Prosthetics in the Developing World

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VANCOUVER, Washington — Limb amputation and the subsequent use of prosthetics are necessary for many around the world. According to the Journal of Orthopedic Surgery and Research (JOSR), amputation is one of the oldest surgical procedures, dating back more than 2,500 years. The reasons for amputation have changed over time. In the United States, those suffering from vascular disease most commonly require amputation. However, in the developing world, land mine injuries, factory accidents and other health risks claim the limbs and livelihood of survivors.

The circumstances that make amputations necessary for patients vary from country to country, even in the developing world. JOSR reported on amputees in Tanzania, stating that injuries from traffic accidents and complications from diabetic foot ulcers were the main causes for amputation.

While amputees in the developed world are usually older than 60 years, JOSR found that amputees in Tanzania are significantly younger and suffer from a variety of issues. Additionally, patients in developing countries often seek medical attention when it is too late to salvage the limb and amputation is the only option. This is in large part due to the lack of public health education, which could have prevented a large number of the amputations in the study.

According to a 2006 report published by O&P, the rate of amputations in constantly increasing in developing countries. Land mine detonations cause up to 85 percent of amputations in war-torn countries and poor sanitation contributes to amputations caused by gangrene, diabetes and other infections.

With the number of amputations on the rise, a sufficient supply of prosthetic limbs and qualified personnel is necessary. An amputee requires not only a replacement limb, but also many replacements over the course of his or her lifetime. Children who lose limbs require dozens of limbs to match their growth. Additionally, damage and repairs account for the production and use of even more prosthetic limbs.

However, the production of limbs cannot match the existing need in the developing world. There is currently a deficit of 40,000 professionals. Training of these professionals is time consuming and costly, which has led many to reconsider how prosthetics are built and distributed.

Materials used to build prosthetics are most often exported from the developed world. This presents a series of problems for amputees in developing countries. While these parts may be completely functional in a city environment, many amputees live in rural areas. The components of Western prosthetics cannot stand up against the amount of wear and tear endured in rural environments. This results in the use of even more limbs, which adds up.

According to O&P, a prosthetic made in a developing country can cost up to $1,875, over six times the average income of a family living in a rural setting. Necessary replacement limbs would amount to thousands of dollars of debt.

Researchers have begun testing cheap, durable prosthetics specifically marketed to endure the challenges of rural environments. Starting in 2007, the LIMBS knee has been distributed to children in Kenya’s CURE International Children’s Hospital. The knee, tested against an expensive commercial knee, was able to perform 80-90 percent as well. For the cost of $15-$20, researchers and knee-recipients were pleased.

The knee is also easy to produce. Local technicians are trained to build the prosthetics, which provides locals with work and keeps the cost low. Similar initiatives for different limbs are being tested in India as well.

Bridget Tobin

Sources: OANDP, JOSR, Engineering for Change
Photo: Abilitypo

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