Philip Chacko

Losing a limb is like to losing a loved one, only harder. Smita Kulkarni should know. A 37-year-old mother of two, this Pune housewife had her left leg amputated in June 2002 following complications from a blood-clotting condition. Ms Kulkarni’s world collapsed around her: crutches became a disliked necessity and despair a regular, unwelcome visitor. But just when it seemed that life would get worse with every passing day, she found sustenance — thanks to her hope and determination and some inspired engineering.

In January 2003 Ms Kulkarni came to know of the artificial-limbs project initiated by TAL Manufacturing Solutions, the Tata Group company that has carved a niche for itself in the machine tool and automation industry. Within weeks of coming to the fitting centre that TAL runs at its production facility in Chinchwad, near Pune, Ms Kulkarni had found her feet again. The transition — from depending on a walker to using an artificial limb — was not an easy one for Ms Kulkarni, but she now has her handicap under control.

Ms Kulkarni is one of many disabled people whose lives have been transformed by the high-quality artificial limbs, or prosthetic devices, that TAL’s ‘engineered mobility’ division manufactures. These products are vastly superior to the conventional wood-and-plastic prosthetic parts, typified by the ‘Jaipur foot’, that has been in wide use in India until now. They are made to world standards and are available at much lower prices than imported artificial limbs. Moreover, TAL’s prosthetic devices are produced specifically for Indians and Indian conditions.

TAL’s prosthetic products are replacement parts for the lower limbs, and they are the only ones of their kind made in the country. They use a structure of lightweight aluminium and steel. Cosmetic foam lends an enhanced look to the limb. These devices provide enhanced stability on any terrain, they take less effort to use, and are long lasting.

This is yet another standout example of the Tata Group using its expertise — in applied engineering in this case — to change the lives of ordinary Indians. According to the 2001 census, there are 4 million disabled people in the country. An estimated 1 million of them suffer from what are known as orthopaedic disabilities, with accidents being the major cause.

Traditional artificial limbs, woeful as they are, reach less than 10 per cent of India’s disabled. TAL’s engineered mobility division is poised to play a crucial role in bridging the chasm between the huge requirement for prosthetic devices in the country and their inadequate supply.

The company’s engineered mobility division was created in August 2000. The idea for the project took shape after an approach by the Artificial Limb Centre (Pune), which is part of the Indian army’s medical-services wing. The Centre, which was established during World War II and is one of the oldest artificial-limb facilities in India, wanted international-quality prosthetic devices to replace the conventional contraptions available in the market. This was in the aftermath of the Kargil conflict. The Centre believed that TAL could produce these limbs at a much lower cost to consumers than their foreign equivalents.

To begin with, TAL concentrated on above- and below-knee artificial limbs. The initial prototypes were taken through a rigorous and extended testing procedure. Some amputees were fitted with the new limbs in March 2001 for clinical and field trials. The results were encouraging enough to convince TAL that its footing was right.

"We then fitted these products on 22 patients across the country," says Prasad Dhume, the manager who heads the five-man engineered mobility team at TAL. "They were from the army, the All India Institute for Physical Medicine and Rehabilitation at Haji Ali in Mumbai, and there were amputees from Bhuj in Gujarat, from Bangalore and elsewhere. There was a fair sprinkling of people from across the country; different professions, different occupations."

TAL later established contact with Handicap International, a French non-governmental organisation working with the disabled. "We arranged for testing according to international standards. Indian prosthetic devices had never been tested in this manner. There were failures, but we improved our products, and we got it right." By September 2002 the company was ready to market its artificial limbs.

TAL has thus far sold more than 100 artificial limbs. That’s a modest number, but this is just the beginning of a project that has the potential to benefit tens of thousands of Indians. TAL’s products are vastly superior to conventional artificial limbs available in the country, and they cost a whole lot less than similar devices manufactured abroad, while matching them in technology, engineering and quality. A traditional artificial limb made in the country costs Rs 6,000-8,000. An imported device is priced between Rs 65,000 and Rs 1 lakh. TAL’s artificial limbs are available in the Rs 18,000-30,000 range.

The advantages of TAL’s products over devices of the Jaipur-foot variety are many:

• Conventional Indian artificial limbs, or ‘exoskeletal systems’, have low stability levels; the fear of the knee buckling is ever present. TAL’s prosthetic device, an ‘endoskeletal system’, is far more stable because it mimics the natural structure and movement of a leg, which means that a knee joint, for instance, will rotate and slide just like an anatomical knee joint.
• The effort that users have to put into walking or any such activity is high with old-style artificial limbs. Exertion levels with TAL’s products are a lot lower by comparison.
• TAL’s devices make the job of the prosthetist (the professional who fits artificial limbs) easier in terms of adjustment and alignment.
• Traditional prosthetic limbs are heavier than TAL’s, and clumsy to boot, and they have to be replaced every three to five years (the basic structure of a TAL product lasts a lifetime).
• TAL’s endoskeletal systems are modular in structure and are made of aluminium and steel. They are covered by cosmetic foam that’s shaped like a leg. Upgrading these devices — a necessity with children — is relatively easy.

TAL has 15 authorised centres across India where its prosthetic devices are fitted. These are run in partnership with non-governmental organisations and private practitioners, with TAL providing the training for those working at the centres. The intention is to put in place a robust delivery system that ensures high quality standards and effective rehabilitation. But TAL’s long-term plan is to concentrate on manufacturing and adding to its basket of prosthetic products, without having to worry about follow-up factors.

"We want to focus on development and delivery," says Mr Dhume. "We will use our Chinchwad centre to field-test our products, but our overall objective is to move the fitting and other activities to outside agencies."

As and when that happens, TAL will have more time and resources that it can dedicate to its goal of expanding its stable of prosthetic products in what is known as the biomedical aids and appliances business. These include upper limbs, mobility aids (such as motorised wheelchairs), therapeutic aids (splints, measuring devices, etc), and appliances (implants, surgical equipment, dental chairs, stretchers, etc).

For the present, though, TAL’s engineered mobility division is applying its technology expertise to help India’s handicapped live a life as close to normal as possible. In a corner of Pune, Smita Kulkarni will be singing hosannas to such commitment.