Therdchai Jivacate

Modern orthopedic science, combined with space-age technology, has transformed the field of prosthetics. But in much of Asia-and even more so in provincial areas such as northern Thailand-modern prosthetic limbs are well beyond the reach of ordinary people who need them. They are too expensive. They are too time-consuming to acquire and maintain. Or they are poorly designed for life in the hills and on the farm. This is why poor people who lose legs from accidents or land mines or diabetes (or from snake bites, for that matter) often resort to makeshift alternatives. They fashion substitute limbs from bamboo shafts and spare bicycle parts and from wood and leather and plastic pipes, or they walk on homemade crutches. Observing this some forty years ago, THERDCHAI JIVACATE JIVACATE, a young orthopedist practicing in Chiang Mai, decided he could help them. 

Therdchai, a graduate of Chulalongkorn Hospital Medical School who also studied rehabilitation medicine at Northwestern University, began to experiment with cheap and sturdy alternatives to the prosthetic limbs available at his hospital, all of them made from costly imported materials. An early breakthrough involved recycling plastic yogurt bottles to fabricate artificial legs. Using his own money and time taken from his private practice, Therdchai tinkered constantly to simplify the fabrication process and to adapt his devices to local circumstances, creating a “farmer’s foot” for working in wet, slippery fields, and another foot for wearing flip-flops. To poor patients, he provided these devices free. 

In time, Thailand’s late Princess Mother Sri Nagarindra came to know of THERDCHAI’s generous project. In 1992, she lent her patronage to create the Prostheses Foundation in Chiang Mai under his direction. With support from the royal family, private donors, and the Thai national lottery fund, THERDCHAI was able to expand his work. 

Amputees from Thailand’s remote borderlands were among the least likely to have access to proper prosthetic limbs. To change this, THERDCHAI initiated field clinics in which teams of doctors, technicians, staff members, and volunteers bring prosthetic workshops directly to the people. Once on the site, he and his team assess the awaiting amputees; make casts of their stumps; mold plastic limbs for each one and then test them for proper alignment, comfort, and “gait.” On the sixth day, a custom-made limb is presented to each amputee-anywhere from 150 to 300 persons. To date, Therdchai has organized one hundred of these mobile workshops, including several in neighboring Malaysia, Laos, and Myanmar. 

In certain high-need areas bordering Myanmar, Laos, and Cambodia, Therdchai also set up permanent satellite workshops capable of making artificial limbs on the spot. The foundation equips these workshops and also trains the technicians, who are often amputees themselves. In ancillary activities, the foundation has organized artificial-leg workshops in Aceh, Indonesia, and trained prosthesis technicians from several neighboring countries. Meanwhile, THERDCHAI himself established Thailand’s first and only school of occupational therapy at Chiang Mai University. 

Through it all, THERDCHAI has remained an inventor, assiduously refining his designs and fabrication techniques in cooperation with engineers at the King Mongkut Institute of Technology and other collaborators. His devices cost about 60-80 percent less than the imported alternatives and are durable. Through the Prostheses Foundation, more than fifteen thousand people have received them free of charge. 

Although officially retired, THERDCHAI at sixty-eight shows few signs of slowing down. He knows that well-made prosthetic limbs not only restore amputees to productive lives; they also restore their self esteem. His work brings great satisfaction. “Seeing my patients’ smiles . . . when they are able to walk on both legs,” he says, “I just feel happy.” 

In electing THERDCHAI JIVACATE to receive the 2008 Ramon Magsaysay Award for Public Service, the board of trustees recognizes his dedicated efforts in Thailand to provide inexpensive, practical, and comfortable artificial limbs to even the poorest amputees.

The Honorable Chief Justice, Chairman and Trustees of the Ramon Magsaysay Award Foundation, Distinguished guests, Fellow Awardees and dear friends. 

First of all, I would like to thank the Foundation for selecting me for such an honourable award. I have often heard about this famous award and its distinguished awardees, ever since I was young. 

I could hardly believe my ears when I was informed by Magsaysay Foundation President, Ms. Carn Abella, that I had been selected to receive one of this year’s awards. At that auspicious time, I was busy fitting an artificial leg for a baby elephant in Lampang province. It was truly great and pleasurable news for me. 

As an orthopedic surgeon for over the past forty years, I needed to cut off the legs of many patients. But when I was a young orthopedic surgeon, it was very difficult for the amputees to obtain artificial legs in Thailand, because access to the technology of making and fitting artificial legs was confined only to Bangkok. In addition, they were very expensive. Amputees had to use bamboo or wood or whatever materials they could find to make into artificial legs. This inspired me to further my studies in prosthetics and orthotics during my residency training in the United States. 

Because prostheses and orthoses, in those days, were only made from imported parts, they were very expensive and could not be made for the poor. I began trying every means to make the parts of an artificial leg from local materials. This reduced the cost of an artificial leg by half and more amputees could receive an artificial leg. 

In 1992 my colleague Mr. Boonyu and I were able to make artificial legs from used, hence wasted, yogurt bottles which made the cost of the materials for a leg ten times cheaper than those made from imported parts in a government hospital. When this became known to His Majesty the King’s Mother, she established the Prostheses Foundation to support me in making artificial legs for poor and underprivileged amputees, to be distributed free of charge. 

Because underprivileged amputees almost always live in remote areas, we set up a mobile unit which could travel to reach them. From 1992 up to the present, I have led 101 mobile unit trips to the rural and remote areas, and about 21,710 artificial legs have been provided to 15,981 amputees. 

I owe a great deal to His Majesty the King’s Mother and to her daughter, Her Royal Highness Princess Galayani Watana, who gave me a chance to do the work as Secretary General of the Prostheses Foundation. 

Once again I would like to thank the Ramon Magsaysay Award Foundation for this prestigious recognition of our work. This Award will certainly give me greater moral support to continue my work for the sake of the amputees, not only those in Thailand, but in the region. I also wish to take this opportunity to thank all my colleagues and my family who have enabled me to continue to fulfill my mission. 

Korb kun krub.