Abstract
The major objective of prosthetics is to restore the functional capacity formerly held by a limb deficient person as closely as possible, while attaining the best cosmetic result afforded to, and deemed necessary by the patient.
On the surface, there appears to be little difference in the design and manufacturing of prosthetic solutions between the approaches of "Western" and "third world" countries. However, considering the availability of materials, economical resources, skilled personnel, cultural, social and geographical differences, it seems that "third world" prosthetics might need a different approach. Direct translation of Western prosthetics technology into developing countrys has, so far, proven insufficient due to many reasons.
This document describes a study into the development of cheap, high quality prosthetics, tools and techniques for production in Fab Labs for developing countrys. The research involves the study of given innovations of prosthetics from developing countrys, the engineering of lowest cost production of high quality molding and casting methods, alignment parts and tooling, and material research for culture-specific designs of prosthetics.
A prosthetic limb consists of three basic components: the socket, which is the interface between the limb and the mechanical support system, the extension (or pylon) which replaces the length of the lost limb and may also incorporate a knee/elbow joint if the amputation is above the knee/elbow, and lastly, an artificial foot/hand.
Introduction:
The most common cause of amputation in the western world is vascular disease (footnote, source). In developing countrys like Indonesia and India , the lack of basic public health often leads to diabetes, gangrene, and infection, and because of poverty, there is a lack of nutrition for babies. In war-torn countries such as Cambodia, Iran, and Afghanistan, 80 to 85 percent of amputees are land mine survivors. Other causes of amputation in developing countries include industrial or environmental accidents and terrorist attacks. All of these causes are adding to the number of amputations at an alarming rate (Berry, 2001).
Demand
Due to the increasing rate of amputations, there is an ever-growing demand for prosthetic limbs. Not only is there an immediate need for a person’s initial prosthetic limb, but also multiple replacement limbs and repairs are necessary over a lifetime. Children between the ages of four and sixteen grow at an average rate of 0.75” annually. A prosthetic replacement is needed typically every 6-12 months for children, and every 3-5 years for adults. For example, if a child becomes limb deficient at the age of 10, he will need approximately 25 limbs throughout the course of his or her lifetime. However, if a person becomes limb deficient while they are adults, they typically will go through about 15-20 limbs during their lifetime (Prosthetics Outreach Foundation, 2005).
Problems:
- personnel
One of the main problems in providing prosthetic limbs to developing countries is the lack of trained personnel. The proper constructing, fitting, aligning, and adjusting a prosthetic limb requires a high level of skill and despite the high demand for this expertise, there are very few training programs in low-income countries. Studies by the World Health Organization (WHO) indicate that while the current supply of technicians falls short by approximately 40,000, it will take about 50 years to train just 18,000 more skilled professionals (Walsh 2003).
- costs
Another problem is that importing components from industrialized countries is not only expensive, but these parts are as well designed for different lifestyles and usually do not meet the challenges of rural environments. Most countries have a farm-based economy and a tropical climate. In these harsh environments, conventional limbs made of wood and resin only have a lifespan of about 18 months. The costs of prosthetic limbs vary substantially by country, but a typical prosthetic limb made in a developing country costs approximately $125 to $1,875 USD, depending upon the region in which they are made. When the costs to make a limb in a developing country can be cut to as little as $41 USD (well below the $5,000-$15,000 USD average cost for a prosthesis in the western world), the costs over a lifetime of replacements and maintenance can still amount to thousands of dollars.
This presents a major problem since the average family income in rural areas is typically around $300 USD annually. Bartering for goods is a natural aspect of their lives, but getting a prosthetic limb requires cash. It can take victims a decade or more to earn the money for an initial prosthesis (Walsh, 2003).
Having affordable and readily available prosthetic limbs is vital for everyone that needs them. In developing countries, many limb deficient people are farmers, herdsman, nomads or refugees and rely on physical labor for survival.
How well limbs perform and how cosmetically appealing they are depend on many variables including cost, the skills that technicians have to make the limbs, and the materials that are available to fabricate the limb. A properly fit limb is the result of a close working relationship between the prosthetist and the patient. Ultimately, the design and fit of the socket is what determines the patient’s acceptance, comfort, suspension, and energy expenditure.
Prosthetics are expensive, custom made, complex high tech devices. Leg prosthetics need to be exchanged every 3. year. The costs of a state of the art upper leg prosthetic in the western world starts at 13'000 $.
Update Indonesia 29 december 2009:
Pusat Rehabilitasi Yakkum Yogakarta
Yakkum Rehabilitation Centre Yogyakarta
The Identification of problems and needs
Unit: Pelayanan Prosthetik & Orthotik
Division : Prosthetics and Orthotic
Kondisi Saat ini | Condition at this moment:
1. Masalah inovasi dan kreasi Pengembangan Alatbantu | lack innovation and development of prosthetics and orthotic
2. Ruang sempit | Narrow workshop space
Banyak Komplain / Keluhan dari Pasien Kita yang datang kebanyakan dari masarakat Ekonomi Lemah / Miskin | Most complaints from the client which from poor families are:
1. Waktu Produksi Lama | duration of production is too long
2. Harga Mahal | cost of production still high/expensive
3. Berat | Heavy
Kendala | constrains:
a. Financial lembaga sangat terbatas masih begantung pada donatur | Yakkum institution budget is very limit and still depends on donator/donations
b. Kecacatan sangat berkaitan dengan kemiskinan | disability is very related to poverty
Kebutuhan | needs:
a. Pengembangan kemampuan dan kapasitas | ability and capability improvements (persons/staff)
b. Riset / Pengembangan Material baru | Research and new material developments
c. Penambahan Peralatan Workshop | additional workshop’s equipments needed
d. Tempat | new place
Keinginan Mimpi | Dreams:
a. Pemerataan Kapasitas Kemampuan SDM | Distribution of human resource capacity
b. Waktu Produksi Cepat | faster production
c. Harga Terjangkau masyarakat Miskin | affordable price for poor people
d. Tempat yang Nyaman | convenience place
e. Bahan Material Mudah di dapat Lokal Material | accessible to material, specially local material
f. Punya Partner bisnes berbasis Sosial | To have social base business partners
g. Produk yang di Hasilkan Punya daya saing di Pasar Lokal | Products able to compete in the market (prosthetics or orthotics)
h. Punya Perpustakaan yang lengkap Orthotik,Prosthestik | To have a complete library of prosthetics and orthotics
i. Punya consultan Tehnik Prothestik,Orthotik | to have prosthetics and orthotics technical consultants
j. Dikenal masyarakat Luas | well known to society
k. Makmur Sejahtera | prosperous
