Sri Lanka: Sustaining the work of the Jaffna Jaipur Centre into the future
After nearly a decade, the ICRC is phasing out its support to the Jaffna Jaipur Centre for Disability Rehabilitation. Felix Trottman, an ortho-prosthetist who has worked for the ICRC’s Physical Rehabilitation Programme in various contexts since 1990, reflects on the expertise he has provided to the country’s disability programme, in particular to the Jaffna Jaipur Centre.
“One should not forget that an amputee will depend on his/her prosthesis for the rest of his/her life” – Felix’s resonating reminder as the ICRC’s last-serving ortho-prosthetist. © ICRC / Sylvester Worthington
The Jaffna Jaipur Centre for Disability Rehabilitation (JJCDR) has a long history. Why did it come about?
The JJCDR started its work in 1987. Its founders were simply spurred by the desperate need for orthopaedic appliances in the region. There were two other centres which provided a similar service, the Friend in Need Society and Navajeevana orthopaedic centre, but they were situated in Colombo and Tangalle, respectively.
Why did the ICRC start supporting the JJCDR and how has its work evolved over the years?
The ICRC’s support commenced in the late 1990s, with a break between 2002 and 2007. It came at a time when it had become increasingly difficult for the JJCDR to operate due to the conflict. Apart from providing all the raw materials and components required for the production of prostheses and orthoses, the ICRC assisted the JJCDR to modernize the technology used in the production of these mobility aids and provided training for staff to upgrade their skills.
Has the ICRC supported similar endeavours in other parts of the country?
The ICRC also supported Navajeevana from 2011 to 2013. This has enabled patients from the south requiring mobility aids such as prostheses to be treated there. The ICRC encouraged cooperation between the JJCDR in the north and Navajeevana in the south through a transfer of expert knowledge. It was done by organizing workshops, where a team from one centre was invited to learn from the other an area of expertise in which it excelled. We were very pleased with the results as well as the quick rapport between them, and believe their good relationship will endure.
What were the challenges encountered along the way with the support to the JJCDR?
During the conflict, the timely provision of materials was a major issue. Fortunately, facilitating logistics, when operating conditions on the ground are difficult, is one of the ICRC’s strengths. Therefore, the JJCDR continued to operate throughout that difficult time because the organization ensured it had the raw materials and other components needed to continue its operations.
Of course, there were many other minor and not so minor challenges, which are to be expected when you introduce new technology. However, our Sri Lankan colleagues were very receptive to novel approaches and in some instances improved on it. For example, some of the heavy-duty prosthetic feet used and made at the JJCDR were also designed there. This development was the result of local input, combined with ICRC assistance. Furthermore, local wheelchair/tricycle production was established to meet the needs of beneficiaries. Local skills and talent, combined with ongoing on-the-job training, helped to improve the quality and quantity of all services delivered by the JJCDR.
From your experience, how do mobility aids such as prostheses change the lifestyle of a beneficiary? And what limitations do those who are fitted with mobility aids have to contend with, if any?
In many cases, it is not just a question of lifestyle, but livelihood. The income of many physically disabled people depends on their mobility. Therefore a well-fitting and functioning orthopaedic appliance goes a long way. It ensures their economic independence, or in the case of children, it maximises their future potential by enabling them to attend school as equals with their peers.
The limitations to the success of a patient’s reintegration depend on the severity of the disability. For example, the level of amputation and how many limbs are affected. Of course, age, fitness, determination and personality are also contributing factors.
Take the recent case where the prosthetic team at the JJCDR fitted a triple amputee (bilateral below the knee and one lower-arm amputation), who was a victim of a shell blast, with a new set of artificial legs. She was also a proud mother, who came to the centre for help with her two young children. After the successful fitting she returned home. Now, she is able to manage her household successfully. Without the aid of her prostheses she would have had no freedom of movement, as even the use of a wheelchair would be virtually impossible with the aid of just one arm. Her perseverance, optimism and strength of character, combined with the competence of the team at the JJCDR, gave her a new lease of life.
Why is the ICRC phasing out its support to the centre and what should be done to ensure its future sustainability?
The ICRC has been phasing out its support gradually over four years to allow the JJCDR to find funding from alternative sources. As the ICRC cannot continue to support its operations in the long term, a broadening of its funding base was clearly desirable to ensure sustainability of its operations. The JJCDR’s efforts in this regard are ongoing and so far it has been able to source the costs of its service provision from various NGOs, businesses, the Department of Social Services, individual donors and some modest voluntary patient contributions.
The need for the JJCDR to provide services to the disabled continues unabated. One should not forget that an amputee will depend on his/her prosthesis for the rest of his/her life. It will need to be maintained, occasionally repaired and renewed every few years. Additionally, new cases are referred to the JJCDR every week.
Reflections by Felix: “The JJCDR continued to operate throughout the conflict because the ICRC ensured it had the raw materials and other components it needed. The centre’s staff were very receptive to novel approaches and in some instances improved on it. Some of the heavy-duty prosthetic feet used and made at the JJCDR were also designed there.” © ICRC