100 Limbs Project

---

Throughout much of the Global South, chronic musculoskeletal disabilities, as arise from motor vehicle and work-related accidents, now represent the most important source of days lost to disability, and the largest health care burden for African economies. For significant limb injuries, amputation is often the first line intervention due to the lack of advanced surgical facilities. Consequently, what might be serious, but transient, disabilities in wealthier countries, more often become permanent disabilities in low-income countries.  Impoverished amputees in remote rural areas are most vulnerable due to the lack of services and financial barriers to care. Solutions therefore need to be tailored to their circumstances. It would be impractical to model prosthetic services for rural Tanzania on the practices common to richer nations. 

As part of the 100 Limbs Project, we are testing a solution that employs Pressure Cast (PCAST) technology developed in Australia by Professor Peter Lee, of Melbourne University, and subsequently implemented in a number of countries in southeast Asia. In brief, the technology involves wrapping the patient’s residual limb (“stump”) in plaster of Paris, placing this inside a waterproof wrapping, and then immersing the wrapped limb in a tank of water. Water pressure molds the plaster wrapping to the residual limb allowing the rapid casting of a high-quality socket for the actual artificial limb. Tailoring the socket, using standard technologies, is the most time consuming, technically complex and expensive part of fitting a prosthetic limb. PCAST reduces all these barriers, and, because it is so simple, can be implemented in remote locations, even in the patient’s home – if adequately trained technicians are available. 

We are also piloting a 'Hub-and-Spoke' model of care whereby our trained clinical officers in remote clinics (the 'Spokes')  perform the casting, and then send casts to a central workshop (the 'Hub') where a qualified prosthetist assembles all of the components into the limb which goes back to the rural clinic for final fitting. The prosthetist can oversee this part of the work remotely through an internet connect, or make other arrangements for particularly challenging cases.

As our 100 Limbs Project progresses, we are celebrating may inspiring personal success stories, but also learning many lessons which will help us to template this intervention to other regions.