PRAMOD KARAN SETHI, the sixth of the eight children of Dr. Nihal Karan Sethi
and Maina Jain, was born November 28, 1927 in the holy city of Benares (Varanasi),
Uttar Pradesh, India. His father was a professor of physics at Benares Hindu
University and had been associated with the institution since its founding
in 1916. Benares University was formally recognized by the British
Government of India but was mainly supported by voluntary public
contributions. It had a strong nationalist orientation and drew its faculty
from Indian intellectuals eager to teach there on meager salaries for the
emotional compensation of participating in an institution attempting to
generate a value system encouraging scholarship, simplicity, sacrifice and
service to the nation.
SETHI feels that his father exercised the greatest influence over the
formation of his character. His mother was extremely devoted to his father,
SETHI says, "and had completely imbibed his firm principles on a code of
conduct, social reforms, and simple living." Mahatma Gandhi was a "major
influence in our family," he adds.
Although the elder Sethi had been raised in the rich tradition of a landed
Jain family and had a brilliant scholastic record which pointed him toward
advanced research in physics, he chose to dedicate himself to teaching,
seeking to make modern science available to Indian students at an
undergraduate level. He wrote the first physics textbook in Hindi and later
translated many scientific texts into Hindi from English. Raised as a Jain,
he was nevertheless a rationalist who believed less in traditions and
religious rituals than in doing the morally "right thing" and he imbued
SETHI, his six sisters and one brother, with a strong sense of rectitude and
desire for intellectual achievement. As a matter of principle he educated
his daughters and refused to follow the custom of providing them with a
dowry declaring: "I will spend money on the education of my daughters; that
is their dowry." SETHI's eldest sister was the first Jain girl to pass the
matriculation examination; his next sister became a doctor.
In 1930 SETHI's father transferred from Benares to Agra College, Agra, as
professor of physics and later principal. SETHI received his education in
Agra, attending St. John's School (1932-33), Balwant Rajput Intermediate
College (1934-42) and Agra College (1942-44).
SETHI describes his decision to embark upon a medical career as a matter of
chance. He was interested in science from his earliest school days but
doubted his aptitude for mathematics, preferring instead the study of
biology. Under the educational system then practiced in India, SETHI
explains, boys who opted for science studies in college had two choices: "If
they were good in mathematics, they became engineers. If they were shaky in
mathematics, they took biology. And if they took biology, they went into
medicine. That was the route I took."
SETHI graduated from Sarojini Naidu Medical College in Agra in 1949 with
bachelor degrees in medicine and surgery, and with honors in surgery and six
other subjects. In 1952 he received his Masters in Surgery from the same
institution. This degree was not recognized by the British Medical Council
and in order to pursue a career at a medical college, he had to become a
Fellow of the Royal College of Surgeons (F.R.C.S.). He applied to the Royal
College of Surgeons in Edinburgh, Scotland, and was allowed to enter on the
basis: of his outstanding record without repeating his undergraduate
examinations as was customary. He received his F.R.C.S. from Edinburgh in
Upon his return to India in December SETHI applied for and obtained the
position of Lecturer in Surgery at the government's Sawai Man Singh (S.M.S.)
Hospital (a teaching hospital) and Medical College in Jaipur, the
institution with which he is still associated.
In 1958, in order to comply with government regulations, the hospital
instituted an orthopedic department which SETHI was asked to start and head.
Although SETHI did not have orthopedic training the principal of the
college, one of his former teachers, prevailed upon him to take the job. His
first two years were spent in organizing the department and learning the
technical aspects of the work. "I learned it the hard way," he says. "If I
had had formal training at some center abroad my mind would already have
been made up on a number of issues. This can result in easy sailing in some
respects, but it also prevents one from thinking of alternatives."
There were no rehabilitative services at S.M.S. when SETHI began his work,
and he recognized the immediate need for physiotherapy. The only therapist
on the hospital staff was being used solely as a masseuse; his equipment
consisted of one case of talcum powder issued to him monthly. The hospital
had no apparatus and no money to provide it.
Making use of the Indian tradition by which grateful patients present gifts
to their doctors, SETHI ruled that doctors in his department could not
accept money, insisting that only a gift of something useful to the hospital
should be accepted. When patients tried to press money on him, SETHI asked
for equipment for his new physiotherapy section. As there were no sources of
ready-made equipment he requested and was given raw material components like
wood and pipes. One patient donated the wages of a carpenter and SETHI
himself set out to find craftsmen who could build parallel bars and similar
Physical therapy apparatus soon began to overflow from the small massage
room into the corridors of the hospital, with the result that SETHI was
allowed the use of an open courtyard for an exercise area and an
asbestos-roofed shed was thrown up to keep his equipment dry when it was not
in use. Now liberated from the massage room, the hospital physiotherapist
became enthused about his new activities and other members of the staff
asked to be trained as therapists. More and more patients were treated as
the section's activities expanded.
SETHI also focused on changing the character of the occupational therapy
practiced at that time, which emphasized training patients in simple
vocational skills such as weaving and knitting. He wanted to set up a
workshop in which patients could use materials designed to improve motor and
coordination skills while doing meaningful work. No space was available in
the hospital, but the opportunity to establish a work area arose when the
lease expired on a small tea shop on the hospital grounds. The shop had
gained a somewhat disreputable reputation as a "hangout for shady characters
from the town," and the hospital administrator was eager to put the building
to other use. He offered SETHI the space. Overnight SETHI set up his
workshop in the teahouse and moved in his staff. When the lease holder
protested the new arrangement, SETHI pointed out that the shop was being
used for treating patients: "How can you turn them out?" he asked.
SETHI was determined to use occupational therapy as a means of increasing a
patient's dexterity through participation in an engrossing activity; this
led him to use nonconventional techniques and equipment. Pedal-operated saws
gave patients the opportunity to exercise their legs while creating a
decorative object. Dice and card games were used to encourage hand and mind
coordination for stroke patients, and activities were designed to increase
hand and finger dexterity for the partially paralyzed. As with the
physiotherapy section the organization of this section was a response to the
recognition of specific needs, using the small staff and simple facilities
During this formative period as head of the Orthopedic Department of Sawai
Man Singh Hospital, SETHI became increasingly concerned with the problems of
providing appropriate and inexpensive appliances for polio patients and
amputees. The nearest sources of rehabilitative devices were over a thousand
miles away (in Bombay and Poona); only his wealthier patients could afford
the trip to obtain them. SETHI began to look for a way to set up a workshop
to create at least some of these appliances at the hospital.
SETHI noticed a male nurse, Mohammad Khan, who, while working in a room
where plaster casts were made, showed an active interest in mechanical and
technical matters. Khan came from a family of craftsmen; to test his skills
SETHI asked him to make splints and other simple aids. Recognizing Khan's
potential, SETHI seized an opportunity to send him to the Bombay All-India
Institute of Physical Medicine and Rehabilitation Workshop for a two-year
training program in the construction of appliances for the handicapped. In
six months Khan returned, having learned everything the institute could
teach him. SETHI thereupon set up a workshop for him in the old tea shop to
which an affluent patient had added two extra rooms, making it possible for
both Khan's shop and the occupational therapy workshop to be housed under
Khan's workshop became known as the Fabrication Unit and its first products
were calipers (braces) for polio victims. Polio in India is a disease
widespread among children; most Indians are exposed to it early in life and
by the time they are adults, have either contracted it or become immune.
Surgical intervention can straighten some of the deformities caused by
polio, but a child needs a caliper to support a paralyzed limb to enable him
to walk again. Calipers are fairly simple devices to make and the
Fabrication Unit became proficient in their production.
SETHI's growing confidence in the unit's capabilities led him to consider
the production of artificial limbs. The simplest limbs to reproduce were
those for amputees whose legs had been taken off below the knee, so in 1965
the Fabrication Unit started making limbs based on Western models using the
"Solid Ankle Cushioned Heel" (SACH) footpiece.
The SACH foot was designed to be worn with a shoe which disguised its
artificiality and protected it. Its rockered sole provided ease for walking,
but its rigid wooden keel—from ankle to instep—made it difficult for the
wearer to walk over rough ground and impossible to squat or sit
cross-legged. It was, however, a great improvement over the peg leg which
medical wisdom had decreed was the prosthesis to be provided to the poor.
"While it is true that a peg leg is simple and inexpensive," SETHI has
written, "even the rural amputee of today would reject it on cosmetic
grounds." Its appearance is a constant reminder of the maiming of the
wearer. It was the SACH foot, then, that the workshop made and which was
fitted to SETHI's patients.
During the first two years that these limbs were being made SETHI became
aware that the limbs were often discarded after their novelty wore off.
Investigation proved that the limbs had been constructed and fitted
properly, but that the wearers found them inappropriate to their needs. The
shoe presented most of the problems. It was superfluous for Indians who
customarily went barefoot in the fields, at home, at work and at places of
worship. It was expensive and deteriorated rapidly when exposed to water or
mud. In addition it severely limited postural flexibility.
Recognizing the defects of the prosthesis SETHI drew up criteria for an
ideal footpiece. He described his needs to the workmen in Khan's shop. The
foot should not require a shoe, therefore, it must look like a bare foot. It
should be waterproof and durable. It should be flexible enough to allow for
ease of walking over uneven ground and for its wearer to squat and sit
cross-legged. Finally, it should be made of inexpensive, readily available
The workshop technicians had enough formal training to lack the ability to
be innovative, SETHI comments wryly. While they were wrestling with the
problem another member of the hospital staff, a craft instructor, who had
been hired to teach vocational skills to paraplegics housed at the hospital,
became involved. Ram Chandra, whom SETHI affectionately refers to as "Masterji"
(great master), was a master craftsman and the son of a master craftsman. As
a boy he had been apprenticed to artisans working for the Maharajah of
Jaipur and had learned both decorative and craft skills. Princely patronage
waned after independence and Ram Chandra was employed by the government as a
teacher at a school of arts and crafts. When school attendance declined the
decision was made to send him out as a village schoolmaster, even though he
was lacking in formal education. SETHI, who knew of Masterji's talents,
arranged for his transfer to S.M.S. Hospital.
Masterji observed the experiments taking place in the workshop where Khan
and his helpers were struggling with the design criteria outlined by SETHI.
He began making suggestions. When a patient donated some simple hand tools
to him, he set up his own workshop in the kitchenette attached to a building
converted by SETHI from servants' quarters to a dormitory for paraplegics.
Among Masterji's many skills were metalwork and die-making. SETHI had a
simple furnace constructed in the courtyard. Using a plaster of parts model
of SETHI’s foot and an ancient sand-casting method for making statues, Ram
Chandra produced an aluminum die—the first breakthrough in making the
prosthesis which would later become known as the Jaipur Foot.
SETHI drawing on the experience in Sri Lanka of surgeon G. M. Muller who had
designed a rubber foot-like covering for peg legs worn by Sri Lankan rice
farmers, decided to pack the die with rubber. Knowing "next to nothing about
rubber," he asked tire manufacturers for help with vulcanizing the foot, but
received no assistance until he went to Chuga Bhai, owner of a one-man tire
retreading shop near the hospital. Bhai not only vulcanized the foot but
became so interested in the project that he refused payment.
The first rubber foot produced, although beautifully natural in form, was
heavy, stiff and the color of automobile tires. SETHI was so discouraged
that he put the project aside for almost a year. Mulling it over in his
mind, he decided to reduce the foot's weight by implanting the mechanism of
the SACH footpiece into the mold, displacing some of the heavy rubber. The
product was considerably lighter but no more useful for squatting or sitting
cross-legged than the Western model.
The doctor and the craftsman produced modification after modification.
Sections of the solid wooden keel of the SACH foot were successively removed
until a large area at the back of the foot was vacated. The space was filled
with glued layers of sponge rubber encased in a hard vulcanized rubber
covering. The foot became even lighter and more versatile, but it was not
completely adapted to squatting or sitting cross-legged. Finally, the SACH
foot assembly was eliminated completely and different components were used.
A carriage bolt anchored in a laminated wood block furnished strength at the
ankle. The sponge rubber heel section of the foot then acted as a universal
joint, permitting freedom of movement in all directions and allowing the
flexibility necessary for the amputee to sit in his normal manner. A single
wooden block, later supplanted by layered rubber, "provided rigidity to the
forefoot essential for efficient takeoff." Both components were wrapped in a
rubber casing reinforced with a rayon cord lining commonly used in
automobile tires. The life-like foot shell of vulcanized rubber— about two
millimeters thick—gave the components a durable and waterproof covering. The
flat sole of the foot was constructed from the rubber compound used for tire
treads and provided traction much like that of a tennis shoe.
The appearance of the foot was improved when an amputee's brother provided
colored rubber from his factory and the foot could then be made in a choice
of three shades—light, medium or dark brown— to correspond with the wearer's
skin color. The first feet produced were all the same size but later
different dies were made. The solid unseparated rubber toes, which had a
discouraging habit of getting knocked off during hard wear, were improved by
hollowing them out and packing them with light sponge rubber. A slit could
be made between the great and second toes to permit the amputee to wear a
Trials of the Jaipur Foot demonstrated its durability and comfort. An
unexpected bonus was the discovery that the broad flat walking surface gave
a feeling of security to the wearer which was not experienced when the SACH
foot was worn; the gait of lower limb amputees was very natural and they
were able to walk on uneven ground with remarkable ease. The tough rubber
shell provided "virtual immunity from breakdown" and most repairs to its
surface could be made in the same manner that bicycle tires are patched. The
versatile Jaipur Foot could also be inserted into an oxford by the
shoe-wearing urban middle class, and the adaptability of the footpiece to
walking on rough terrain could not be matched by the Western design. The
most ringing endorsement of the foot came from its wearers who found
satisfaction with its appearance, its comfort, and its adaptability to their
Masterji's shop became the center of production of the Jaipur Foot and of
light aluminum limbs which his skill as a metal worker made an inexpensive
alternative to the plastic and wooden limbs specified by current Western
design. SETHI dubbed the workshop his "Research and Development Department"
as modifications and improvements to the foot and limbs were being made
SETHI presented his first scholarly paper on the Jaipur Foot at the
Association of Surgeons of India's annual conference held in Bangalore in
1970. The following year he presented a paper on a modification for amputees
whose feet had been taken off at the ankle (Symes amputation), an adaptation
made possible by constructing the foot with a boot top which could be laced
on the leg. That same year he reported on the foot at a meeting of the
British Orthopedic Association at Oxford, England. The Western India
Orthopedic Society presented SETHI with a Gold Medal in 1973. In 1974
international attention was again called to the foot when SETHI was asked to
give the lead talk at the First World Congress on Prosthetics and Orthotics
held in Montreux, Switzerland.
In 1975 Arjun Aggarwal, a wealthy former patient from Bihar who had followed
and supported SETHI's experimental work, donated a large sum of money toward
the construction of a five-story rehabilitation center on the hospital
grounds. A matching grant of money from the State of Rajasthan and donations
of equipment and furnishings from other ax-patients allowed SETHI by 1976 to
consolidate his scattered departments into the handsome new building. The
Rehabilitation Center housed a modern workshop for Mohammed Khan and a staff
of formally trained technicians, and rooms for physiotherapy, occupational
therapy, classes and seminars, and a library which SETHI enthusiastically
stocked with professional publications.
Although Masterji Ram Chandra and his growing band of artisans retained
their workshop near the old courtyard where amputees awaited the
construction of their artificial limbs, it was Masterji who added the final
touch to the splendid structure. His gift was the poignant statue which he
made from hammered aluminum and placed at the new building's entrance. It
portrays an Indian peasant, cruelly maimed by accident or disease. The face
is thin and careworn, the body emaciated, the left leg long and muscular,
the right leg is missing. The figure, clad only in a tightly wrapped dhoti,
leans forward, supported by crutches. The statue is not a symbol of despair,
however, but of hope, for treatment lies within.
The same year in which construction of the new Rehabilitation Center began
marked the 2,500th anniversary of the attainment of nirvana by Lord Mahavir,
the "great hero" and spiritual leader of the Jains. Committees of Jains were
established to organize various activities appropriate to celebrate this
occasion, among them a committee headed by D.R. Mehta, a respected member of
the prosperous Jain community in Jaipur. Mehta's group formed itself into
the Mahavir Society for the Physically Handicapped (Bhagwan Mahaveer Viklang
Sahayata Samiti), and raised a large sum of money which it planned to use to
establish a rehabilitation center. Mehta, who had been SETHI's patient after
a severe automobile accident, sought the doctor's advice on how to go about
Contrary to the expectations and desires of the committee, SETHI advised
against creation of a new institution, arguing that the S.M.S. Hospital was
already building such a facility and that in any case construction of a
center would deplete the society's capital, leaving very little money to
assist the poor directly. SETHI suggested instead that the Mahavir Society
work with the hospital—which was often inhibited by government restrictions
and regulations—to supplement its treatment of the handicapped. Society
money could be invested and the interest used to pay the costs of services;
the untouched capital would insure continuation of the work. Mehta joined
SETHI in convincing the other committee members of the soundness of the plan
and in March 1975 the fruitful association of the Rehabilitation Center and
the Mahavir Society began.
Although established by Jains, the Society's membership was open to all
regardless of "sex, caste, religion or region." The cost of memberships
ranged from a modest two rupees (less than 25 U.S. cents) a year, to life
memberships of Rs.l,OOO for patrons. Donations were welcomed but not
solicited. The society's broad objective of helping the physically
handicapped was narrowed to that of providing free lower limbs and other
rehabilitative aids and services. SETHI became head of the three member
Technical Committee which was responsible for overseeing the work at the
Rehabilitation Center. Some society members volunteered to work with
amputees at the center, others were instructed to seek out the legless and
send them to Jaipur. The enthusiastic members, some of them amputees
themselves, spread the news so effectively that by the second year the
number of people helped by the society jumped sevenfold.
The Mahavir Society became an integral part of the Rehabilitation Center,
relieving the professional staff of routine work, short-cutting bureaucratic
restrictions and providing a hospitable reception for the amputees who
arrived every day. Additional artisans were hired for Masterji's shop to
provide for the increased demand for limbs, and society money was used for
the purchase of raw materials.
The construction of the Rehabilitation Center released hospital space in old
buildings surrounding the courtyard. The servants' quarters, previously
converted to SETHI's paraplegic ward, were reconverted, when the paraplegics
were moved into hospital wards, into two small offices and a large workshop
for Masterji's artisans and apprentices. Small storerooms in a building
which was originally a warehouse provided free lodging for the large number
of male amputees; women were housed separately. If their numbers exceeded
the space provided, amputees were sheltered under the asbestos-roofed shed
which formerly protected SETHI's physical therapy equipment. When the
weather was fine they could sleep in the open courtyard, where they could
also cook if the food provided by the hospital was not to their taste. The
courtyard well provided water for drinking and bathing.
Although most amputees arrive at the center without prior notice, often
accompanied by relatives, no one has yet been turned away. During the first
interview with the social worker the amputee is asked to write a message
home to inform relatives or friends that he has
arrived safely and is awaiting treatment. The social worker tries to find
out if he is eligible for government pension because of his disability and
helps him with the application if he is qualified. The center does not
charge for food or care; S.M.S. is a government hospital and both are free.
A simple kit containing toilet articles, a plate, a mug and a towel is given
to the amputee. Thus equipped, he enters the unique ambience of the
The courtyard is alive with activity as amputees attend to their daily
needs. The atmosphere is convivial and relaxed. SETHI seeks to maintain the
village atmosphere and the human scale in this part of the hospital. Most of
the amputees are quite healthy and would feel imprisoned if placed in the
sterile confines of a traditional hospital ward. However, Mahavir Society
volunteers move easily through the group engaging amputees in conversation
and making notes of their general physical condition so that if medical
treatment is necessary the hospital staff can be informed. While here the
amputee is encouraged to be selfreliant and care for himself. He is at home
with his peers who understand him and respect his individuality and the
communal experience helps build his confidence and self-esteem. Unless there
are urgent reasons for his limb to be made ahead of others, the amputee
settles down to wait his turn.
The process of making and fitting the new limb is described by
"The amputee comes and sits on a chair. The workman comes with a tape
measure. He is like a tailor. He makes no plaster cast, he just measures the
limb. He quickly notes the measurements down in a small notebook and then
takes an aluminum sheet. He draws a center line then quickly draws the
measurements and makes a pattern. He cuts it with shears. The sheet is put
on an anvil and the workman turns it into a tube. This is welded, then the
tube is shaped with a mallet. The workman looks at the patient—is he a fat
man, a lean man? He gives the leg the appropriate shape right away. Then the
workman fits the limb and
the patient says, 'It's a little tight here.' So, with a stroke of the
mallet, the correction is made. Now he says, 'It seems to be all right.'
Then the Jaipur Foot is inserted into the limb and the workman asks the
patient to stand . . . . the whole process from the measuring to the time
the patient stands on the limb is usually about 45 minutes. Then the man
sets out to walk and, if he finds the limb is not properly aligned, the
aluminum is cut or bent until he is satisfied."
The amputee's delight as he tries out his limb is an emotional experience
for everyone present. Other amputees crowd around him and shout out
suggestions as with growing confidence he takes his first steps. He is
supported and encouraged by them. "Here group therapy is being
unselfconsciously applied with great effectiveness," an observer has noted.
All share in the joy and renewed hope of the man whose limb has been
The amputee's length of stay at the Rehabilitation Center depends on the
number of patients awaiting limbs and, in some cases, on the difficulties
presented by the need for complicated fittings. A few have stayed for
several months, but the average stay is about three weeks. During the time
spent waiting the amputee may attend literacy classes, study a craft or a
trade, obtain additional medical treatment at the hospital or socialize
companionably with other patients who share his handicap.
The foundation of true rehabilitation has been laid with the provision of
limbs which are so life-like that the casual observer finds it difficult to
determine their artificiality, and so versatile that no longer does the
legless farmer have to go to the city to seek a sedentary occupation or beg
for his living. He is now able to perform the work he did before. The
Mahavir Society's final service to the amputee is the gift of a railway
ticket to his home; the hospital provides a packet of food to eat enroute.
He is sent away prepared to blend back into his community both physically
Before the Mahavir Society began to spread out through India to locate
amputees, most of the patients treated were from the area surrounding Jaipur
in Rajasthan. Since 1977 the majority of the patients have come from other
Indian states. The number of amputees fitted with limbs or other aids has
grown to over 2,000 in 1980, compared with 59 in 1975.
SETHI is aware of the problems created by the increasing number of amputees
seeking out the center. His hope is that the Jaipur model of uniting the
skills and services of doctors, craftsmen and volunteers can be duplicated
throughout India so that the handicapped can be served closer to their
homes. The Jaipur Rehabilitation Center, he feels, should shift from being a
service center to being a training center for artisans and doctors. SETHI
believes there is a danger, however, in trying to set up centers on the
Jaipur model too hastily, diffusing the "low technology" concepts of
providing services to the handicapped without a proper understanding of the
value system which has insured the success of the program in Jaipur. He
prefers that centers be established only in areas where responsible people
are available to take on the work: dedicated medical personnel, motivated
craftsmen and a responsible group of volunteers.
A rehabilitation center has been organized on that basis at Jodhpur's
Mahatma Gandhi Memorial Hospital where a chapter of the Mahavir Society has
associated itself with a doctor trained by SETHI, the "committed kind" who
SETHI feels is essential to marshal community support. Two workmen trained
in Ram Chandra's workshop have been sent to Jodhpur to establish a workshop
there. Other hospitals have used the Jaipur Foot and have sought technical
advice and information concerning the center's work which SETHI freely
SETHI has begun work on simple instruction manuals which will provide
step-by-step illustrations of the construction of rehabilitative devices
which local artisans could make from materials available in almost any
village. "Every village in our country has a cobbler, a carpenter and a
blacksmith," he writes. "If this group can make agricultural tools, bullock
carts or saddles for horses, why can't they make appliances for the
SETHI’s faith in the native intelligence and ingenuity of Indian artisans
has been justified by the stream of innovations from Masterji's workshop.
The design for the orthosis (aid) for polio victims has been improved by
replacing the shoe, to which the conventional caliper is attached, by a
wooden-soled, ankle-strapped sandal which is cooler, less expensive and more
in harmony with the wearer's life style. SETHI took the idea from the
Huckstep clog, originated by a British surgeon in Uganda to simplify
calipers for polio children, and made modifications based on a clog design
for lepers. Many structural failures were encountered which called for
continuous monitoring and refining of the caliper. It took almost 10 years
of experimentation in Masterji's workshop to arrive at the present design. A
bicycle axle, easily obtained in the markets of Jaipur, has been adapted as
a kneejoint mechanism, replacing the complicated and expensive component for
an above-the knee prosthesis specified by Western design. The appearance of
the aluminum leg was vastly improved when Masterji discovered that the
cotton stockinette cover of the limb, necessary for insulation from heat and
cold, could be given an extremely durable finish and a natural color by the
application of a coat of common carpenters' glue mixed with dye. The problem
of the artificial limb of an upper leg amputee slipping off the stump when
the wearer sat cross-legged, was solved by replacement of the leather strap
by an elastic one. With his usual generosity, SETHI has commented that he
finds an "illiterate artisan limb maker analyzing a limb on an amputee using
the same kind of logic I employ in my clinical work and I often find that
his analysis is superior to mine."
The existence of two workshops at the Rehabilitation Center has led SETHI to
compare the quantity and quality of their services. The workshop of the
formally trained rehabilitation engineers started by Mohammed Khan caters to
patients of the urbanized middle class, producing appliances of conventional
Western design. Masterji's workshop, which SETHI refers to as the
"indigenous technology workshop," serves primarily the poor, producing
appliances adapted to their needs. SETHI has found that the output from the
indigenous workshop is "more than double with less than half the investment;
the quality of products is superior and . . . patients are much more
satisfied." SETHI’s son Harsh, who has written a case study of the center
has noted: "There is a qualitative difference between a craftsman who has
learned his work as an art, a tradition, almost a philosophy, and a formally
trained technician. Both may be working with the same machines to produce
the same items, but their attitudes toward their work are strikingly
different. For the technician, the work is a job and nothing more. He does
not think twice before asking a patient to report to him a fortnight later.
This would be a sacrilege for a craftsman who is emotionally involved in his
The artisan's pride and personal concern have produced enormous bursts of
energetic work. In order to provide limbs for 80 patients waiting at the
center before Diwali, the great Hindu Festival of Lights, the craftsmen
worked unpaid through the night so "that every single patient could
celebrate the festival at home."
It is unrealistic, however, to expect that such enthusiasm can be maintained
consistently and the problem of arranging an appropriate salary scale for
the craftsmen has arisen. Without formal education or other credentials, an
Indian craftsman does not qualify for anything other than the lowest wages
under government job descriptions, wages which cannot match the artisan's
earnings when independently employed. SETHI has partially solved this
problem by arranging for the Mahavir Society to pay the full salaries of one
third of the artisans employed in Masterji's workshop, and to supplement the
wages of the others. A government sponsored training program for 10
apprentices resulted in a new government classification of "metal limb
worker" which granted a reasonable wage to the graduates; however, the
program has not been renewed since its beginning year and the wage problem
is still an issue.
As the work load has increased with larger numbers of amputees seeking limbs
each year, the problem of quality control has been exacerbated. In their
eagerness to provide appliances as soon as possible, some artisans have
produced ones that were hastily and imperfectly made. SETHI has had to coax
Masterji out of retiring several times when he had lost patience with
apprentices who found it difficult to maintain the standards of the
brilliant but tyrannical master. SETHI believes this problem can be solved
with the employment of a workshop director who can provide managerial and
organizational skills which the craftsmen may not possess. "The pride of a
master craftsman in his work has to be supported," SETHI writes, but "a very
close supervision of the work will have to be exercised by the medical
profession. If this is not done and ill-fitting limbs are produced, the
entire scheme shall lose its credibility."
To work meaningfully with the artisans SETHI believes that doctors must free
themselves of professional arrogance and share their knowledge with the
craftsman. "The Jaipur experience," he has written, "demonstrates that the
major difficulty resides in persuading the medical profession to demystify
its knowledge and participate in the program with conviction and
enthusiasm." He adds, "If we adopt a general policy of exhorting artisans
and learn how to communicate to them our requirements they are perfectly
capable of rising to the occasion and producing results with their
traditional technologies which are appropriate in every sense of the term."
SETHI’s trust in the abilities of his unlettered craftsmen led to
controversy with the Artificial Limb Manufacturing Corporation (ALIMCO), a
public sector enterprise established by the Indian government in 1971.
ALIMCO was set up to mass produce the various components of Western-style
artificial limbs, and the Rehabilitation Center at Jaipur was selected as
one of the five regional centers for dissemination of these components.
SETHI found that the limbs received were "ill-suited to Indian conditions,"
having been produced to British or American specifications and usually too
large and inflexible for the Indian amputee. Furthermore, not all components
were delivered together, resulting in long waits before a complete unit
could be assembled. The cost of the ALIMCO limbs was five to six times the
cost of those being manufactured in SETHI’s workshops. SETHI therefore
stored the unusable components and continued supplying limbs from his own
workshops. ALIMCO criticized the Jaipur Center for being "uninterested in
providing better technology to its patients" and cut off its money grants.
SETHI has recently been appointed to ALIMCO's Board of Directors and
foresees an opportunity to obtain a hearing for his own concepts.
SETHI is also disillusioned with medical and technical training which he
feels "confuses schooling with education" and trains personnel according to
the advanced medical practices of Western society, ignoring many of the
realities of the culture in which the training will be applied. In the field
of physiotherapy, for instance, SETHI has become convinced that the Western
emphasis on "increasing use of instrumentation and the treatment of more
complex problems related to old age, rheumatoid arthritis, spastics, spinal
bifida, etc.," does not relate to the disease and disablement patterns in
India where diseases like leprosy and polio are still major disablers.
Western training more often than not, turns out therapists who want to work
in the few affluent institutions which possess the facilities their training
demands. "It is the rich who get served," SETHI says, "the poor remain where
The answer, he believes, lies in using alternative training strategies which
emphasize "education and motivation of patients, handling larger numbers
with group exercises, increasing self-reliance so that revisits are reduced
and involving family members who can supervise and participate in home
treatment." Also needed is radical revision of physiotherapy techniques,
development of communication skills and awareness of the importance of
cost-effectiveness. A small group of therapists who would receive longer and
more intensive training could constitute a resource and supervisory group.
SETHI denies that he is advocating a lowering of standards. "Quite the
contrary," he says, "I want a therapist . . . . who knows what is important
and what is not."
SETHI’s clear sense of values and priorities in his work with the disabled
continues to draw others into this service. Young doctors, trained by him,
have imbibed his philosophy of "indigenizing and demystifying" the delivery
of services to the handicapped and have helped spread his ideas. Jaipur
tradesmen contribute much of the raw material used by the center's artisans.
Private and public donations to the Mahavir Society have increased its
capital tenfold during the six years of its existence.
The work of the Rehabilitation Center has received increased popular
attention in newspapers and magazines. Government officials and medical
professionals who have seen the work have left the center's visitors' book
studded with compliments. SETHI’s contribution has been recognized by his
receipt in 1978 of the B.C. Roy Award as "Eminent Medical Teacher," and of
the Padma Shri (Exalted Jewel) honor from the Indian government in 1981.
SETHI’s strenuous schedule has left no mark on him physically. He is a trim
man who looks younger than his years, despite the horn rimmed spectacles
which give him the look of a scholar. He is soft spoken but eloquent; his
conversation is serious but with an occasional turn of phrase or inflection
of voice which demonstrates a quiet sense of humor. He lives simply; his
recreation consists of omnivorous reading and listening to classical Indian
ragas and a melange of Western jazz, early rock and folk music. He belongs
to no social clubs and takes no vacations, preferring to spend his leisure
at home with his family.
SETHI’s wife, the former Sulochana Patni, married him in 1951 while he was a
medical student and has devoted herself to rearing their three daughters and
one son—Lata, 29;Harsh, 28;Nita, 25and Amrita, 19. She has accepted SETHI’s
lack of social life without complaint; he considers her understanding
attitude a contribution toward his work. She is a frequent visitor to the
center where she has developed a warm rapport with workmen and amputees who
often share with her their complaints and problems. She has become a fast
friend of Masterji, spending several days at his home when the craftsman's
wife needed help in arranging a daughter's wedding.
SETHI’s work at the Rehabilitation Center includes a rigorous routine of
surgery and teaching which consumes 70 percent of his time. The remaining
hours are spent working with the amputees. His mandatory retirement from
government service in 1982 will free him from these responsibilities, but
his association with the center will continue through his position on the
Technical Committee of the Mahavir Society. He plans to start a small
private practice; "otherwise I will starve," he remarks half humorously.
The doctor can take satisfaction from his 27 years of work with the Sawai
Man Singh Hospital and Rehabilitation Center. He has demonstrated new
approaches to the problems of rehabilitation by proposing alternatives which
proceed from the needs of the handicapped rather than dictated by formal
training. He has encouraged the production of models of rehabilitative
appliances—especially adapted for the poorest Indian—which can be
constructed from readily available materials. He has inspired and drawn
together into a supportive association three diverse elements of Indian
society—medical professionals, laymen from the community and traditional
craftsmen; each sector has gained increased respect for the others in their
work and shared devotion to their countrymen's needs.
With customary modesty, SETHI gives himself little credit for what he has
done, referring to himself as "more of a technician—less of a leader than a
catalyst." Evident in him, however, is the quality he admires in others: he
is a "man who knows what is important and what is not."
"Bhagwan Mahaveer Vikland Sahayata Samiti," Jaipur: Rehabilitation Center
Sawai Man Singh Hospital. N.d.
"He Designed Limbs to Suit Indians," Indian Express. Delhi. August 3, 1981.
"Jaipur Body Develops New Artificial Limbs," Financial Express. Bombay.
January 1, 1981.
"Jaipur Foot Helps Disabled to Cycle," Indian Express. Delhi. January 8,
Khandekar, Sreekant, "Best Foot Forward," India Today. Delhi. August 16-31,
"Normal Life with Aids," Indian Express. Delhi. January 8, 1981.
"Rehabilitating the Disabled at Jaipur," Patriot. Delhi. January 11, 1981.
Roy, Bunker. "Rehabilitation with a Difference," Lok Kalyan, Official
Journal of the Ministry of Social Welfare. Delhi: Government of India.
Sethi, Harsh. The Rehabilitation Research Centre; Jaipur. Alternatives in
Development Case Studies, No. 1, Kothrud, Pune: Indian Institute of
Sethi, Pramod Karan. "The Foot and Footwear," Prosthetics and Orthotics
International. Copenhagen: International Society for Prosthetics and
______."The Physiotherapy Situation-a Plea for Alternative Strategies,"
paper delivered at Annual Meeting of Physical Therapists, Jaipur. 1981.
______."The Use of Appropriate Technology in Rehabilitation Aids," paper
read before the I.C.M.R. Conference on Appropriate Technology in Primary
Health Care. April 23-26, 1981.
______."Utilization of Traditional Craftsmen in Production of Rehabilitation
______, M. P. Udawat, S. C. Kasliwal, and R. Chandra. "Vulcanized Rubber
Foot for Lower Limb Amputees," Prosthetics and Orthotics International.
Copenhagen: International Society for Prosthetics and Orthotics. Vol. 2,
1978, p. 125-136.
Interviews with Dr. P. K. Sethi and with persons acquainted with his work.
Visit to S. M. S. Rehabilitation Center.