The Clean Room / Making the Jaipur Foot

“The Clean Room” is a column by David Serlin on science and technology.

Allen Christian, a Minneapolis-based artist, tells a story about a homeless Indian man he knew years ago who wore a prosthetic leg. Christian recalls how he met the man one summer outside his former storefront studio, another of the nameless acquaintances one accumulates when living in an urban downtown area. “I talked to him a couple of times but mainly remember one evening we sat on the bus-stop bench and looked out at the skyline,” says Christian. Several weeks passed before he caught another glimpse of the man. And then one day Christian spotted the lone prosthetic leg standing all by itself in a nearby vacant lot, as if it had been left behind in desperate haste.

What happened to Christian’s friend remains something of a mystery. In fact, we know more about the man’s leg than about his life. The plastic, padded leg, which Christian keeps in his studio, is custom-made, designed and crafted by a Western-trained professional prosthetist, and costs thousands of dollars. Despite his mysterious disappearance, the Indian was probably someone from a middle-class—or perhaps even aristocratic—background who had fallen on hard times. Indeed, the notion that an artificial leg can be a marker of economic status or national identity—especially for the national of a country often associated with a developing or impoverished economy—is deeply intertwined with histories of prosthetic devices, however submerged such a notion may be.

In early modern Europe, for example, men or women of privilege commissioned artisans to supply prostheses made of carved wood, painted leather, and even precious metals to replace body parts lost to injury or illness. In the collections of London’s Science Museum, an elegant carved mechanical hand made for a Victorian concert pianist has circular patches of green felt attached to its fingertips, mirroring the delicate wooden hammers inside the piano case. This was not a hand made for digging ditches. In nineteenth-century United States, the regular amputation of limbs by battlefield assaults, dangerous machinery, and transportation-related accidents gave rise to another industrial trade as a burgeoning middle-class demanded mass-produced, articulated limbs to replace homemade peg legs and rough-hewn hooks. Rural and suburban consumers seeking these modern products of industrial efficiency and a more genteel sensibility could order made-to-measure arms and legs from manufacturers such as A.A. Marks on the same day that they ordered home-building kits from the Montgomery Ward catalogue.

Over the past half century, the use of industrial products such as stainless steel, molded plastics, silicon, and fiberglass has resulted in state-of-the-art prosthetics that can cost tens of thousands of dollars. In 1997, for instance, the worlds of medical commodification and sexual fetishism collided when British designer Alexander McQueen featured model and celebrity paraplegic Aimee Mullins on the high-fashion runway with a pair of $30,000 carbon-graphite legs. Many active in the disability community argue that the discourse surrounding assistive technologies such as prostheses gives too much authority to prosthetists and engineers, rather than to the patients themselves. This attitude has been compounded by postmodernism’s continuing romance with prosthetic technologies, which Western historians and theorists tend to treat as symbolic or metaphorical objects rather than as everyday material tools used by individuals who have read not a whit of Donna Haraway.

The ultimate proof of a successful prosthetic, after all, resides not in space-age products using DuPont chemicals or in customized designs using CAD software but in the amputee’s ability to become autonomous. For this reason, the will to circumvent medical expertise and improvise with home-made technologies runs high among the mechanically inclined as well as the uninsured. The National Museum of American History in Washington, DC, for example, contains many ingenious examples of legs fashioned out of wood, rags, scrap metal, and wire donated to their collections as late as the 1970s. Such vernacular legs may have been unsightly but, the donors claim, they were infinitely more hardy than the realistically rendered but often painful plastic variety. Without some form of agency, the amputee has no choice but to remain forever dependent on an intricate web of medical-industrial products and services defined by multibillion dollar, for-profit health-care providers, ensuring that access to such technologies remains a singularly First-World option.

In the mid-1960s, Dr. Pramod Karan Sethi established a rehabilitation center for below-the-ankle amputees in Jaipur, India, to redress some of the basic inequities inherent in prosthetic design and accessibility. Sethi helped to develop a new kind of prosthesis made from discarded rubber tires and other industrial detritus available in abundance in Jaipur and across India. His center trains recent amputees—from street beggars to middle-class housewives—how to make new feet. Once it is slipped over the ankle stump, it can serve as a cosmetic foot replacement, a weatherproof shoe, or both. At a cost of about $5, it is a mere fraction of the price of a Western prosthesis. Best of all, if the patient damages, loses, or outgrows his or her foot, he or she can simply make a new one. Sethi’s invention has become known internationally as the “Jaipur Foot.” Over the past three decades, developing nations have been drawn to the Jaipur Foot as a viable alternative to costly prosthetics. With the Jaipur Foot, patients retain complete control of the material as well as the method of their rehabilitation rather than succumbing passively to the top-heavy Western medical model. For his invention and his vision, Sethi received in 1981 the Magsaysay Award, the Asian equivalent of the Nobel Prize.

Giving a prosthesis a local identity seems to be a recurring motif. In the 1960s, for example, the first myoelectric arm—one which uses electrical signals to stimulate and amplify residual nerves in an above-the-elbow amputee’s stump—became widely known in the US as the “Boston arm” because of its inventor, MIT mathematics professor Norbert Wiener. Unlike sophisticated Western prosthetics, however, the Jaipur Foot is a self-sustaining technology made from local materials that is crafted and maintained by the individual once he or she has been given proper guidance. It is paradigmatic of what many green activists call an “appropriate technology,” since it uses materials and production methods that are sensitive to immediate economic and environmental contexts. As Raman Srinivasan has written, in an extensive history of the Jaipur Foot to be published later this year, “the technology for making this prosthetic device requires little in the way of start-up capital or cumbersome machinery, uses locally available materials such as rubber and wood, and provides ample scope for the expression of artistic skills and artisanship. As a consequence, it is not protected by intellectual property regimes, thus making it widely available.”^[1] One powerful photograph taken by Srinivasan in 1986 depicts an Indian woman who has customized her Jaipur Foot with ornamental rings, nail polish, and even traditional designs etched in henna.

The Jaipur Foot is also a beautiful example of the ways in which vernacular technologies can be used to challenge the legacies of colonialism in order to promote both physical and cultural autonomy. As Srinivasan has described, the history of the Jaipur Foot is intimately intertwined with India’s history under British rule. Sir Clemens Markham sponsored the first shipments of caoutchouc (rubber) seeds to Ceylon in 1876. Within a decade, Markham had established rubber as a significant export product within the global distribution system of the British Empire. Even after India gained independence in 1947, rubber remained a compelling symbol of the former imperial power’s transformation of the country’s physical landscape. This is precisely what Sethi found so liberating in rubber: it was a domestic product that could be re-appropriated for a completely different use.

In a sense, the Jaipur Foot provides a fitting conclusion to the exploits of nineteenth-century European imperialism. In his recent opus Late Victorian Holocausts, Mike Davis shows how European powers in India and Asia created the conditions for vast starvation by forcing their colonies to grow agricultural products for global distribution rather than local use.^[2] Davis argues that while tens of millions of Asians died in the droughts and famines of the 1880s and 1890s, imperial power brokers and policy makers in European capitals like London encouraged their subjects to resist the temptation of paternalistic aid, calling upon them to become self-sufficient in the face of adversity. Ironically, India’s development of a late nineteenth-century rubber monoculture for global use enabled a late twentieth-century rehabilitation model that emphasizes local materials and local artisans and supports local environments. These are self-sustaining technologies, not ones that rely on external resources or expertise. By contrast, it is the citizens of Western countries, succored at the breast of free-market economics, who have been forced to accept a paternalistic health care model that puts control and expertise in the hands of powerful HMOs and other bureaucratic medical organizations. Our dependence on the medical-industrial complex is proof enough that we have absorbed the legacies of colonialism to the degree that we are incapable of retaining control over our own bodies. It is we who accept medical authority (and its attendant expenses) in direct proportion to our physical vulnerability. This is the triumph of the Jaipur Foot over not only the legacies of nineteenth-century British colonialism, but over twentieth-century Western medicine in general.