Dr Pramod Karan Sethi gets Ramon Magsaysay award for his 'Jaipur foot'

Sethi: innovative geniusOn August 1, as on any other day, the bespectacled and grey-haired professor of orthopaedics drove home from the Sawai Man Singh Hospital in Jaipur for his afternoon siesta. He was fast asleep when the phone rang, and the caller, who refused to be put off, insisted on speaking to the doctor, Pramod Karan Sethi.What the bleary-eyed Sethi heard from the excited caller was enough to wake up anyone: the radio news had just carried an item announcing that the Philippines-based Ramon Magsaysay award for community leadership had gone to Sethi for his development of the "Jaipur foot"."It came as quite a surprise", says Sethi, 54, who is head of the Department of Orthopaedics and director of the hospital's Rehabilitation Research Centre. The award carries a cash prize of USS 20,000 (Rs 160,000) and is described as the Asian version of the Nobel Prize. He recalls that in mid-March he played host to Belen Abrew, a Filipino, who said she was a social worker. She was very impressed with what she saw, but Sethi, who is used to out of town visitors, gave it no further thought. It was only after he got the award that the significance of that visit hit him.Though the award praises him for his "surgical genius", Sethi's success is because of more than just that. Reserved, but articulate when he chooses to be, he casually dismisses the adulation: "The importance of the Jaipur foot has been exaggerated out of all proportion." Coming from a doctor who has just won a coveted award, it seems a strange statement, but then, Sethi is, if anything, a doctor out of the ordinary.Innovative Ideas: Widely read, he holds views that would disturb any established colleague. It has led to his methods being branded as primitive, until some years ago when his work was finally recognised- he is already recipient of several awards, among them the Padma Shri.Sethi regrets that in spite of the considerable publicity, the basic point he has been trying to make has been lost, particularly on fellow doctors across the country. Says he: "The issue is more than that of mere surgical perfection in creating the Jaipur foot. The question is really of formal education which prevents doctors from considering solutions other than those taught in their class-rooms. The question is really of the futile and continuous race for higher technology, whereas the attempt should be to achieve a higher science content, preferably with a low level of technology." He stresses indigenisation at a time when his profession is turning increasingly sophisticated, and the basic needs of rural health and medicine are being quietly ignored.If the Banaras-born Sethi has been able to avoid the groove into which formal education so easily drops its students, it is because he never did receive training in orthopaedics and had to learn the hard way. He got his masters in surgery in 1952, became a Fellow of the Royal College of Surgeons in 1954, and in March of the following year joined as a lecturer in Jaipur. As in other medical institutions at that time, there was no separate department of orthopaedics - "it has traditionally been a low-priority field" - and when the Medical Council of India decided that this state of affairs should change, it put the college management into a quandary. There were no facilities and what was more, there was no one adequately qualified to take charge. The principal asked Sethi to head the new department. "I had no training in orthopaedics and so I naturally resisted his demand. But I was bullied into it," laughs Sethi.The Orthopaedics Department as it existed in 1958 had nothing. There was no space and no finances. Aids for physiotherapy and occupational therapy, so essential to any programme of rehabilitation, were nonexistent. What passed for a place of exercises was a tiny room in one corner of the hospital. Says Sethi: "Let alone outsiders, even doctors did not know where the department was."Amazing Response: If Sethi today has an unshakable faith in his patients and in the local craft, the reasons are not far to seek. While his department was struggling to find its feet, Sethi realised that in the absence of the administration's support. there was only one solution: local involvement. His team approached patients, told them of the difficulties, and asked them for their help. The response was amazing. Even those who were not well off. pooled in with whatever they could and exercise equipment was almost entirely made or gifted by grateful patients.Still cramped for space, exercise equipment was shifted into the hospital corridor, into its courtyard and later into the space provided for a ramshackle tea stall. And all the while their activities - and public participation -kept growing. One of his patients was Arjun Aggarwal, a wealthy Bihar colliery owner, who made liberal donations, and in 1960 a small workshop was started. Initially only caliper splints worn by polio patients to take the weight off their leg-were made and it was only five years later that the doctor could think in terms of a unit to manufacture artificial limbs. For two years the traditional SACH foot was fitted {see box) until it was discovered that its utility in the Indian environment was sorely limited.Though indigenisation of the footpiece was the obvious answer, few of Sethi's colleagues agreed, the professional orthopaedists among them arguing forcefully against any change. In fact, it was a local artisan. Ram Chandra, who first understood Sethi's concept, found it feasible, and began working on the Jaipur foot. When the need for information into rubber 'technology arose, established tyre manufacturers did little to help them. However. Chuga Bhai, who owned a small tyre retreading shop in Jaipur, did their work, taught them vulcanization,- and refused to accept money.It was only after 1975 that Sethi's luck changed. Public cooperation - and donations - were organised under the banner of the Bhagwan Mahaveer Viklang Sahayata Samiti, a charitable body, without whose assistance Sethi's work might have remained incomplete. The Rs 20-lakh trust still contributes awards the workshop which is housed in what used to be the hospital's servants quarters. Apart from paying for limbs for the poor, and picking up their transport bills, it helps Sethi get past bureaucratic problems. It pays the salaries of a third of those 40 artisans who though talented, would not be employed by the hospital, since they are not formally qualified. Moreover, the society purchases raw materials so that the laborious process of inviting tenders is avoided. The success of this joint effort has been phenomenal. In 1975, 59 patients received new limbs, this figure rising to 437 in 1976, 711 in 1978, and 1,415 in 1980. The number for this year may be in the region of 1,800.Reduced Costs: But the success has been more than just quantitative. A continuous quest for perfection - and Indianisation - has brought down costs drastically. Modern limbs, for example, are made of willow and plastic, which makes them expensive, and not easily avail able since willow is difficult to acquire. Sethi's team has resorted to aluminium limbs, which were in use earlier, and he is now accused of turning back the clock, even though they have proved their utility. Raw material costs for below-the-knee calipers have dropped to Rs 50 instead from the usual Rs 380; below-the-knee artificial limbs cost Rs 135 instead of Rs 500; and above-the-knee artificial limbs can be had for Rs 250 in place of the normal Rs 850.Today, seated in his office in the five-storied centre - 50 per cent of the cost of construction came in donations - Sethi's thoughts are clear in spite of the considerable adulation. Far from being satisfied with the centre's growth, he is worried that this may soon lead to its decay. Says he: "Centralisation has to be avoided. We have a wealth of talent in our villages, thousands of artisans who can be trained to do this work. What we need is doctors who will believe in them." But the pity of it all is that India's medical establishment, convinced of its correctness, believe in nothing but itself.Published By: AtMigration Published On: Nov 11, 2013 13:39 IST--- ENDS ---

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Dr Pramod Karan Sethi gets Ramon Magsaysay award for his 'Jaipur foot'

What the bleary-eyed Pramod Karan Sethi heard from the excited caller was enough to wake up anyone: the radio news had just carried an item announcing that the Philippines-based Ramon Magsaysay award for community leadership had gone to Sethi for his development of the "Jaipur foot".

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