One of the key elements of the Fit 4 Purpose project is that any upper limb prosthesis that is developed is able to be manufactured from locally sourced materials in LMICs where possible. This approach has a number of significant potential benefits over relying on imported materials and components. Locally sourced materials should in principle end up reducing the cost of production of a device since there is no need for long distance shipping, therefore also reducing the cost to the end user. With the cost of a prosthetic limb being one of the major barriers for the vast majority of individuals with limb absence in LMICs, this is a huge advantage for any new prosthesis design. It is important that any materials necessary to facilitate repairs are readily available and affordable in order for provision to be sustainable and have a lasting impact, as is ensuring that replacement components are accessible when required. This also opens up the potential for repairs to be undertaken away from specialised workshops, which is desirable since travelling to these can present a barrier for users who are often required to travel large distances across countries where this can be challenging- we managed to gain a very personal experience of this on the Link bus!
With this in mind, a group of students from the University of Salford spent four weeks visiting orthopaedic workshops in Uganda in August and September to investigate supply and availability of materials, alongside an elective clinical placement organised by the knowledge sharing charity Knowledge for Change. We visited a number of sites and spent time working with and learning from orthopaedic technologists in both state and NGO funded facilities across the country. This allowed us to have a first hand experience of the supply and availability of the materials and components for prosthetic and orthotic provision in the country, as well as investigating the viability of other local materials that could potentially be used in the design of a new prosthesis. In addition to this, we were able to speak to the patients themselves to gain a real insight into user preferences and cultural sensitivities, which could really have an effect on the way any future device is received. Some early prototype components for a new prosthetic socket were manufactured locally and will be tested back in the UK, before feeding into the development process.
One thing that was clear from the time we spent in Uganda was the need for the device that the Fit 4 Purpose project aims to develop. Speaking to upper limb amputees in Uganda confirmed that the majority did not currently wear a prosthesis, with the cost of a suitable limb being simply unrealistic given their personal circumstances. Another promising finding from the research visit was the enthusiasm and positivity with which the orthopaedic technicians met the project; it was really interesting to be able to share methods and best practice, and see how they are able to adapt to differently resourced settings. The way this network of professionals respond to any new device is likely to be vital to successful implementation in the country. These are encouraging signs for everyone involved with the project.
We would like to thank Fit 4 Purpose, Knowledge for Change, Legs4Africa and our hosts at Makerere University, Mulago National Referral Hospital, Fort Portal Regional Referral Hospital and Katalemwa Cheshire Children’s Home for making this trip possible and enjoyable, and allowing us not only to broaden our knowledge in our field, but also to explore such a beautiful and welcoming country.