An Artificial Limb Can Bring Hope — But Who’s Going To Make It?July 28, 2015
Sultan Mahmud's pink shorts revealed his new prosthetic leg made of plastic and metal. The boyish 20-year-old gripped a railing and stepped forward with feet in blue sneakers. The sweltering spring afternoon marked the first time Mahmud walked without crutches since his motorbike accident in 2013. His crushed left leg was amputated above the knee, and he remained bedridden in a hospital most of last year.
How did he feel about his new leg? His answer was not so much about the limb but about the new hope it represented. Without hesitating, Masud said he would continue studying and finally take his high school exams. Then, emboldened, he tried walking across the room on his own but a physical therapist urged him back to the railing.
Each day 20 to 30 patients like Masud come to this clinic at the Center for the Rehabilitation of the Paralyzed (CRP) in Dhaka, the capital city of Bangladesh. But in this country of 160 million, there aren't enough specialists to treat the large number of patients. Only 25 clinicians in the country have international certification to make artificial limbs, braces and splints. For a country this size, 1,100 would be the target number of trained professionals.
Until recently, Bangladeshis had to go to schools in India or Vietnam to train. Now that's changing.
A new school is trying to fill the gap. Last year, the CRP started the country's first diploma course for clinicians. Ten students enrolled in the three-year program, which is supported by the International Committee of the Red Cross and international donors. Another ten have signed up for this year's class. All the students get full scholarships and are candidates for jobs at CRP after graduation.
Why is there such a need for artificial limbs and braces in Bangladesh? With chaotic traffic and poor safety standards, the country has 400,000 road accidents each year, according to the World Health Organization. In addition, many people in this poor country have deformities or musculoskeletal diseases, and they don't get sufficient care.
Last year nearly 820 patients were fitted with prosthetic and orthotic devices at CRP's two clinics in Dhaka and in the port city of Chittagong. Ninety percent of these patients receive free treatment, subsidized by CRP and Red Cross.
After chatting with Masud, I watched a young girl with cerebral palsy walk with leg braces for the first time. She was so excited she almost ran with her tiny metal walker screeching across the floor.
Nearby, a thin man with a hip-high prosthetic leg struggled to walk. He grimaced in pain with every laborious step. Beauty Khatun, a 32-year-old mother, lost her leg when the bus she was on collided with a truck. She extended her stump as a clinician wrapped it in plaster-coated bandages to make a mold for a new artificial limb.
Opening a school to train clinicians had been talked about for years in bureaucratic Bangladesh. But after the horrific collapse of the Rana Plaza garment factory in 2013, which killed 1,100 and injured 2,500, the government expedited clearances for the school and donors came on board. CRP is located just a few miles from Rana Plaza.
In the wake of the collapse, hundreds of injured were brought to CRP; even its dining hall was turned into a triage center. Two years later, CRP continues to treat Rana Plaza survivors, including amputees whose trapped limbs were cut off to free them from the wreckage.
Students at the school take classes on biology, physiology and other subjects, as well as practical training in a new workshop equipped with saws and drills to make limbs as well as ovens where the plastic is baked to hardness.
It's not easy to get special imported materials like plastic. Finding enough volunteer patients for the students to work with is a challenge too. But the students are learning quickly.
In a classroom, Kim Song Bo, a teacher from Cambodia, lectured in front of a slide projector, showing different kinds of sockets and artificial limbs. He noted which ones are not good for rice farmers — limbs that might get stuck in mud and come off.
During a break, the students examined the artificial legs on Bo's desk. When asked why she joined the school, 19-year-old Rani Shankar replied, "After Rana Plaza, many people became disabled, and they can't walk or work." Two days earlier, Shankar made her first socket — that's the connector between the residual limb and the prosthetic. The patient said the socket felt comfortable. "I felt very inspired. I have done something for this patient," beamed Shankar.
Abdullah Mamun, 21, said he didn't know anything about artificial limbs before enrolling in the program but now he is hooked. "When I see one person standing with my prosthesis, that will be the thing I can be most proud of," he said.
The students continued to chat and picked up plastic feet lying on their teacher's desk. And in the clinic just downstairs, 20-year-old Masud continued to practice walking with his new leg, moving each foot forward, step by step.