Dr Gopichand Katragadda tells the story of how a doctor and a sculptor came together to create the famous low-cost prosthetic limb, the Jaipur Foot
In 2015, a group of Tata CTOs visited the MIT Tata Center for Technology and Design. One of the programmes showcased at the centre was the ongoing work on improving the Jaipur Foot (an artificial limb). Graduate student Kathryn Olesnavage presented how her work would improve the gait of users of the Jaipur Foot. Ms Olesnavage’s thesis for her master’s degree investigated trade-offs between mechanical, metabolic and subjective parameters. Her prototype foot received mixed feedback with improvements identified in the perception of stability and specific requirements for rural India, such as squatting. Ms Olesnavage is currently pursuing a PhD working on these improvements.
For this issue of Tata Review, which focuses on community impact, I will narrate the story of the Jaipur Foot based on a visit to the Jaipur Foot factory that I and my colleagues at GE had undertaken in 2007.
The story of the Jaipur Foot has been told a few times in different ways. I start the story with Guarantee Baba, who sits outside the Jaipur Foot workshop. I ask him if I can take a picture and he quickly positions himself like a veteran model. With saffron robes and a flowing beard, he seems a misfit at an orthopaedic centre. It is appropriate that his name is Guarantee Baba (baba means father) — those who limp in through the doors of the workshop in the morning are guaranteed to walk out with a Jaipur Foot or calipers that give them vastly improved mobility, all provided free of cost. The workshop itself is very interesting — those present include cobblers, sculptors, carpenters, metal workers, doctors and engineers. There are also a bunch of foreign students walking around in open-eyed wonder at a place that has helped improve the lives of more than 1.3 million persons with disabilities.
The Jaipur Foot is the story of a doctor, a sculptor and a surprisingly demanding Indian consumer. In 1958, Dr Pramod Karan Sethi, a fellow of the British Royal College of Surgeons, was doing a stint at the Sawai Man Singh Hospital in Jaipur, where he provided prosthetic feet to local farm workers. To his surprise, he found that his patients would prop up the prosthetic foot on the wall at home and go about their jobs on crutches. On further enquiry, he learnt that people fitted with the western-design based prosthetic feet could not squat, and that was a habit they did not want to give up. They also wanted to be able to remove footwear before entering homes or places of worship and were not comfortable with the permanent boot-like design of the western prosthetic foot. Another surprising reason was that rural Indians wanted a foot that was aesthetically pleasing and lifelike rather than a bionic contraption. Enter Masterji, as sculptor Ram Chandra Sharma is popularly known.
Dr Sethi and Masterji started working on a prosthetic foot that would better meet the needs of the locals. There was a lot of back and forth on various possibilities with Dr Sethi imparting his knowledge of anatomy, pressure points and motion joints in a foot and Masterji going beyond the typical sculpting of surfaces to the inner mechanics of a foot.
The breakthrough came when Masterji was having his cycle tyre fixed and observed the mechanic using vulcanised rubber to retread a truck tyre. That sparked the idea of using a combination of wood and vulcanised rubber to create a prosthetic limb. It took a lot of work before the final prototype of the Jaipur Foot emerged with a hinged wooden ankle and rubber to shape the likeness of a foot. The Foot was ready for the public in 1968. From 1968 to 1975, Masterji, with all his enthusiasm, was able to provide the newly developed ultra-lowcost foot ($30) to less than 60 individuals.
Enter DR Mehta, who set up the charitable organisation Bhagawan Mahaveer Viklang Sahayata Samiti (BMVSS). In 1969, Mr Mehta had an accident that broke his femur. Although he had little hope of recovering the full functionality of his foot, to the astonishment of his surgeons, he did recover completely. In 1975, as a final outcome of the incidents that followed the accident, and on the occasion marking the 2,500th death anniversary of Mahaveer, the great sage of the Jain tradition, Mr Mehta established BMVSS. In the first year of its existence, BMVSS undertook the deployment of the Jaipur Foot as a charitable activity. Today, 60,000 limbs are deployed every year. This turn-in-tide was engineered by the Mehta family and their ability to generate an inflow of charitable contributions.
Mr Mehta and BMVSS contributed by bringing a value system and management practices to the table, in addition to continuing to improve the technology behind the Jaipur Foot. Here’s an example of values. Though the patients who walk into the workshop are mostly from the lower strata of the society and are themselves extremely hesitant to sit at the same level as the doctor (they would prefer to squat on the floor in front of the doctor or stand), BMVSS insists on a culture of equality.
The biggest management innovation at BVMSS is the turnaround time. In a typical hospital, the admission process takes half a day and the wait for the doctor the other half. When a prosthetic limb is required, the patient often has to make a couple of visits for measurements, and the limb is fitted a couple of months later.
At the Jaipur Foot workshop, most patients can register and expect to walk out the same day with a prosthetic foot. This can be attributed to the equivalent of a lean manufacturing process adopted at the workshop. The leadership of BMVSS recognised that multiple visits cause problems to patients from the lower economic bracket, in terms of time away from work and the cost of travel.
Today, the Jaipur Foot has smashed the hand-mind-market barrier and is deployed in more than 20 countries; it has helped rehabilitate 1.3 million disabled individuals. This impact was made possible by the hand of Masterji, the mind of Dr Sethi, and the consumer understanding of Mr Mehta.
Extracted and updated from: Katragadda, Gopichand; Smashing The Hand-Mind-Market Barrier; Wiley India, 2008, ISBN 9788126519064