Mar 1, 2010
“I imagine that not since the Crimean War have surgeons seen and amputated so many limbs… perhaps the Civil War in the United States,” declared anesthesiologist Deanne Marchbein of the Medecin Sans Frontieres organization, after witnessing the vast number of Haitian amputees in make-shift tents. On January 12th, 2010, Haiti was crippled in the figurative and literal sense of the word. In addition to the estimated 200,000 lives lost1, there are as many as 200,000 Haitians with lost limbs2. Reports from doctors on the scene estimated jarring rates of hospital patients needing one or more amputations (up to 1,000 per day) during the days following the earthquake. Although medical supplies are finally reaching Haiti now, the growing amputee population faces significant challenges that must be addressed to prevent them from tomorrow becoming additional casualties of the killer quake.
Sadly, the 7.0 magnitude earthquake ravaged what little infrastructure that existed prior to January 12th,2010 in Port Au Prince, Haiti. As a result, prosthetics shops and rehabilitation resource centers like Healing Hands for Haiti (http://www.healinghandsforhaiti.org/) and Walking Free have had to regroup and start over. They are now mobilizing new staff to bring in larger networks of doctors to train locals on physical therapy, fitting and rehabilitation. Although state-of-the-art prosthetics donations are invaluable in addressing the needs of Haitian amputees in the short term, the technical maintenance, physical therapy and exorbitant costs (typically exceeding thousands of dollars) associated with advanced prosthetics are unsustainable in the long term. To put it into perspective, the average income of a Haitian household is approximately $US400 per year (ref. 3), and Haiti’s annual health care expenditures are approximately $US80 per capita4. Consequently, the need for low-cost prosthetics that are capable of resisting wear and tear is at the heart of the crisis facing Haitian amputees today. St. Petersburg Times staff writer John Barry recently argued that the true challenge to adoption of new prosthetics in daunting environments could be in the lack of technical support or ruggedness. The Jaipur Foot (http://www.jaipurfoot.org/) is a particularly good example of low-tech trumping high-tech in developing countries. The ‘Jaipur Foot’ could be worn without a shoe, and could be used for squatting or for activities in rugged terrain. Nearly 500,000 amputees in India have been fitted with the Jaipur Foot since the organization was founded in 1975.
At MIT, some of the most creative and impactful strategies for overcoming global challenges involve simple innovations. In particular, MIT’s D-Lab (http://d-lab.mit.edu) is a unique academic program that supports an elite unit of techies to develop appropriate simple innovations within the framework of international development. D-Lab’s overarching mission is to create viable solutions that MIT students then field-test in developing countries. Amy Smith, Senior Lecturer in the Department of Mechanical Engineering and founder of D-Lab, has co-directed several projects conceived and implemented by D-Lab students, including ceramic water filters, portable solar cookers and pedal-powered washing machines for use in countries like Ghana and Tibet. D-Lab also has a Developing World Prosthetics (DWP) track that is well-suited to providing development support and innovations to help Haitian amputees. Ken Endo, a computer science graduate student in Professor Hugh Herr’s Biomechatronics Laboratory, is the instructor for DWP. Endo and Jose Gomez-Marquez, D-Lab Health instructor and Technology Review’s Humanitarian of the Year in 2009, are now developing prosthetics and vacuum casting techniques (for limb socket prosthetics) with common materials that could dramatically reduce the cost of prosthetics. The Lego-Leg (a prosthesis assembled with sheets of carbon fiber and aluminum) and the Exo-Knee (a prosthesis with a locking knee joint) are two recent examples of projects tackled by students in DWP, evolving into projects that get implemented in the field. Endo has also hosted guest speakers who are developing similar prosthetic innovations like the Plastic Sodabottle Prosthesis, which was invented by D-Lab collaborator, Dr. Yeonchi Wu of Northwestern University. The Sodabottle Prosthesis can be built in less than a day with just a few materials: a used two-liter bottle of soda, a heat gun, and a plastic mold of a residual limb. Endo and Gomez-Marquez estimate that D-Lab prosthetics solutions could cost less than $US30, while standard prosthetics can cost as much as $US10,000. Because the D-Lab approach to prosthetics innovations requires significantly less capital and could be prepared by local craftsmen using available materials, prosthetics manufacturing in Haiti is feasible, and is crucial given that most prosthetic devices require constant tuning and maintenance.
The novel prosthetics solutions currently being developed by Endo, Gomez-Marquez and MIT’s D-Lab students hold great promise for Haitian amputees. These simple innovations will not only ease the suffering of a rapidly growing disabled population, but more importantly, could provide a path towards sustainable prosthetics development in Haiti for many years to come. The drive towards self-empowerment of local populations and creation of a sustainable supply of prosthetics has important consequences that transcend the impact that expensive prosthetics donations can have. “Give a man an artificial leg, he can walk for as long as it fits or lasts. Teach a man to make artificial limbs and he will have a livelihood helping his countrymen for the rest of his days.”5
- Library of Congress, Federal Research Division. Country Profile, 2006.