Repair in Reach—Makeshift
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Clinicians repair damaged bodies with whatever materials are available—and a healthy dose of creativity

— Repair in Reach

02. Mobility Dispatches
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The sounds of grinders and drills echo off the walls in the Hospital Central de Maputo, the largest hospital in Mozambique, where thirteen men and women cut and melt industrial plastic PVC pipes into braces and artificial limbs.

When the country’s 16-year civil war ended in 1992, as many as five million land mines were left in the ground. Today, roughly half of the 2,000 patients this hospital houses have been injured by landmines. Others who come here for help suffer from disease or accidents on bad roads.

“We cut the tube in half, then put it in the oven to melt. Then we take it out and bend it open,” explains technician Paulo Rafael. He opens a hinged-door furnace, which lets off a waxy heat. Inside, a metal rod stuck through a 20-inch length of PVC pipe rests on supports on either side of the oven, suspending the plastic in the air.

Donated to the hospital by the Indian government in 2010, the plastic was designated for prostheses. But plastic alone is too weak to do the job of an arm and a leg. The workshop used to make prostheses by reinforcing the PVC tubes with metal pipes, but metal stockpiles ran out in August.

“A lot of prostheses came back because they didn’t work,” says Rafael. “We can only use the plastic for small things. For bigger things it just doesn’t work,” explains Rafael.
Instead they use the 0.8-inch diameter pipes to produce braces to support a patient’s own arm or leg weakened by accident or disease. The process is a creative improvisation, hatched in the face of scarcity. “As we have nothing, we’re using the material from India so people don’t leave empty-handed,” says technician Paulo Rafael.

Prosthetists at the Hospital Central de Maputo constantly refine the design of their prosthetics, using plaster molds and whatever materials are available get their patients moving again.

Prosthetists at the Hospital Central de Maputo constantly refine the design of their prosthetics, using plaster molds and whatever materials are available get their patients moving again.

The technicians shape the molten plastic around models of arms or legs made of plaster of Paris and then bake them again. Once cooled and hardened, the plastic is cut loose with a grinder, trimmed, and fitted with leather straps. The new brace fits like a glove on the patient’s limb.

17-year-old patient Ana Cossa’s right arm and leg have been disfigured by muscle weakness. She is here to try on her first brace, which should help her arm grow straight again. When it’s fixed on, she smiles. “It’s comfortable,” she says, impressed with her new gadget.

The workshop was set up in the early 1990s by the Red Cross after the civil war but was handed over to Mozambique’s health ministry later.

“Then we started using our own methodology,” says Sergio Nhamtumbo, Head of Orthopedics. The unit incorporated plaster of Paris and leather in its designs, changing from more conventional steel and plastics.Farmer Fernando Wamba, whose right leg was blown off below the knee by a landmine in 1989, waits patiently while the technicians mend his third prosthesis since the accident. He comes in from the countryside twice a year to have his artificial leg repaired.

“I can walk and do everything I need to do,” he explains, happy that a few bits of plastic and metal have enabled him to earn his living with dignity.

 

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More Takes on Limbs

From Stanford to Jaipur

A team from Stanford University is trying to revolutionize prostheses by making highend artificial limbs available at low cost. Cheaper prosthetics usually hinge like a door, making the joints uncomfortable and unstable under pressure. The students researched both the inputs used in cheap prosthetics in developing countries and the function of expensive titanium knee joints, with price tags up to USD 100,000. Their final product, with a more flexible joint, sells for just USD 20. The team piloted nearly 50 new limbs in Jaipur, India in 2009 and plans to mass produce 100,000 even more affordably within the next three years.

Artificial limbs for animals

The Thailand-Myanmar border is littered with land mines that pose a risk to people and wildlife alike. Injured elephants have long been patients at the local Friends of the Asian Elephant hospital. With help from the Prostheses Foundation, founded by the Thai royal family, the hospital outfitted its first grown elephant with a prosthetic limb last fall. Even with the cost of the state-of-the-art device covered, outfitting the three-ton mammal was no small matter. The hospital gave the elephant several pre-prostheses to help her adjust to the feeling and balance of a returned fourth limb and minimize the chance of rejection. Reportedly, she’s taken to it.

Global problem, local innovation

Outfitting those in need with prosthetics means contending with a basic resource problem: how to keep raw materials flowing, especially if donor interest wanes. In its work in Angola, Handicap International experimented with making limbs out of locally available materials. It teamed up with local prosthetics makers, many of whom it had trained, to innovate with what’s around. They have devised artificial feet out of vulcanized rubber—a mixture of rubber from worn tires and sulfur that becomes both flexible and durable under heat—and used woven cushions to protect amputees’ own limbs from the sharp angles of new prosthetics.

 

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Designing appropriate vehicles for new frontiers

— Off the Beaten Path