By Adam Bernstein
Washington Post Staff Writer
Tuesday, January 8, 2008
P.K. Sethi, 80, an orthopedic surgeon credited with devising below-the-knee artificial limbs that have helped countless amputees in the developing world, died of cardiac arrest Jan. 6 at a hospital in Jaipur, India.
The Jaipur Limb and Jaipur Foot were named after the northern Indian city in which they were created by Dr. Sethi and his colleagues. The devices have became lifesavers for the desperately poor and are particularly welcome in parts of the world strewn with land mines, including Afghanistan, Angola, Cambodia, Rwanda and El Salvador.
The Jaipur prosthetics are made cheaply, quickly and durably from rubber, wood and aluminum. Craftsmen can also improvise with locally available materials, ranging from spent artillery shells in Afghanistan to truck tires in Cambodia.
Most importantly, the prosthetics are slipped into sandals instead of shoes.
"Wearing shoes, which were integral to the Western designed limbs, was uncomfortable in our hot climate," Dr. Sethi said. "Our people walk barefoot or in well-ventilated footwear.
"We are essentially a floor-sitting people, requiring a range of mobility in our feet and knees which is not needed in the chair-sitting culture of the West. We should not expect our people to change their lifestyle because of a design we were forcing on them."
Dr. Sethi initially developed the prosthetics in 1968 while working in the orthopedic department of the state hospital in Jaipur. He said surgery was pointless if the patients, most of whom were desperately poor, could not leave the hospital mobile.
Although the issue of full credit remained complex, Dr. Sethi said he adapted an idea for his prosthetics from a Sri Lankan doctor who covered a peg leg with rubber to help a rice farmer. Dr. Sethi worked with an uneducated master artisan in Jaipur to concoct artificial legs and feet using flexible vulcanized rubber.
Use of the Jaipur limbs was limited -- 59 patients by 1975 -- until the International Committee of the Red Cross began trumpeting its effectiveness for land mine victims after the 1979 Soviet invasion of Afghanistan.
The concept was given a further push when the celebrated Indian folk dancer Sudha Chandran lost a leg in an accident in 1982 and turned to Dr. Sethi for help. She came back to perform rigorous dance routines on stage and film with the help of Dr. Sethi's prosthetic foot.
Pramod Karan Sethi was born Nov. 28, 1927, in Benares, now Varanasi, India. His father was a physics professor at Benares Hindu University who was credited with writing the first physics textbook in Hindi.
Dr. Sethi graduated from Sarojini Naidu Medical College in Agra in 1949 with bachelor's degrees in medicine and surgery and received a master's degree in surgery from the same school in 1952.
He became a fellow of the Royal College of Surgeons in Edinburgh, Scotland. With his credentials, he was asked in 1958 to create and lead the orthopedics department at Sawai Man Singh College and Hospital in Jaipur -- an institution in danger of losing its accreditation by the Medical Council of India.
At the time, the department suffered from neglect. A physical therapist was working as a masseuse, and supplies consisted of a monthly case of talcum powder, he said.
Patients were mostly those suffering from polio, leprosy and gangrene-infected snakebites. Others severed their limbs by falling from overcrowded trains.
Dr. Sethi was disheartened to see patients he had fitted with expensive Western-style prosthetics giving up on the fake limbs and reverting to crutches because they disliked covered footwear.
He turned to Ram Chandra, an illiterate master craftsman who taught handicrafts to lepers at the hospital. Chandra, who later said he was denied due credit, claimed a large role for himself in the development of the Jaipur limb and foot.
What is undisputed is that Dr. Sethi and Chandra worked together to create lifelike artificial limbs that would prove flexible and waterproof. It took them two years of experimenting with materials to refine their product. One notion, using sponge, proved less than ideal for rice farmers.
Chandra, whose expertise was in metalwork and die-making, produced the first aluminum-die model of what would become the Jaipur prosthetics. Some published reports said Chandra first came upon the idea of packing the die with vulcanized rubber after seeing tire repairmen fix his bicycle. A wooden ankle was later fashioned to prevent the rubber from shredding.
In the early 1970s, Dr. Sethi began introducing the limb at medical symposiums in an effort to spur worldwide interest. He met with protests of the Artificial Limb Manufacturing Corp. in India, a government-sponsored business that mass-produced Western-style artificial limbs.
But the Jaipur devices, which now cost about $30, were widely hailed for their accessibility and won major backing from powerful sponsors who had benefited from prosthetics after accidents. Dr. Sethi's creation received a boost in credibility when he won the 1981 Ramon Magsaysay Award for Community Leadership, often called Asia's version of the Nobel Prize.
Dr. Sethi, long retired and having fallen out with Chandra, spent many years working for a Jaipur charity that gives artificial legs to the poor. He also helped establish limb centers internationally to aid those harmed by land mines.
In 2004, he told the British Medical Journal that he was angry over what he called blatant corruption in Indian medicine, involving kickbacks from corporations making machinery and the dehumanization of patients by doctors who see their clients as test subjects.
"I have often advised our young doctors not to rush to make a lot of money -- the gratitude of the patient should be enough," said Dr. Sethi, who maintained the family's Jain traditions. "But my main regret is that I have not been able to pass on my ideology to them."
Survivors include his wife, Sulochana Patni Sethi, whom he married in 1951; three daughters; and a son.