad a range to cater to many common feet shapes. Made from rudimentary substances, rubber and wood, the remarkable fact about the Jaipur foot is that it gives flexibility to each toe as each toe is individually threaded. Similarly, it gives flexibility to the ankles as well because of the pliable materials used. Dr Ismail explains how this cheap but ingenious technology greatly benefits the patients: “It’s much superior because it suits our terrain. Our people coming from the interior, for example, walk on rough surfaces. In fact, most of the guys come barefoot.” The Eva sheets, used for the inner lining, are also imported because the locally produced ones are more expensive. The ALC acquires the raw materials on subsidised rates from India. What is available from China or produced locally is much less feasible and of poorer quality.
A great advantage that the Jaipur foot has over other prostheses is that it is custom-made for each patient, and once it is fitted, it is hard to tell the natural leg from the artificial on a patient. The technology ensures that you can not only walk but also run, jump, squat and sit cross-legged, and it will not break. A below-the-knee prosthesis can be made in three hours and an above-the-knee prosthesis can be made in one or two days. Usually, after a surgery, you can fit a limb in four months’ time, after the tissues have hardened and the flabbiness is lost.
Each limb is custom-made according to the stump, height and the cut. An important factor in ensuring that the prosthetic leg suits the patient is to make a cast of the stump with the stump’s particular features so that the skin is not scraped or the limb is not too tight for the stump, which may result in discomfort or pain. A stump sock is worn so that the skin is protected from scraping and remains clean. Usually the negative cast or mould of the prosthesis is made with plastic, which is a difficult and costly process because the plastic has to be melted and remoulded, put in special machines — which are expensive — and then a number of plastic sheets are produced to go round the cast to make it thick. But the Jaipur technology uses High-Density Polyethylene (HDP) sheets which are found in abundance for industrial use. HDP sheets are unbreakable, even under water pressure from a 300-foot tubewell.
The ALC has produced 1,600 limbs and callipers since its official opening last July. It has given hope and, indeed, a new life to those who shuffle in with crutches or on wheelchairs or in the arms of their caretakers. “Within a day, they are able to walk straight and unaided, with their lost dignity returned,” says Dr Ismail. Many disabled persons have learned of the Jaipur foot by word of mouth, and arrived at the ALC from all over the country.
Dr Ismail feels that Pakistan does not need to stay behind the more advanced world as the technology is out there and can be acquired easily through video conferences and the internet etc. “We don’t need to reinvent the wheel,” he says, “all we need is dedication.”