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Passing Away of a Role Model

A tribute to Dr P K Sethi, inventor of the "Jaipur foot", who died on January 6.

COMMENTARY

him two decades later, he was “famous”.

Passing Away of a Role Model

When he learned that I had specialised in biomechanics, he invited me to evaluate the Jaipur foot as an engineer.1 Encouraging Dinesh Mohan young professionals and treating them as

A tribute to Dr P K Sethi, inventor of the “Jaipur foot”, who died on January 6.

Dinesh Mohan (dmohan@cbme.iitd.ac.in) is at the Transport Research and Injury Prevention Programme and the WHO Collaborating Centre at the Indian Institute of Technology, Delhi.

W
ith the passing away of Dr P K Sethi, many of us have lost a role model of a teacher, a professional and of a human being with enormous compassion.

I did not have much interaction with him in the past few years. But his loss leaves a deep void. Memories come flooding back and one feels guilty for not having made the effort to see him more often. I first met Dr Sethi about 28 years ago and then faced him in an interview for a faculty position at the Indian Institute of Technology (IIT) Delhi in 1991. The next time he met me, he said, “You’ve got what you always wanted, ab jum ke kaam karo (now get down to hard work)”. Those words have haunted me ever since.

At times like this it is difficult to write about someone you did not work with, who is not a relative and who you do not know intimately. A fear that you might write something inaccurate about the person persists. But, when someone has such an enormous influence on your thinking, on your views and understanding of a professional life, write you must.

Dr Sethi was born in Varanasi and then educated in Agra. From what I recall in conversations with him, his father (also a teacher) made him spin yarn on the ‘charkha’, which was then woven into ‘khadi’ for his clothing, and in the evenings their house was a centre for discussion and cultural interaction. Those were the heady days of the freedom movement when Dr Sethi was a student in Agra. It is probably those early experiences that shaped many of his values and world views.

From Agra he went on to Edinburgh to earn a Masters in Surgery and the prized position of a Fellow of the Royal College of Surgeons (FRCS). He returned to India and joined the Sawai Man Singh College and Hospital in Jaipur as a lecturer in surgery. In 1958, the hospital asked him to organise and head an orthopaedic department required by the National Medical Council of India. Very quickly he made a name for himself and when I met equals was a rarity among people of his stature. This started an interactive association for the next decade and gave me insights into technologies for the disabled in India, which would not have been possible otherwise.

Though my introduction to Dr Sethi’s work was through the Jaipur foot, that is not only what I found most remarkable among his work and achievements. And there were many. He probably received all the awards that a doctor can in India, including the Padma Shri, Ramon Magsaysay Award, Guinness Award for Scientific Achievement, Dr B C Roy Award, Knud Jansen Medal and Oration, and many others. But despite receiving all these awards and achievements, the last time I met him he said that he was disillusioned and sounded uncharacteristically pessimistic. He seemed to be despairing of the medical profession in taking up the issues that really mattered in India.

A Positive Outlook

I had never known Dr Sethi to be cynical or pessimistic. One incident comes to mind. At a national conference on aids for the disabled everyone was expounding on the vast number of disabled persons in India and the enormity of the problem. Calculations were presented on the hundreds of millions of rupees needed to help these people. A member of the Planning Commission sombrely said that such funds were not available. Then came Dr Sethi’s turn to speak. He in his inimitable soft spoken manner reminded us that we should not think of disabled persons in terms of millions in the country as it makes them faceless and turns us into helpless handwringers. He said that we should think of the two or three amputees ineveryvillage. Then the problem becomes solvable because each village can raise the few hundreds of rupees needed to take care of them. Ever since I have used this example in every class I have taught to impress upon students that most of our problems are amenable to solutions once you change your way of thinking.

january 19, 2008 Economic & Political Weekly

COMMENTARY

Dr Sethi was passionate in his criticism of the overwhelming influence of expensive technology, crass commercialisation and drug company propaganda in the practice of medicine. He went from meeting to meeting, conference to conference, telling practitioners not to be bewitched by fancy technology and lose sight of the problems facing us – infection rates in hospitals, overuse of drugs, excessive and wrongful use of technical interventions, and putting medical care outside the paying capacity of ordinary Indian people. It was an intellectual engagement with the realities of Indian healthcare promoted with great optimism.

Jaipur Foot

My task involved the biomechanical evaluation of the Jaipur foot (JF) and to compare it with the then most commonly used lower limb prosthesis called the Otto Boch lower limb prosthesis. The latter was much more expensive and took a longer time to fit on an amputee than the JF. While I was setting up the jigs and fixtures to test the foot at IIT Delhi, Bob Pluyter (a master’s student in mechanical engineering from the Twente University of Technology in the Netherlands) turned up in my office all afire with the ideas of Ivan IIlych, E F Schumacher and Paulo Freire. He wanted to work on the JF for his thesis. Dr Sethi set him up in Jaipur and he spent the next six months there to end up writing one of the most interesting accounts on the whole process of rehabilitating amputees at the Jaipur centre.2

Our technical analysis showed that flexibility and strength of the JF was in no way inferior to the Otto Boch prosthesis and amputees would not loose any movement needs using the JF. Further, because the foot was made of vulcanised rubber (encasing specially shaped rubber blocks taken from bathroom slippers and wooden pieces wrapped by tyre cords) with a shank of aluminium, the prosthesis was specially resistant to wear and tear by water and dust. Special dies were made to give the look of a realistic foot with toes and other visual features of a human limb.

Work on this project brought us in close contact with Dr Sethi and his colleagues and the internal workings of the limb fitting centre. That is when we realised that the foot design was just a part of the story.

Economic & Political Weekly january 19, 2008

The success of the foot had more to do with Dr Sethi’s philosophy on healthcare and his unmatchable quality of involving anyone who could contribute to the process. He had a master craftsman (Ram Chander Sharma) for all the metal work, experts in tyre retreading, mechanical engineers, polymer scientists, sociologists, social workers, rehabilitation experts, an aerospace engineer and a host of others intimately involved in the design of artificial limbs and running of the centre. A process of constant review, innovation, questioning and understanding. He wanted ordinary people to be able to make limbs, ordinary people to train amputees and ordinary people to participate in the excitement. I saw amputees living in the centre sharing their misfortune and encouraging each other, the older patients teaching the new comers how to walk and giving them hope in coping with the world.

A personal experience comes to mind. I had crushed my heel and landed up with a horribly painful cast all the way to my knee. I sought Dr Sethi’s advice. He gave me two choices – to have an operation to fuse my bones or do nothing, take off the cast, and slowly start walking again with a regular regimen of specific exercises. I asked him about the implications. He said that the first choice included the everpresent 2-5 per cent possibility of infection and the scientific reviews indicating that the pain could come back in seven or eight years, and the second choice was living with some pain all your life. I chose the second. He showed me how all the physiotherapy tools I needed could be cheaply improvised at home. Though Dr Sethi was conservative in treatment and wanted to minimise the use of technology, he was always current with scientific literature in medicine in general and orthopaedics in particular.

This was because he kept a couple of hours for reading every night, and before that held an open house for people to drop in (an eclectic lot) and discuss everything from politics to the latest Nobel Prize winner in literature. He kept in touch with most doctors working with the poor or trying out innovative ways of providing healthcare. It is this wide range of friends and reading which gave him the broad critical outlook on healthcare in India. He would discuss and interweave the ideas and experiences of Ivan IIlych, Lewis Thomas, Tara Shankar Bandopadhyay, Maurice King, A K N Reddy, Ashis Nandy, Donald Gould, Raj Arole, N H Antia, Zafrulla Choudhary, Oliver Sachs, Richard Feynman, Rene Dubois, Hassan Fathy, and so many others to convince us that Indian medicine had to be more creative, and shed the shackles of a colonial mind and the oppression of money.

Having done this all his life, it is discomfiting for people like me to know that he was not so happy toward the end. It is worth quoting him at length to understand this despair:

It forces one to concede reluctantly to Ivan Illich’s accusation that the modern physician is the most virulent pathogen let loose on mankind… We have been so bewitched by some of the so-called high technology in the western medical world that we are losing sight of the problems, which really ought to be of concern and which are very different from those encountered in affluent western societies… It offends my sensitivity when I find how our professional conferences and workshops are being hijacked, dominated and controlled by commercial enterprises. I do not quite know who is helping whom… The abominable standards of asepsis in most Indian hospitals do not detract young surgeons from using power tools whose whine so excites their psyche that they behave like adolescents revving up the throttle of a 500 cc motorbike… We have made them (patients) forget their language of pain and suffering and started treating images rather than persons. We have stopped being good listeners and have forgotten the art of communication with our patients, an art which plays such an important role in the equation for recovery... Medicine should consider the possibility of contributing more by doing less… I believe that informed self-care should be the main goal of any health programme or activity. Ordinary people, provided with clear, simple information, can prevent and treat most common health problems in their own homes – earlier, more cheaply and often better than doctors. People with little formal education can be trusted as much as those with a lot. And they are just as smart. Basic healthcare should not be delivered, but encouraged. Instead of treating family members as a nuisance, we should invite them to participate in something which deeply concerns them. This calls for the medical profession trying to understand our social structure, the ways of thinking of our people, social and economic injustices our

COMMENTARY

people are subjected to, their language and idiom. An insight into these converts a clever physician into a wise one. I very deliberately make this distinction between smartness and wisdom. Please look around and try to locate this class of wise people. They are becoming an endangered species which may soon become extinct…I am now getting somewhat disillusioned. Not only are we nowhere near to achieving our earlier dreams of conquering diseases or providing an equitable service to our people, we are actually witnessing the congealing of what was at one time considered a healing profession into something mechanistic and often commercial… Lone voices of protest are quickly smothered, as I have personally experienced”.3

This from a man who worked with un

common compassion for people he did not

know and received recognition and fame in his lifetime. An indicator that society can give all the awards without listening to the person honoured. I am also not privy to many of the failings Dr Sethi may have had in his personal dealings. One vice he did have was his addiction to ‘paan masaala’. He would sit in the mornings reading his newspaper, sipping tea, and in parallel cutting fresh ‘supari’ for mixing with his daily stock of the ‘masaala’ and tobacco. I would always ask him to share his ‘masaala’ whenever I met him.

I do know some would complain behind his back about petty issues, and that some of those associated with the Jaipur foot in the early years came to part ways with him as his fame grew. It is possible that those who have compassion for those they do not know are not as compassionate with those they know well!

However, Dr Sethi will remain a role model for me.

Notes

1 Dr Sethi became well known all over the world for pioneering the design and fitment of a low cost artificial foot for amputees in India, known as the Jaipur foot. This has now been adopted in many different ways in a number of countries around the world.

2 B Pluyter, ‘On Social Rehabilitation with Technical Appliances: An Explorative Research into the Rehabilitation Care and Some of Its Ramifications in an Indian Limbshop’, Master’s Thesis, Technology and Development Group, Twente University of Technology, Enschede, The Netherlands, 1984.

3 Quotations of Dr P K Sethi taken from two articles, ‘The Doctor in the 21st Century’ (Seminar, # 500, April 2001) and ‘Orthopaedics in an Unjust World: Whither Indian Orthopaedics?’, (Indian Journal of Medical Ethics, July-September 19997:3). Not reproduced in the order in the originals.

january 19, 2008 Economic & Political Weekly

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