“It’s demoralizing for us to amputate an arm knowing that there is no good solution,” Catena told me by email. “We have many arm amputees—both above and below the elbow as a result of the war here and general lack of medical care. This in an agricultural society, where nearly everyone is a subsistence farmer. If one is missing an arm, he is not very functional in this society. They become totally dependent on the family and they have a difficult time getting married (also very important in this society).”
The idea of using 3-D printing to help arose when Mick Ebeling, an American film producer and philanthropist, learned about this work at the same time as he was hearing about the emerging work on low-cost prosthetic hands. Searching for information on Catena, Ebeling read about one of his patients: Daniel Omar, a 12-year-old boy who had wrapped his arms around a tree to protect himself during an aerial attack. His face and body were protected when a bomb exploded nearby—but both the boy’s arms were blown off.
Ebeling travelled out with printers and, working with hospital staff, fitted about a dozen people with new arms. “Unfortunately, as time went on, none of the amputees were using the prostheses as they felt they were too cumbersome,” said Catena. The doctor concluded that “the 3-D model was good, fairly easy to make and inexpensive… although it hasn’t worked out so well here, perhaps with some tweaking, the 3-D printers can be of great use for arm amputees.”
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Yet for all the agonies and difficulties associated with arm loss, the bigger problem in low-income countries is when lower limb disability leads to loss of mobility. Wheelchairs are expensive and can be difficult to use when roads are pot-holed, streets are muddy and pavements are non-existent. Without a prosthetic limb, people struggle to fetch water, to prepare food and, above all, to work. This throws them back on their families and communities, intensifying any hardship and poverty.
One group that has spent almost three decades trying to tackle such issues is Exceed, a British charity set up by diplomats and academics at the request of Cambodia’s government to help thousands of landmine survivors. It works in five Asian countries, training people at schools of prosthetics and orthotics. In Cambodia, there are still almost 9,000 landmine survivors in need of artificial limbs, although these days traffic accidents are a more likely cause of disability, while children also need braces for a range of common conditions such as spina bifida, cerebral palsy and polio.
“If you wear a prosthesis you are disabled for about ten minutes in the morning while you have a shower, then you put your leg on and go to work. If you do not have one, then your hands are out of use with crutches so you can’t even take drinks to the table,” said Carson Harte, a 59-year-old prosthetist and chief executive of Exceed. “Without a prosthesis there are no expectations. You just go back and rely on the goodwill of your family.”