India’s Feet and Minds

NEW DELHI – Last month, I visited the Jaipur Foot clinic in New Delhi. You may have heard of the Jaipur Foot. It is both an invention – a prosthetic foot made from cheap materials costing about $45 (versus $8,000 for a similar device in the United States) – and an amazing, low-cost network of clinics around the world that has served more than 1.3 million people with new limbs, calipers, and crutches.

I was expecting something like a hospital – saintly ladies bustling around in white uniforms, earnest doctors with stethoscopes, and, of course, hospital beds. Instead, I found a hole in the wall; it looked more like a place where mechanics strip down used motorbikes.

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A group of people, some of them missing limbs, sat on a bench waiting to be served; others were limping or walking from one small room to another – from assessment to fitting to testing. Overall, there were roughly 50 customers (who paid nothing) in a set of six cramped rooms, plus a courtyard in the back with another six sheds. In those sheds, a dozen men were shaping rubber and plastic, baking the fake feet in autoclaves, and stretching molten plastic pipes over fiery molds to make the fittings that would connect feet with stumps of amputated legs.

I stayed for a couple of hours, during which I followed three people as they progressed from the fitting stage to walking around to test their new limbs. A doctor watched critically as each of the patients tested their new feet. One was still limping; so the doctor examined the foot and its fitting, and sent it back for more work. Fifteen minutes later, the man was walking normally.

Lost limbs are a huge problem in India. Most cases result from traffic accidents, including car crashes and falls from overcrowded trains, buses, and trucks. But there is also polio (now eradicated, though many still suffer from its effects), diabetes, civil strife, and other causes – 10 million people in all.

Earlier in my trip, I had visited a team developing a curriculum for plumbers (more on that below). So now, I wondered, why not provide training for the amputees as they return to their new lives? But in fact, they do not return to “new” lives. Now able to walk normally, they return to their previous careers. One Jaipur Foot owner is a runner; another is a dancer.

But many of them had no careers to begin with. Perhaps in the six months between the amputation and the new limb, someone could arrange for them to learn a new trade, such as plumbing. (I doubt that many people would intentionally lose a limb to get a free training course.)

Such a scheme would be consistent with the growing attention in India nowadays to addressing root causes, rather than just dealing (ineffectively) with bad outcomes. Indeed, despite India’s complex political and economic situation, its great expertise in scaling processes could have great impact if applied to the country’s own development.

It is a truism that China is the place to go for cheap manufacturing, whereas India is the home of cheap processes – call centers, X-ray reading, and the like. So far, much of that expertise has been used for the benefit of foreign customers and domestic businesses; but there is increasing interest in deploying it for broader public benefit. That includes miracles of personal service – not just the Jaipur Foot, but also the Aravind Eye Hospital. Yet hundreds of millions of Indians remain illiterate and unskilled.

Indian businesses and other institutions are finally beginning to see opportunity in addressing their country’s problems – which brings me back to plumbing. The training program I have in mind is part of a broader initiative that I saw at Amrita University, founded by Sri Mata Amritanandamayi Devi (known as Amma).

I was lured to the computer center at Amrita’s Ammachi Labs by a haptic simulator – in essence, a device that lets you feel directed pressure and vibrations (accompanied by an infernal noise!), like when one is cutting plumbing pipe. But in fact, sexy as the technology is, I was more impressed by the overall notion of practical courseware – and not just in plumbing – that could give millions of people marketable skills at a fraction of the cost of conventional vocational training, ultimately in many other fields, such as welding, carpentry, painting, and the like.

The plumbing course includes taps and faucets, how to lay and cut piping, and, finally, “plumbing ethics.” What was that? I asked.

Partly, it addresses safety, cleanliness, and how to charge for one’s work; but it also concerns respect for plumbers and the dignity of the individuals taking the course. In India, plumbing is a low-caste job (because it is connected with toilets and human waste); the course tries to fight that perception and instill pride in its students.

As it happens, plumbing is fraught with social significance in India; many girls do not go to school, owing to inadequate or broken plumbing. The course teaches women as well as men, and many of the women plumbers work in female sections of schools, hospitals, and other institutions where male plumbers are unwelcome or forbidden.

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And that is just plumbing. The lab acknowledges that online videos alone cannot effectively train most people; but they can provide a baseline of competence, to be supplemented by local training and practical exercises.

India has more than a billion people. The challenge is to think of them not just as mouths to feed, but also as minds to educate and skilled workers to employ. And, with a steadily widening focus on the underlying causes of India’s problems, perhaps a few million more will be able to stand on their own feet.