Sethi, Pramod Karan

The lot of amputees and paralytics from polio and leprosy is especially cruel among the rural poor in the developing world where rehabilitative appliances for missing or withered limbs and alternative means of livelihood, are few. Witness to this condition in India is the prevalence of crippled beggars, old and young. Amputation of a foot or leg frequently follows accidents with cars, trains and in factories. Also common are amputations to halt gangrene resulting from poisonous snakebites—a major hazard to farmers who traditionally go barefooted. 

The elaborate artificial lower limbs developed in industrialized countries do not meet the needs of rural Indian amputees. The prostheses are too expensive, they are difficult to get and require the wearing of shoes. If obtained they are frequently discarded because users cannot sit cross-legged, squat or walk on uneven ground. 

PRAMOD KARAN SETHI, born in 1927 in Benares, now Varanasi, India, studied medicine in India and Scotland. Upon returning to his homeland he joined the Sawai Man Singh College and Hospital in Jaipur as Lecturer in Surgery. In 1958, when the hospital asked him to organize and head an orthopedic department required by the National Medical Council, rehabilitation problems of amputees and polio victims became his immediate concern. 

As Dr. SETHI and his colleagues investigated foreign designs of artificial feet and legs, they began to improvise an artificial foot that would respond more like a real one. A breakthrough came when master craftsman Ram Chandra, using an age-old sand casting method, produced a die for a natural-appearing foot which could readily be cast in any size. When large manufacturers refused to cooperate, the local owner of a small tire retreading shop vulcanized a rubber foot in the die. After many trials SETHI used a shell of this foot to encase a totally new design of components which allows flexibility. Eventually the firm-gripping, adaptable “Jaipur Foot” was made in three colors—light, medium and dark brown—and a separation could be made beside the big toe to allow the wearing of sandals. Life-like aluminum legs were also made by villager craftsmen while amputees watched. For polio patients inexpensive, light calipers (braces) were fabricated quickly by skilled but unlettered artisans who were proud to be socially useful. 

Although relatively cheap, the new devices were still beyond the means of the penniless cripples who began desperately making their way to Jaipur as word of the new prostheses spread. In 1975 the Mahavir Society for the Physically Handicapped offered Dr. SETHI monies raised during a large Jain religious festival. Endowment funds were established so that each gift of 2,500 rupees (US$312) earns annually enough interest to buy an artificial limb and to help pay for a railway ticket for those with a long journey home. The number thus assisted each year has grown from 59 in 1975 to 2,035 in 1980. 

While demystifying the medical profession by including artisans and patients in the rehabilitative process, SETHI and his associates continue to devise better artificial lower limbs; patients can again farm and climb trees. In the Rehabilitation Reseach Center amputees may join in literacy classes and receive occupational counseling while finding new comradeship as they learn together to walk with fitted limbs. When a formerly legless man bicycles off to his village wearing his new limb and Jaipur Foot he is a renewed man with an opportunity to become a productive participant in his community. 

In electing PRAMOD KARAN SETHI to receive the 1981 Ramon Magsaysay Award for Community Leadership, the Board of Trustees recognizes his application of his surgical genius and his joining of doctors, craftsmen and community in a popular program enabling the crippled and limbless to resume near normal lives.

I am deeply indebted to the Trustees of the Ramon Magsaysay Award Foundation for the honor they have done me. In effect they have honored our small team of doctors and artisans and the community of my town of Jaipur without whose contributions it would have been impossible for me to do the kind of work we are doing. 

For years our work went almost unnoticed because there was nothing exotic or glamorous about the simple, almost austere technology which was associated with it. It was the occasional pat on our back by some of our distinguished visitors and the unconcealed joy exhibited by the large number of our poor, rural patients which sustained our faith and enthusiasm. This prestigious award, however, has suddenly lent credibility and legitimacy to our efforts and hopefully, our research institutions and planning bodies will now be compelled to carry out some hard reappraisal of their priorities. 

For too long we, in the developing countries, have looked towards the advanced nations for selecting areas of research. There is a deepseated desire on the part of our research workers to win applause in an international gathering of experts. The needs of the poor, the downtrodden and the underprivileged are constantly being overlooked. This has distorted our priorities which are leading, if anything, to a heightening of the contrast between the rich and the poor. I find the Magsaysay Award as a solitary shining example where importance is given to those efforts which work towards a more humane and just social order. 

One word about the “Jaipur Foot.” It is not the technical virtuosity of its design features which excites me. Better designs will soon overrun it. I value it because it represents the first major departure in our thought processes and our value system. Instead of looking to the West for our inspiration, it enabled us to look to our poor peasant for his approval. It taught us the way to tap creativity, innovation and participation from our humble and underrated craftsmen. We realized, as many others doubtless already have, that education should not be confused with institutional schooling, and that creativity is not a prerogative of the elite. The lack of financial resources is not always an obstacle to useful work, and the response of the community can be startling once the members realize that your work is meaningful and relevant to them. The work on the “Jaipur Foot” has given us the courage to be self-reliant and to question orthodox dogma. It has taught us that the demystification of professional knowledge is a powerful tool to allow us to draw on a very large reservoir of talents which otherwise continue to lie dormant. 

The Jaipur Foot, thus, is not merely a technical innovation. It represents a departure in our development strategies. The results of this strategy are already apparent in many other innovations for the disabled. The realization that an identical approach can be utilized with great effect in the entire field of rehabilitation medicine is now becoming clear to us. Other individuals and groups can refine and develop these ideas and test them in different situations. They can have the assurance that they will be watched with interest by the Ramon Magsaysay Award Foundation.