Recycling limbs, rebuilding lives

A foundation started by a UK-based doctor is bringing used prosthetics and their components – prohibited from reuse in the UK – to Sri Lanka and refitting them for local use.

Sri Lanka was plagued by a civil war which lasted for more than 25 years, only ending when Sinhalese forces from the south successfully drove north into Tamil rebel-held territory. During the fighting 2,061 square kilometres were heavily mined with around 1.6 million land mines. Despite the war being over, the land mines continue to kill and main.

In July 2009 – four months after the war officially ended – Dr Bandara Panagamuwa was visiting Mannar in the north and was shocked by the number of amputees lining the corridors of a hospital. Dr Panagamuwa, a senior consultant in rehabilitation medicine at West Midlands Rehabilitation Centre, decided to set up the Meththa Foundation to help.

Sinhalese Dr Panagamuwa says that he doesn’t care and doesn’t ask how the person was injured. “What does it matter how the patient got injured from a clinical point of view?” he says. “We try to get them to a point where their disability is no longer the central part of their life. We want that to be behind them.”

He says that he understands how the decision to set up a base in Mannar could be perceived by some members of the Sri Lankan diaspora. The question why a Sinhalese doctor is working in Mannar is one he knows is asked by both the Tamil and the Sinhalese community. But his answer his plain, because there is a need.

“Some of the younger people are calling me uncle now,” he says, “and that is the highest tribute that they can pay me.”

 At RAFT we support the work of people like Dr Panagamuwa who are improving the lives of people whose economic status might have them outside the care of many hospitals.

In part, this drives Dr Yazan Al Ajam who heads RAFT’s prosthetics project which is developing a bionic limb.

Because they are uncomfortable to wear and bring little benefit to the patient as far as usability, the vast majority of prosthetic wearers stop wearing one within two years of being fitted. RAFT – along with other independent groups – is working to overcome this problem by providing amputees with an artificial limb that is comfortable to wear and actually works: duplicating the actions of a real limb.

One of the ways to get around this problem is to use a metal tap which is planted into the bone at the stump and then goes into the prosthesis. However, while this eliminates the problem of the stump being chaffed, there is still a lack of control.

A solution being experimented with arm amputations is to use sensors – either on top of the skin above the stump, or inside the arm – so that impulses going to the arm’s muscles can be fed into the prosthesis where in turn these can be used to control micro-motors.

While putting sensors outside the skin is cheaper and easier to install, the problem with this method is that it’s too limiting.

Natural hand movement relies on a multitude of contracting muscles to move fingers and wrist – the forearm alone has 32 muscles responsible for hand and wrist movement. But outside sensors cannot distinguish between individual signals coming down for separate muscles, such as the index finger touching the thumb, or for ‘mass-action’ contractions such as opening the hand.

While prototype models in the USA, which use implanted sensors, have shown excellent results, all aspects of these are extremely expensive – from manufacturing to installing in the patient. In addition, the sensors used require a power source – adding to their complexity – and might require scheduled replacement.

“For me, I want this project not to be confined to state-of-the-art hospitals in USA or Europe, but to be simple enough so that surgeons in developing world countries will be able to benefit their patients,” says Yazan.

“My project will use passive sensors implanted in the muscles. They are much simpler in design and should be far more robust and longer lasting.”

In seeing what other companies are doing in regards to detecting a signal, Yazan sees many advantages with the RAFT project.

“Looking at just the sensor itself, there are no moving parts, no serviceable parts: just an inexpensive reliable solution to the problem.”

With the initial pilot tests underway, Yazan can start to taste success. But as a research, he knows the unexpected can always happen.

“It is crucial that we build up on our current findings and keep refining our design and make it successful,” he says. “Our data is good, we’re on the right track.”