From WHAT CAN A BODY DO: How We Meet the Built World by Sara Hendren published on August 18, 2020 by Riverhead, an imprint of Penguin Publishing Group, a division of Penguin Random House LLC. Copyright © 2020 Sara Hendren.
One of the largest public hospitals in Asia is in the city of Ahmedabad, in India’s western state of Gujarat. The sheer magnitude and reach of the care it offers has resulted in an informal economy that thrives around and between its long row of buildings. Families camp out along its sidewalks and entryways, waiting for relatives or friends. Vendors in brilliantly colored clothing sell snacks, and dung patties for fuel, to these captive crowds, talking and trading as their paths are crisscrossed in every direction by mopeds, bicycles, animals, and pedestrians. And down at the end of the row, in the basement of a building that houses an extension of the hospital’s offices, there’s a small workshop for lower‐leg prosthetics. This is one outpost of Jaipur Foot, a nonprofit organization that designs, builds, and distributes their eponymous artificial legs all over India and in surrounding countries, at hospitals and in mobile clinics to Asia, Africa, and parts of South America. The signature Jaipur Foot is a below‐knee prosthesis, one designed to be the most robust and affordable of its kind.
On the day I stopped by the clinic, as a visiting professor running a design workshop at Ahmedabad University with my students in tow, a stone mason named Devansh from a tiny rural town was there for a fitting on what would be his fourth prosthetic leg from Jaipur Foot. Tall and taciturn, with a face weathered by many years of outdoor labor, Devansh told us the story of how he got his first foot. He’d gotten an infection after a bad fall twenty years earlier, and the infection had necessitated an amputation. He had spent a year without work while the leg healed, until he’d seen an advertisement for one of Jaipur Foot’s mobile clinics on television: a team was coming to his region. Getting that first leg had made it possible for him to return to work, and each replacement has come when the prior one has worn out its functionality.
My students and I watched as Devansh sat with the clinic staff, who wrapped his knee in plaster that, once dried, would make a reliable mold of the uniquely organic shape where his limb ended. Jaipur Foot’s limbs are made partly en masse and partly customized, in a smart mix of manufacturing and service that keeps costs low and distribution easy. The mold is used to shape the socket for more precise joinery between the leg and the plastic extension. The leg for Devansh wasn’t made with metals or carbon fiber; there are no electronics or circuitry of any kind. It’s made of a combination of rubber, lightweight willow wood, nylon cords, and high‐performance polyethylene, a strong and waterproof plastic with joints for bending at the knee and ankle. These limbs do the crucial work of weight‐bearing support and the bend‐flex required for a walking gait. The rubber and plastic used in these models is heavy‐duty, suited for multiple kinds of walking surfaces and weather conditions, and resilient over time; unlike prosthetic arms, the leg limbs have the benefit of gravity working in their favor, easily supporting upright human walking in a gait that presses down and pushes off for its locomotion. Each model costs around fifty dollars to produce, and most remarkable of all, almost all are given away for free, paid for by charitable organizations with local chapters. Since Jaipur Foot got its start in 1975, more than a million and a half of these limbs have been distributed in India and other countries, including places where land mines in conflict zones have created spikes in amputations.
I had traveled to India to see prosthetics like this one in use — the kind produced as technology for masses of people around the globe who are looking for replacement parts, a world away from the laboratories that create the elaborate customized arms and legs in the domain of Rehabilitation Engineering, with its military‐backed funding in search of simulacrum and enhancement. Those high-tech limbs invite the imprecise slang of “bionic” or “cyborg,” language used to describe both the prosthetics and the people who wear them. But Jaipur Foot is something else: it’s a product and a service, built on networked locality and strong communications to assist people like Devansh, who might otherwise opt for a wheelchair in a country with very little of the hardscape that makes wheeled mobility possible. For him, the leg and foot were the difference between two decades of work and unemployment. The fitting on the day of our visit was brief and efficient. Soon Devansh would be on his way.
My students and I let all our questions multiply and then dwindle; we took pictures and shook hands repeatedly with the group of men who had assembled as our hosts. As my students left in ones and twos, making their way through the hospital campus maze and its crowds on their mopeds, I thought about the product we’d just seen, inextricable from the web of connections that, together, produced the leg for Devansh. Jaipur Foot is just one of scores of examples like it around the world: organizations using low‐cost, readily available materials and local labor to create robust and elegantly designed prosthetics, suited to the living and working conditions at hand, for those with little money to spare. But this very ingenuity brings with it a host of questions we didn’t get into at the clinic. Would the availability of better healthcare have successfully provided treatment for Devansh’s original infection and obviated the need for an amputation? What about the multidimensional irony by which global armed conflict creates the technical leaps in engineering that produce the high-tech “cyborg”-style prosthetic limbs and also the land mines that inflict injuries that become amputations that necessitate replacement parts?
With just a little bit of digging below the surface, you can find prosthetics doing the work that all material culture does; they are artifacts that, under close attention, yield an index of infrastructure, local histories, and social norms. They carry stories that precede their manufacture and follow from their user—into conditions of life, into economics and family and work structures and more, conditions that are partly inherited and partly chosen. Prosthetics, like other designed objects, are ideas made real in things. When they’re used by human bodies, they become part of the story of those bodies, and the word cyborg could never even begin to indicate how deep and compelling these tales become. Cyborg talk is an easy passport out of the here and now and into a vaguely imagined future. Meanwhile, the parts‐and‐systems stories of everyday prosthetics are infinitely more interesting. Anthropologist and prosthesis user Steven Kurzman is impatient with the term cyborg altogether, with its slick commercial appeal. A prosthesis is an extension of the body, not its driver; it’s also a tiny node caught up in a constellation of manufacturing streams, politics, and history:
If I am to be [seen as] a cyborg, it is because my leg cost $11,000 and my HMO paid for it; because I had to get a job to get the health insurance; because I stand and walk with the irony that the materials and design of my leg are based in the same military technology which has blown the limbs off so many other young men; because the shock absorber in my foot was manufactured by a company that makes shock absorbers for bicycles and motorcycles, and can be read as a product of the post–Cold War explosion of increasingly engineered sports equipment and prostheses; and because the man who built my leg struggles to hold onto his small business in a field rapidly becoming vertically integrated and corporatized. I am not a cyborg simply because I wear an artificial limb, nor is my limb autonomous.
Amputees (and other disabled people using assistive technology) are not half‐human hybrids with semi‐autonomous technology; we are people.
A use‐centered lens recasts the meaning of prosthetics when they land in our own lives, compelling us to think both about the material of the object and about the real wonder that’s happening with all replacement parts: the wonder of human adaptation. What the gizmo does or doesn’t do will always pale in comparison to the real miracle at hand—each body, endlessly plastic, responsive, operating with and through technologies of all kinds to get its tasks done in a resourceful mix of workarounds, glitch‐ridden patchworks, quick fixes, and slow evolutions. A more meaningful perspective on tools takes into account not only technological effects or how many units are bought and sold but the whole context of use and adaptation: when and how people opt in or opt out, access to supplies for repair, local customs, and always — always — who has the power to decide. Together, these parts and systems and the ideas behind them form a mixed‐together story of how and when prosthetics arrive for and get taken up by people. It’s what philosophers of science call the realm of the biopolitical.