Sri Lanka: a step towards self-reliance
In Sri Lanka lack of transport and financial means makes it difficult for hundreds of disabled people to get treatment and orthopaedic devices. An ICRC-supported rehabilitation centre in Jaffna comes to their aid.
The Jaipur Centre for Disability Rehabilitation Centre
The Jaffna Jaipur Centre for Disability Rehabilitation was established in Jaffa in 1987 by the Friend in Need Society in cooperation with the Mothers’ Front. The Centre helps conflict victims and people with physical disabilities return to a normal life by fitting them with artificial limbs or prosthetic devices. This was its initial goal. Among its beneficiaries were people who had lost limbs in accidents and those who suffered from congenital or acquired disabilities, including polio and club foot.
Before the Centre was established in Jaffna, patients had to go all the way to Colombo, which made treatment inaccessible and costly. To date the Jaffna Centre is the only facility providing prosthetic and orthotic devices and rehabilitation services on the Jaffna peninsula. The Friends in Need Society has also opened branches in Galle and Kandy.
The Centre has had to modify its initial goal to also take into account the needs of people who lose their limbs in landmine accidents. The estimated number of mines in Sri Lanka is 600, 000 – 2, 000, 000, a large proportion of them in Jaffna. Out of over 1,750 patients registered at the Centre, more than 1,000 are war wounded while some 650 are landmine victims. Between 1987 and 2006, the Centre supplied some 4,000 prostheses, over 2, 000 of them for victims of landmines.
K. Uthayarani is registered at the Centre and has come to have her orthoses fitted the day the ICRC is visiting it. Uthayarani, 30, suffered from polio as a child and as a result has little mobility in either leg. But she did not allow this to stop her from working as a seamstress or carrying out her routine activities. Using an improvised walking aid she went about her daily life as best she could until she was referred to the Centre by an organization she worked for.
Explaining how Uthayarani will benefit from orthotic devices, Julia Srinivasan, one of three trained physiotherapy assistants working at the Centre, says, " Once the devices are fitted, they will stabilize her knees and increase her mobility. The purpose of an orthosis is to prevent future deformity and help maintain good body posture by supporting weak body parts " .
Today is a turning point for Uthayarani as she prepares to lead an independent life. " I needed he lp even for basic personal care, but now I will be able to do it all by myself”, she says beaming as she gingerly takes her first steps, helped by Julia and Dhamayanthy, the Centre's other physiotherapy assistant. Uthayarani plans to continue with her sewing and lead as normal a life as possible.
V. Thambi, 62, a farmer from Achchuveli, lost his leg after he stepped on a landmine in a paddy field near his home in 1992. " It happened in an open field, where cattle often grazed. No other mine incident had been reported in the area and I thought it was safe”, he points out. He spent 36 days at the Jaffna Teaching Hospital (JTH), where he was transferred after treatment at the local hospital.
About the Centre, Thambi says, " Without it, I would have had no prostheses, and would have been unable to work, which would have left me and my family destitute. I might even have committed suicide as a result. But now I am able to lead a normal life " , says the father of two, who continues to farm.
Explaining the circumstances of his accident, V. Vasanthan is less upbeat. " I was rich " , he reminisces. " I owned a van and ferried people in and around Jaffna, and between Jaffna and Colombo, following the opening of a highway in 2002. One day I stepped on mine planted outside my house by people jealous of my success. I was admitted to the hospital in Point Pedro and later transferred to the JTH, where I my leg was amputated below the knee. I was devastated " .
In March 2002, three months after the accident, he was fitted with a prosthesis at the Centre. Life has not been the same since the accident for the 30-year-old man who lives with his wife and five-year-old daughter in Karavatti, Point Pedro, in the north. " I had to sell my van to pay off loans. Now I work as a labourer and do the occasional hire”, he says.
The ICRC began assisting the Centre in 1994, providing training, raw materials and machinery for the manufacture of artificial limbs and prosthetic devices. Following a break, between 2003 and 2007, it resumed its assistance to the Centre. It provides financial, logistical and material support and equipment for the production of these appliances. It also offers technical expertise in physiotherapy and orthoprosthetics, management support and staff training.
Initially, the Centre used technology developed in the state of Jaipur in India to produce artificial limbs. Using local raw materials, the Jaipur technology provided a quick and cost-effective way of making these devices to suit individual needs.
In 1999, with ICRC funding, the Centre began using the polypropylene technology, making it possible to produce prostheses out of plastic sheets instead of aluminium. The advantag e of this is that it prevents skin damage and allows for a snug fit because of better alignment with the natural limb. The ICRC reinforced the use of the new technology at the Centre by sponsoring the training of four technicians and allocating it a full-time expatriate orthoprosthetist. The organization also donated equipment including ovens for softening polypropylene sheets.
Patients who come to the Centre are usually referred by the JTH, aid agencies or, like Vasanthan and Uthayarani, learn about it word of mouth. Once a patient approaches the Centre they are registered and their needs are assessed. It takes about a week to fit a patient with artificial limbs.
The fitting is not always smooth and patients may have to return for a follow-up if the limb causes pain. Thirty-year-old Rajasekeran, whose leg was badly burnt after he was electrocuted, is in the Centre’s gait-training area where patients do their exercises before and after being fitted with prostheses and orthoses. " My prosthesis was fitted two weeks ago but I am back to have it readjusted because I am in pain, " says Rajasekeran, who plans to return to work after eight months on sick leave.
Putting something back in
Patients are expected to contribute to the cost of their devices, which have to be replaced when they become worn out, or outgrown, in the case of children. Vasanthan, who contributed some money when he had his prostheses says, " I am happy to pay this nominal fee because I know how costly it is to make prostheses " . S. Devendram, 62, who had his leg amputated as a result of diabetes and has come to the Centre to have his prosthesis mended says, “I paid for my first prosthesis but the second one was free, thanks to the ICRC”. However the majority of p atients are very poor and rarely make the contribution.
The ICRC supports the Centre financially by reimbursing the production costs for artificial limbs and prosthetic devices, thereby enabling patients like Devendram to have artificial limbs free of charge. For 2008 the ICRC expects to reimburse the cost for the production of 300 prostheses, 100 orthoses, 60 mobility aids and the repair of 500 devices.
In addition to the production and fitting of artificial limbs the Centre produces mobility aids such as crutches, tricycles and electric wheelchairs, all tailor-made for its patients.
Physiotherapy, which is important for the rehabilitation of people with impaired mobility, is a crucial aspect of the Centre’s work, said the ICRC’s Emmanouil Kokkiniotis. The Centre holds a free monthly clinic where the consultant orthopaedic surgeon at the JTH sees special cases needing further consultation. Once a week the Centre's physiotherapy assistants work the physiotherapy department of the JTH, registering new amputees and providing patients with physiotherapy treatment and advice on care for their prostheses.
The Centre also provides education grants for students registered as patients at the Centre and a revolving loan scheme for income generation for bread winners who have lost limbs.