THE $28 FOOT

By Tim McGirk

People who live inside the world's many war zones, from Afghanistan to Rwanda, may never have heard of New York or Paris, but they are likely to know of a town in northern India called Jaipur. Jaipur is famous in strife-torn areas as the birthplace of an extraordinary prosthesis, or artificial limb, known as the Jaipur foot, that has revolutionized life for millions of land-mine amputees.

The beauty of the Jaipur foot is its lightness and mobility--those who wear it can run, climb trees and pedal bicycles--and its low price. While a prosthesis for a similar level of amputation can cost several thousand dollars in the U.S., the Jaipur foot costs only $28 in India. Sublimely low-tech, it is made of rubber (mostly), wood and aluminum and can be assembled with local materials. In Afghanistan craftsmen hammer the foot together out of spent artillery shells. In Cambodia, where roughly 1 out of every 380 people is a war amputee, part of the foot's rubber components are scavenged from truck tires.

The inventors of the Jaipur foot seem a mismatched pair. Dr. Pramod Karan Sethi, 70, an orthopedic surgeon, is a fellow of Britain's Royal College of Surgeons, while his collaborator, an artisan named Ram Chandra, reached only the fourth grade in Jaipur. Their paths first crossed more than 30 years ago at the Sawai Man Singh Hospital in Jaipur. There, Sethi was helping his orthopedic patients wobble down the corridor on their crutches, and Chandra was teaching lepers to make handicrafts.

Chandra is a kind of Pygmalion: he can turn whatever piece of stone or gold he touches into a lifelike creation. Born into a family that had been master artisans for four generations, he quickly established himself as one of Jaipur's finest sculptors, and his talents were sought by temple priests and princes. "If all I saw was your nose, it would be enough for me to sculpt a likeness of your entire body," says Chandra, 75, whose folded hands are like a box of old wooden tools. "It's all to do with proportions. That is the way God has made men."

When the two met, the Sawai Man Singh Hospital was turning out only five or six artificial limbs a year, mostly for people injured in road and train accidents, and a few of the wealthier patients wore American-model limbs. Both were too expensive for the common man, and neither permitted very much mobility. Besides, as Sethi explains, the old artificial limb was a cultural misfit not just for Indians but for people in most developing countries. "We sit, eat, sleep and worship on the floor--all without shoes," he says. Also, the "shoe" attached to the old limb was made of heavy sponge, making it worthless for any farmer working in the rain or in irrigated paddies.

Watching Sethi's patients, Chandra became convinced that he could fashion a more lifelike--and useful--artificial limb. He took his proposals to Sethi, who explained to the barely literate craftsman about pressure points and the intricate movements of bones within the foot. For two years, the two men fashioned limbs out of willow, sponges and aluminum molds, but their experiments failed. Their choices proved to be either too fragile or too unwieldy. "We made all kinds of silly mistakes," says Sethi.

Then one day, while riding his bicycle to the hospital, Chandra ran over a nail, and his tire went flat. He wheeled his bicycle to a roadside stall, where the repairman was busy retreading a truck tire with vulcanized rubber. Once his bicycle was fixed, Chandra raced to the hospital and consulted with Sethi. Soon Chandra returned to the tire shop with an amputee patient and a foot cast. He asked the repairman if he could cast a rubber foot. "He agreed,'' Sethi says, "and refused to accept any money once he found out why we were doing it."

Rubber alone was not good enough; it shredded within a few days. It was only after Chandra and Sethi began to construct the rubber foot around a hinged wooden ankle--wrapping it in a lighter rubber (similar to a bicycle inner tube but flesh colored) and then vulcanizing this composite--that their invention succeeded. The resulting limb takes only 45 minutes to build and fit onto the patient and is sturdy enough to last for more than five years. Sethi says of his partner, "We had a lot of opposition from formally trained doctors. In a way, someone who's not so educated is much more free."

In 1971 Sethi felt confident enough about the invention to present it to British orthopedic surgeons at Oxford, who were impressed by the artificial limb's suppleness and durability. From 1968 to 1975 only 59 patients were outfitted with the Jaipur foot, but the use of the new limb spread outside India during the Afghan war, which began in the late 1970s. Russian land mines--some diabolically shaped like butterflies to attract curious children--caused thousands of injuries, and the International Committee of the Red Cross discovered that the Jaipur foot was the hardiest limb for the mountainous Afghan terrain.

Since then, countless land-mine victims in many countries have been fitted with the Jaipur foot. "Western aid agencies have helped millions of amputees, and they've found that they can't do it as cheaply as with the Jaipur foot," says Sethi. In India most of the 72,000 amputees wearing the prosthesis were migrant laborers injured while trying to hitch free rides by clinging to train roofs and windows. During their long journeys to the harvests, many of these workers slipped off the trains and were run over.

Much of the credit and many of the awards for the Jaipur foot have gone to Sethi; the two inventors have not seen each other since the surgeon retired from active medicine in 1981. Chandra works with a Jaipur-based charity, the Bhagwan Mahaveer Viklang Sahayata Samiti, which provides free artificial legs for the poor not only in India but in other countries too. He says he feels no bitterness over Sethi's greater fame. At his Delhi workshop, where he has been developing above-the-knee artificial limbs, Chandra points out a little girl whose leg was severed in a bus crash. "People said I would be a rich man if we had patented the Jaipur foot, but it's enough satisfaction for me to see the joy on that girl's face when she walks again." He adds, "I'm still learning from my patients. I haven't done anything yet."

He too is semi-retired. He dresses in a simple white dhoti and lives frugally. "I only need money for the barber and occasionally the tailor," he says, laughing. He rises at 4:30 a.m., milks his cow and prays until breakfast time. Only then does he resume his ongoing effort to improve the Jaipur foot and create new artificial limbs that will be as real and useful as humanly possible.