Making Suraj Smile: A Prosthetic Case Study In Nepal
Meet 20 year-old Suraj. He lost his leg as an infant due to infection. As someone who grew up with one leg, he was determined not to let his amputation limit him in any way. Suraj lives a full and active life and is currently a University student.
Recently, however, his prosthetic leg has gotten uncomfortable. Enter Operation Namaste, in coordination with Dhan Prasad Roka and Shovakanta Sharma at Green Pastures Hospital (GPH) in Pokhara, Nepal.
The new prosthesis was made over four days. First, Suraj visited GPH for evaluation and casting. When he removed his prosthesis, his practitioners discovered that he had a sore on his limb. It was clear that his Patellar-Tendon-Bearing (PTB) socket was causing irritation on his skin.
Next, practitioners gave him a Namaste Liner, made using a process created by Operation Namaste. Suraj’s liner was made the week before in Kathmandu by Amrita Lama, a member of ACT Nepal, a group whose goal is to provide easy access to quality rehabilitation services, so that those with disabilities may live a life of dignity. Amrita and other members of ACT Nepal had just been trained to make liners that week by Operation Namaste’s Jeff Erenstone. Since the liner making process utilizes low-cost, 3D-printed molds, and medical-grade platinum-cured silicone, ACT Nepal is able to provide them at a small fraction of the cost of conventional liners.
Once the liner was on, practitioners casted and measured Suraj’s limb, using the finished plaster cast to create a mold. Working collaboratively, Jeff Erenstone, CPO and founder of Operation Namaste, and Shovakanta Sharma, a staff prosthetist at GPH, modified the shape. While Shovakanta is very skilled at making older style prostheses (PTB style), he had only made a modern prosthesis (total contact style) once in his career. Jeff taught him the process, and he will continue to learn under the guidance of Operation Namaste volunteers.
After the plaster model was completed, an EVA foam inner was made and a plastic socket formed. GPH uses ICRC methods and components, and these components were used in this prosthesis. Erenstone and Operation Namaste believe that you should change as little as possible in introducing new technology. Since these components were working, and practitioners at GPH were familiar with them, there was no need to change them.
Four days later, Suraj returned and the prosthesis was trimmed, height-adjusted, and aligned. After some dynamic gait adjustments, Suraj began to walk extremely well.
Results were measured using a 2-minute walk test. On Monday with his old prosthesis, Suraj performed the test and was able to log 150 steps in 2 minutes, which is below normal for a person of his age. On Friday with his new prosthesis, he walked 180 steps which is within a normal range for an able-bodied 20 year old.
He came to the visit using crutches and walked out because he didn't need them anymore.
On top of that, the prosthetic care was not expensive. The new prosthesis, clinical care, and Namaste Liner cost $380 total.
This level of care was sustainable.
All the components are from normal supply chains, or fabricated in Nepal and easily distributed.
The care was modern but the cost was not increased much.
The local clinicians were left with the knowledge to reproduce the care and provided a mentor to answer further questions.
This type of care is scalable across all of Nepal, so we can help numerous Nepali enjoy their lives with dignity and without pain, despite any physical limitations they may experience.
One Month Update:
A month after fitting the Namaste Liner, Suraj's limb has healed quite a lot. Notice the open spot on the outside of his limb is much smaller.