Losing a hand, digits, or limbs can sometimes be viewed as unfortunate accidents or the traumatic consequences of life in war-torn regions. However, estimates suggest that major (amputation above the elbow, below the elbow, above the knee, below the knee, or the foot) or minor (amputation of the hand, fingers, or toes) limb loss occurs more often than we realize in the general population. According to separate reports, almost 2 million people lived with limb loss in the USA and hospital expenses associated with amputations totaled $8.3 billion in 2009. A small fraction of the cost could possibly be attributed to treatment of 1,715 US soldiers (as of December 2012) who lost limbs in Iraq or Afghanistan or congenital limb deficiencies. Based on a 2008 report, the remaining amputations were mostly caused by vascular disease (54%) – including diabetes and peripheral arterial disease – trauma (45%) and cancer (less than 2%). The percentage of non-traumatic lower limb amputations in diabetics increased to more than 60%, according to data from the 2011 National Diabetes Fact Sheet. Moreover, it is estimated that up to 55% of diabetic amputees will require amputation of the second leg within 2‐3 years.
Globally, one amputation occurs every 30 seconds. In addition, The International Society for Prosthetics and Orthotics and the World Health Organization (WHO) estimated that at least 0.5% of populations in developing countries and other regions are in need of prostheses or orthotics and related services. Prosthetic devices can range from basic walking support for lower-limb amputees to state-of-the-art devices mimicking human movement, enabling amputees to navigate rough terrain, climb stairs, or perform athletic feats. Physical and societal obstacles, leadership and governance, service delivery, human resources, production, and affordability are key barriers to assisting amputees.
While the WHO made suggestions to overcome these barriers, it means that in practice considerable time would have elapsed before people like Richard Van As in South Africa and limbless children in the Sudan obtained access to affordable prostheses. Van As, a master carpenter, lost four of his fingers in a work accident and collaborated with others to make mechanical fingers (using a 3D printer). Richard has since expanded theRobohand project to making mechanical fingers for people with congenital deformities or who have lost their digits. Similarly, Not Impossible’s Mick Ebeling gave hope to Sudanese child amputees (through Project Daniel) by setting up a 3D-printing prosthetics lab and facility in that country.
State-of-the-art prosthetics may simply be beyond the pocket books of many amputees. Could Project Daniel and the efforts of the Open Prosthetics Project be replicated in other low- or middle-income countries where disabled people may have inadequate health insurance? In those cases, low-cost 3D-printers (such as a prototype currently in development in Togo or the printrbotPLUS) could conceivably be used to print replacement digits while awaiting evaluation by a medical professional. While amputees in poor countries and elsewhere await government support, ordinary folks will likely continue to fill an important need and inspire others through their actions.