ORIGINAL ARTICLE |
https://doi.org/10.5005/jp-journals-10079-1107 |
A Novel Idea of an Orthopedic Surgeon that Changed the Lives of Differently-abled Persons Who have Lost Their Limbs in Tamil Nadu: Reaching the Unreached
1Department of Emergency Medicine, Government Udhagamandalam Medical College, Udhagamandalam, Tamil Nadu, India
2Bragathi Hospital, Coimbatore, Tamil Nadu, India
3,4Institute of Orthopedics and Traumatology, Coimbatore Medical College Hospital, Coimbatore, Tamil Nadu, India
Corresponding Author: Ranjith Kumar Selvaraj, Department of Emergency Medicine, Government Udhagamandalam Medical College, Udhagamandalam, Tamil Nadu, India, Phone: +91 8668036279, e-mail: drran89kumar@gmail.com
Received on: 03 September 2022; Accepted on: 05 September 2022; Published on: 03 January 2023
ABSTRACT
Aim: Among the disabilities in India, locomotor disability ranks the highest among others due to a growing number of road traffic accidents, diabetic foot, peripheral vascular disease, and cancers that have led to the loss of one or the other limb; the primary aim is to study about how an idea of an orthopedic surgeon Professor S Vetrivel Chezian of creating an artificial limb production center at Coimbatore Medical College and Hospital has changed the lives of locomotor disabled persons and also provided monetary benefit to the government.
Background: The idea of an orthopedic surgeon Professor S Vetrivel Chezian at Coimbatore Medical College and Hospital to start a lightweight artificial limb prosthesis production center with Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Tamil Nadu Chief Minister’s Comprehensive Health Insurance Scheme (TNCMCHIS) funds without expenditure to the government but creating revenue to the government at the Institute of Orthopaedics and Traumatology, Coimbatore Medical College and Hospital to benefit locomotor disabled persons.
Results: Lightweight artificial limb prosthesis production center started at the Institute of Orthopaedics and Traumatology, Coimbatore Medical College and Hospital, benefiting about 101 locomotor disabled persons to lead their life independently within 2 years of its establishment without any expenditure to the government rather making monetary benefit to the government under AB-PMJAY-TNCMCHIS.
Discussion: An innovative idea of Professor S Vetrivel Chezian in using AB-PMJAY and TNCMCHIS fund generated by the Institute of Orthopaedics and Traumatology, Coimbatore, Tamil Nadu, India to establish a lightweight artificial limb prosthesis production center at Coimbatore Medical College and Hospital which gave not only new lives to locomotor disabled persons of very low socioeconomic status but also generated monetary benefit to the government for the infrastructure development of the institution.
Conclusion: An idea by orthopedic surgeon Professor S Vetrivel Chezian is to be followed in all government institutions in India, which will lead locomotor disabled persons of the country to lead their life independently with confidence and also generate monetary benefit to the institution to improve health care in India.
How to cite this article: Selvaraj RK, Rathinasamy S, Balakumaran A, et al. A Novel Idea of an Orthopedic Surgeon that Changed the Lives of Differently-abled Persons Who have Lost Their Limbs in Tamil Nadu: Reaching the Unreached. J Orth Joint Surg 2023;5(1):16-19.
Source of support: Nil
Conflict of interest: None
Keywords: Artificial limb production center, Ayushman Bharat Pradhan Mantri Jan Arogya Yojana-Tamil Nadu Chief Minister’s Comprehensive Health Insurance Scheme, Lightweight artificial limb prosthesis, Locomotor disability
INTRODUCTION
In modern India, the most common locomotor disability is due to the loss of limbs. The most common cause of loss of limbs is due to trauma. Other conditions like diabetes mellitus, peripheral vascular diseases, and malignancy are also causes for loss of limbs.1 People with locomotor disabilities are deprived of their basic independence, which is required to have a productive social life. For the activities of daily living like taking a bath, attending nature’s call, eating, and wearing clothes, they have to depend on others.
In India, most people who have lost their limbs are from below the poverty line. Hence, the whole family will be in physical, mental, and financial agony as they may be the only earning member of the family. Hence, people who have lost their limbs are under depression since they have to depend on others for everything, leading to suicidal thoughts.2
In India, Coimbatore is known as an industrial hub and is also called the Manchester of South India.3 Coimbatore Medical College and Hospital is more than 50 years old. Even then, the persons who have lost their limbs in and around Coimbatore have to go to Chennai to get an artificial limb, or they have to depend on nongovernmental organizations like the Rotary club, Lions club, or Sathya Sai foundation for the artificial limb. The objective of the novel idea of Professor S Vetrivel Chezian is to produce and provide modern lightweight artificial limbs with complete rehabilitation using a multidisciplinary approach to the persons who have lost their limbs without expenditure to the government under AB-PMJAY-TNCMCHIS in Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India. The genesis of the modern lightweight artificial limb production center by the novel idea of the orthopedic surgeon, Professor S Vetrivel Chezian, who changed the lives of the persons with locomotor disabilities who have lost their limbs and how it reached the unreachable people below the poverty line are discussed in our study.
MATERIALS AND METHODS
The study was done in the Institute of Orthopaedics and Traumatology, Coimbatore Medical College and Hospital, from August 2020 to August 2022. A total of 91 males and 10 females benefited from the venture. The lightweight prosthesis was provided to all the beneficiaries in our study under AB-PMJAY (Figs 1 and 2) and TNCMCHIS (Figs 3 and 4).
Fig. 1: Government of India logo
Fig. 2: Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana logo
Fig. 3: Government of Tamil Nadu logo
Fig. 4: Tamil Nadu Chief Minister’s Comprehensive Health Insurance Scheme logo
Professor S Vetrivel Chezian, Director, Institute of Orthopaedics and Traumatology, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India, having perceived the difficulties and hardships faced by persons who have lost their limbs for many decades, have come up with a novel idea to start lightweight artificial limb production center and discussed with the then Dean in charge, Professor Kalidas. Professor Kalidas formed a committee to start an artificial limb center in Coimbatore Medical College and Hospital under the leadership of Professor S Vetrivel Chezian.4
Professor S Vetrivel Chezian had a detailed discussion with the physiotherapist, orthotist, occupational therapist, orthopedic surgeon, and psychiatrist. As per the discussion, it was decided to start the artificial limb center in Coimbatore Medical College and Hospital without extra expenditure to the government, even though a qualified physiatrist was not available. A protocol was formed for the management of such beneficiaries by Professor S Vetrivel Chezian formed the multidisciplinary approach protocol. According to the protocol, the persons who have lost their limbs are to be admitted to the orthopedic ward under the orthopedic team; 10 beds will be exclusively utilized for the persons who have lost their limbs. The fabrication of artificial limbs will be done by the orthotist, gait training by the physiotherapist, and occupational counseling will be given by the occupational therapist. Counseling about improving the mental ability to stand on their own and to use the artificial limb to become independent will be addressed by the psychiatrist.
Hence, the existing manpower will be better utilized. Regarding infrastructure, the existing building will be renovated as per the needs of the lightweight artificial limb production center, and the cost of renovation and the entire procuring of the accessories will be taken care by recycling AB-PMJAY-TNCMCHIS, the orthopedic fund generated by treating orthopedic patients as per the novel idea of Professor S Vetrivel Chezian without extra expenditure to the government.
The lightweight artificial limb production center was established during the COVID-19 pandemic in July 2020 at the Institute of Orthopaedics and Traumatology, Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India.
RESULTS
The modern lightweight artificial limb production center work was initiated and completed within 60 days, and the idea was executed flawlessly overnight. Since Professor S Vetrivel Chezian, Director, Institute of Orthopaedics and Traumatology, was in charge of the Department of Physical Medicine and Rehabilitation, it was easy to coordinate Orthopaedics and Physical Medicine departments and to work efficiently for patients from below the poverty line.
The first transtibial lightweight artificial limb prosthesis was fitted to a lady who had lost her limb due to diabetes mellitus on 15th August 2020 under the AB-PMJAY-TNCMCHIS. After that, more than 100 persons benefitted from the lightweight artificial limb center under AB-PMJAY-TNCMCHIS.
A total of 61 persons were fitted with transtibial prostheses, 27 persons were fitted with transfemoral prostheses, six persons with transradial, and seven persons with transhumeral prostheses were provided as their genuine rights as citizens of India. A total of 10 females and 91 males were among them (Fig. 5). Transtibial prosthesis was fitted more than any other prostheses.
Figs 5A and B: Image of bilateral upper limb and bilateral lower limb amputee. (A) Before prosthesis; (B) After prosthesis
Guidelines provided by the Government of Tamil Nadu were followed in full spirit by Professor S Vetrivel Chezian and the administration. As per the government order, 25% of the claim amount goes to the institutional account to improve infrastructure. The profit is generated at the institutional level and will be used to repay the money used to start the modern lightweight artificial limb production center under AB-PMJAY-TNCMCHIS (Table 1). Hence, the Coimbatore model has very easily converted the expenditure concept to a profit concept.4 Money more than the recycled money was generated, and hence, the profit could be used to procure more accessories and for the maintenance and welfare of the center. Hence, this project will be sustainable and profitable forever under AB-PMJAY-TNCMCHIS.
| Prosthesis | Beneficiaries | Claim amount | Actual cost | Consumables | Infrastructures |
|---|---|---|---|---|---|
| Transfemoral prosthesis | 27 | 1,419,524 | 745,200 | 851,714 | 354,881 |
| Transtibial prosthesis | 61 | 1,566,550 | 622,200 | 939,930 | 391,637 |
| Transhumeral prosthesis | 7 | 500,100 | 275,730 | 300,060 | 125,025 |
| Transradial prosthesis | 6 | 242,000 | 93,600 | 145,200 | 60,500 |
| Total | 101 | 3,728,174 | 1,736,730 | 2,236,904 | 932,043 |
DISCUSSION
India is the largest democratic country with a large number of individuals in the community with various locomotor disabilities, mostly due to loss of limb. It has been estimated that there are roughly 0.62 amputees in India per 1,000 population. This equals to more than 1 million individuals with amputations in the country.5
The novel idea of Dr S Vetrivel Chezian, who understood the hardships of persons with disabilities, has resulted in the establishment of an artificial limb production center at the Coimbatore Medical College and Hospital without any expenditure from the government. This feat was achieved even though a physiatrist was not available at that time. In this way, the unreached persons from below the poverty line have enjoyed a new lease of life with lightweight artificial limbs under the AB-PMJAY-TNCMCHIS. Dr S Vetrivel Chezian was efficient in coordinating with all the necessary subdisciplines to make this idea possible.
The only available artificial limb reconstruction center at that time was in Chennai. Hence, the beneficiaries in and around Coimbatore had to travel all the way to Chennai and get the limb fitted. This increased their financial burden and further strained the family economically. In spite of traveling so far, they were provided only with heavyweight artificial limbs. The problem with heavyweight artificial limbs is that it is not patient-friendly or service-friendly, and they are forced to be in the house without using them.
In India, all manufacturing centers are mostly dominated by private players. The institution or department is not generating money from insurance schemes. Private players supply artificial limbs to the patient without necessary gait training, occupational training, and psychiatric counseling, and hence, the probability of the patient using the limb efficiently decreases. There is a gap between the beneficiaries and the service providers in the private sector. Moreover, if there is a service issue like size adjustment or other wear and tear issues, they are inaccessible to the beneficiaries immediately. Whereas in the Coimbatore model, the services here run 24×7, except on Sundays; hence, the worries of the beneficiaries are immediately catered to.
Coimbatore is the first lightweight artificial limb production center without expenditure on the government. As the lightweight artificial limb prosthesis package is available in AB-PMJAY-TNCMCHIS, the money is generated through their package. The generated money is not only useful for recurring expenditures but also used for infrastructure developments and repaying the money to start a lightweight artificial limb production center. In this way, the total claim amount was 37.28 lakhs for 101 beneficiaries. The amount used for renovation and procuring accessories was about 8 lakhs. The infrastructure amount generated was 9.32 lakhs under AB-PMJAY-TNCMCHIS. This amount is a profit to the government at the institutional level and will be used to repay the seed money utilized to start a modern lightweight artificial limb production center in Coimbatore Medical College and Hospital, Coimbatore, Tamil Nadu, India.
The already existing manpower and infrastructure were used to set up this artificial limb center which has sustained in spite the COVID-19 pandemic and provided artificial limbs to more than 100 beneficiaries. In the Coimbatore model, the entire amount for the project was taken care of by recycling the orthopedic AB-PMJAY-TNCMCHIS fund generated by treating orthopedic patients. In this way, the expenditure model was efficiently converted to a profit model. Hence, Dr S Vetrivel Chezian’s idea, visionary, is practical and sustainable and can be expanded to the other government medical colleges in India, under AB-PMJAY-TNCMCHIS, where physiatrists are also available, improving efficiency.
CONCLUSION
The novel idea of Dr S Vetrivel Chezian has resulted in the setting up of the modern lightweight artificial limb reconstruction center at the Coimbatore Medical College and Hospital without expenditure on the government by recycling the AB-PMJAY-TNCMCHIS fund. In this way, it has reached the unreached people below the poverty line and provided a new lease on life with the lightweight artificial limb, even though a qualified physiatrist was not available at the time. In the Coimbatore model, the so-called expenditure concept is converted into a money generation concept, which is useful for the infrastructure development of Coimbatore Medical College and Hospital. Hence, this model can be taken up as a profitable role model to start lightweight artificial limb production centers without expenditure on the government in other government medical college hospitals in India.
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