“If you build it, they will come” is an adage that may have served Kevin Costner well in the movie, Field of Dreams, but one that a lot of technology startups and innovators, inevitably, fall into the trap of. We somehow, misguidedly, believe that if a product is designed well, everybody will want it, often failing to account for the user’s lifestyle, culture and environment. This gap is often even more pronounced when you begin designing products or solutions for people who are so far removed from your social/cultural/economic background.
This is the gap that, 23-year-old Fulbright scholar, Claire Gutermuth is pivoting her prosthetic innovation research on. Claire was introduced to the maker movement when she interned at the Tech Museum in San Jose. As she dabbled in various 3D printing projects, she realised one of its real potentials, when she started prototyping prosthetic hands for Enabling the Future (eNABLE). This is a global online community that designs, fabricates and distributes 3D printed prosthetic hands to children and she has been collaborating with them ever since. She worked on fitting, customising and building prosthetics for a girl and a boy, under 11. “It’s an iterative process and we were constantly prototyping to ensure that the adoption is smooth”. She continued to use the maker space at Davidson College, during her undergrad there.
When kids are fitted with prosthetics, because they grow out of them so quickly, they require at least 25 limbs through the course of their lives. They need a replacement every 6-12 months, whereas an adult may need one every 3-5 years and resulting in about 15 limbs in a lifetime. This need for constant replacement, plays a role in making 3D printing a good option for building prosthetics. Some of the advantages:
- Rapidity – a prosthetic limb can be printed out within a day, and assembled within 3 to 4 hours, once the initial measurements have been taken care of. As opposed to traditional manufacturing methods where casts and test sockets are calibrated and produced over weeks.
- Accessibility – Anyone with access to a 3D printer can download designs and print one out themselves.
- Versatility – Since designs are created and shared freely, the variety in colours, styles and customisation are available for anyone to use.
- Affordability – prosthetics can be printed and assembled for less than $50, which is a tiny fraction of a traditionally manufactured limb. This, given the rate at which people outgrow their limbs, makes replacement very, very affordable.
Like Claire says, even though 3D printing is not the most durable solution, its benefits are undeniable. “I’ve seen kids get used to it so quickly and ride a bike in no time!” she says.
She’s moved to India for nine months, on a Fulbright-Nehru research grant. Being inspired by the journey and success of the Jaipur foot, she knew that she wanted to focus her research in India. As per data from the WHO, India has the highest number of road accidents in the world with 38.9 non-fatal injuries per 100,000 population, which would be a significant cause of lower limb amputation. Apart from the road, train accidents due to over-crowding and illegal track-crossings, also contribute to traumatic injuries. The second major cause is diabetes mellitus. India is the diabetic capital of the world and estimatedly, 40,000 lower limb amputations are performed each year in India due to diabetic complications. Keeping these facts and the challenges of distributing low-cost prosthetics in mind, Claire began her research in Delhi, prototyping and working out of the Maker’s Asylum there.
She has even leased a printer of her own, in her apartment, so she can build while she sleeps! This printer can utilise carbon fibre, which is potentially a great material for prosthetics. Although this may be tougher to work with, it will weather the rugged lifestyles and environments of its users better than the more widely used PLA or ABS material.
Three months into her research, she feels like she has a lot that she needs to understand about the people here. Her research here is two-pronged – the feasibility of 3D Printing as a low-cost prosthetics solution for under-privileged amputees and their rehabilitation process, quality of life and social context.
During my conversation with her, she was mildly perturbed by the cultural challenges of truly understanding the people she is trying to help. Her struggle to empathise and create a positive impact is compounded by the knowledge that her time here is limited. She has been interviewing patients at the ISIC (Indian Spinal Injury’s Centre), to understand their lives, their use of prosthetics and the problems with it. In her prior experience, designing and fitting the prosthetic was only 10% of the process of treatment, the rest being rehabilitation and therapy. “But here, the opposite is true. They want quick fixes and will often never return after they have been fitted, for follow-up consultations and rehabilitation exercises” she says. There could be several reasons for this:
- As daily-wage labourers, a lot of them cannot afford to take time off to keep coming back to for consultations
- They simply do not have the space or time to exercise, thereby resulting in their condition atrophying
- The stigma of disability and a prosthetic device amongst the society they live in, is high
- They prefer medication or quick-fixes, as they’re prone to believe that devices will hinder or not survive the wear and tear of their labor-intensive jobs
Even when you consider the story of the success of the Jaipur foot, the ‘technology’ played a cameo role. Pandit Ram Chandra Sharma, a traditional craftsman, designed the foot in 1968, while working at Dr. P K Sethi’s hospital. Dr Sethi, an orthopaedic surgeon, made it famous, got the Ramon Magsaysay Award in 1981, and then continued on to fit only 50 limbs between 1968 and 1975, at a commercial hospital. Eventually, in 1975, D.R. Mehta suggested taking the neglected Jaipur foot to the needy. He realised that “technology by itself cannot bring about change, however elegant it may be”. He wanted to make the approach of dealing with the amputees more ‘human’. “These are usually the poorest of the poor, who lose their limbs in the course of daily labours for employers who took no responsibility. They arrived penniless, starved and were without shelter as they waited for days in hope of being fitted with a limb”. So he fed them and gave them a bed while they waited to be fitted. (Read more about the story of the Jaipur foot here)
Claire reinforces the concept of jugaad, as an essential means to improvise and customise aid for the people. At ISIC, she recalls, a little girl was in a wheelchair and her arms were just too small to reach the small wheel meant for controlling movement. Purchasing another wheelchair or customising this one would require significant cost and time. So the consulting doctor, attached small knobs at regular intervals on the outer wheels, so she could grip them and turn the wheel. There is no one size fits all approach, which makes a standardised solution to the problem impossible.
She started with the hope that 3D printing could be a ubiquitous solution, that could help serve the low-income communities. But as a large segment of the population lives in remote villages, with poor access to electricity and necessities, 3D printing will remain a democratised method of manufacturing within larger cities. As she delves deeper, in order to make the best use of her time, she has gently steered away from 3D printing as a focus and solution, while interacting with people with amputations. As she says, the entire premise of human-centred design, is to begin without any assumptions regarding the required solution, instead keeping the people, their needs and challenges as the primary objective.