Pramod Karan Sethi, popularly known as Dr P.K. Sethi made a unique contribution in the field of orthopaedic rehabilitation by developing ?Jaipur Foot?, a wood and rubber ankle foot prosthesis, which has changed the lives of millions of amputees in the developing and underdeveloped countries. He was born on November 28, 1927, in the holy city of Banaras (Varanasi) in India. His father, who was a professor of physics at Banaras Hindu University, exercised greatest influence over him. BHU'snationalistic environment of pre-partition days created a style which was essentially swadeshi, ascetic and deeply devoted to scholarship. In words of Sethi, ?my father imbued me with a strong sense of rectitude, doing things ?morally right? and a desire for intellectual achievement. Dr Sethi graduated from Sarojini Naidu Medical College, Agra in 1949, with honours in Surgery and six other subjects. In 1952, he received his Mastership of Surgery from the same institution. This degree was not recognised by the British authorities and in order to pursue a career at a medical college, it was necessary to become a Fellow of the Royal College of Surgeons. He applied to the Royal College of Surgeons of Edinburgh and was selected, due to his outstanding academic record, without repeating his undergraduate examination, as was customary in those days. He received his FRCS in 1954. Upon his return to India, Dr. Sethi joined as lecturer in surgery at the Sawai Man Singh (SMS) medical college, Jaipur. For the next 28 years, he worked in that institution and after retirement in 1982, continued his professional career and research work in another local hospital, the Santokba Durlabhji Memorial Hospital.
A general surgeon by training, like most of the orthopaedic surgeons of his generation, he was asked to start the department of Orthopaedic Surgery in the local medical school by the then principal of the Sawai Man Singh Medical College, Jaipur, India, in 1958. Even though he took Orthopaedics reluctantly, once he consumed himself in its practice, he realised the potential, as well as the limitations of modern Orthopaedics, in relation to the needs and resources of the less developed world. Development of the ?maintenance free? and low cost Jaipur foot, using locally available material, technology and skills of local artisans, was an eye-opening experience to him. He saw clearly that the major orthopaedic problems in the developing world are due to infection, deformities, neglected trauma and lack of access to health care facilities, all a sequel of poverty and illiteracy. He soon realised the futility of the majority of expensive, high-tech solutions of orthopaedic problems as suitable only for a small part of the world population, who can afford it. In fact, Sethi realised that not being formally trained as an orthopaedic surgeon was an asset rather than handicap as he was not hampered by the traditional ideas and could think ?outside the box?.
During the early stage of his career, he came across a large number of amputees, mainly young people, who had lost their legs as a result of accidents or due to infections; unlike western countries where the majority of amputations were due to peripheral vascular diseases in an elderly population. There were not many limb fitting centres in India in those days and amputees from Jaipur would need to travel to centres such as Pune which were more than 500 miles away, to get the limb fitted. Very few amputees could afford the trip and those who could, would throw away the limbs after some time and revert back to the crutches. It puzzled him but soon he realised that the limbs fitted to them were totally unsuitable for their needs. The western designed limbs made of polymers would not let them sit on the floor, walk barefooted, work in fields, mud and water and would break easily. He analysed that the ?floor sitting? life style and culture of a warm country like India was different to the ?chair sitting? culture of the colder countries of the western world and the solutions found there would be alien to the problems of Indian amputees. He, therefore, embarked upon designing a suitable prosthesis for Indian amputees and as they say?rest is the history.
When he made the first technical presentation of the foot, he was advised to call it ?Sethi Foot?. He refused and instead, named it as ?Jaipur Foot? after the name of the city, which remained his karma bhoomi (place of work) throughout his life. Sethi did not patent his invention in spite of the fact that he could have made millions. He knew that this foot was so simple to fabricate that it could be made in any village which had a local artisan, so let everyone who could make, produce it. It would innovate and improve. The sheer number of amputees in India is so large that it needs unconventional solutions. It is because of his innovative approach that Jaipur foot has been fitted to millions of amputees in India, Pakistan, Sri Lanka, Bangladesh, Vietnam, Cambodia, Afghanistan and many countries of Africa. A model of Jaipur limb is also on display in the Imperial War Museum, London in the Land Mine section.
When Sudha Chandran, the south Indian dancer, lost her leg in an accident, she tried various different types of artificial legs but could not dance which she desperately wanted to do. Somebody told her about Jaipur Foot and she came to see Dr Sethi. In the words of Dr Sehti??when she asked me if I would be able to dance again after using the Jaipur Foot, I simply told her, it all depends upon your determination. Jaipur Foot would definitely help you in that.? As everyone knows she could dance perfectly well after that but Dr Sethi gave all the credit to the her, rather than to the Jaipur Foot. The film Nache Mayoori was her true life story. Dr Sethi once told me as to how the film was conceived. After getting the Jaipur Foot fitted, Sudha Chandran gave her first public performance in Mumbai. She specially invited Dr Sehti for that. Vijay Merchant, the former Indian cricket player and famous philanthropist was sitting besides Dr Sethi. After the performance, everyone was deeply moved. Dr Sethi than suggested to Vijay Merchant that her life story can be very inspiring for many people in India if it is made in a film and shown around. Soon a film was made which also transformed Sudha Chandran from a dancer to an actress.
There is another aspect of his research, which has largely gone unnoticed. The Jaipur Foot has overshadowed his other research interests and inventions. He worked to provide suitable callipers to polio-affected people since the 1950?s. Polio was and remains the biggest cause of deformities and immobility in India. Similar to the artificial foot, the callipers for polio were unsuitable for the patients, being quite heavy, uncomfortable and expensive. He collaborated with the Indian Institute of Technology Mumbai and the National Chemical Laboratory, Pune to develop polio callipers, which were made of polyurethane and were lighter and cheaper.
Unfortunately, Dr Sethi died as a disillusioned man in Jaipure, India on January 6, 2008, even though he received all the awards, a doctor in India could dream of, including Dr BC Roy award, Ramon Magsaysay award, Guinness award for scientific achievements, Knud Jansen Medal and Oration and many others. He felt that new generation of doctors in India are being seduced by western ideas, and are simply trying to copy and apply them in India. He was of the firm view that the problems of Indian patients are quite different from their western counterparts and the ?one size fits all? concept would not work. He was aghast at the crass commercialisation of medicine, excessive use of drugs and investigations and undue influence of pharmaceutical companies. He often regretted that today'sdoctors are so obsessed with technology that they have stopped listening to the patients, and have forgotten the art of communication, an art that plays such an important role in the equation for recovery. His greatest regret was that he has not been able to pass his idealism to the younger generation of Indian doctors.
(The writer is working in the Department of Trauma & Orthopaedics, Kings College Hospital, London and can be contacted at [email protected])