On Gandhi´s tracks

 

India – Country of holy cows, gurus and audacious rickshaw drivers in the chaos of everyday life. The mystical Asia appeared to me like an ideal place for new unique experiences after my successfully completed training as a pedorthist in Germany. Having been curious about different ways of living and thinking all my life it was of particular importance for me to experience the foreign culture in everyday life. In combination with the opportunity to develop further professionally and to be able to make a social contribution, I consequently decided on a Volunteer Servive of about three months.

Because of the high specialization of the pedorthic profession the quest for a suitable project proves to be more difficult than expected. After numerous futile attempts I discover APD (Association of People with Disability), a NGO in the relatively westernized metropolitan city of Bangalore in the South of India. Founded by an Indian woman who is herself severely affected by Polio 52 years ago, this organisation stands for the rehabilitation of the handicapped, who are gravely socially disadvantaged in India. A variety of different therapies and in particular the provision of a basic training in school and in a professional training centre aims at enabling physically challenged people to lead a self-reliant dignified life. What started as a modest training course in tailoring in the house’s garage has grown into an organization that has reached over 28000 affected persons. In 1994 a second organization, Mobility India, was established, which additionally dedicates itself to the provision of research and a college education in orthopedic (shoe) technology in South Asia.

Having made the choice of this organization, I find myself in the midst of a sea of brown faces in Bangalore in the beginning of August last year. Masses of motorbikes, rickshaws, buses, cars and horse-drawn carriages that writhe through the streets without any apparent order do not allow a moment of boredom, but instead provoke an increasingly dizzy head. This situation does not change over the next couple of days when I get an introduction to the foreign Indian customs and languages. Fortunately an almost fluent communication with the socially advantaged people in urban areas is possible thanks to the former presence of the British in the country.

Linguistic and cultural barriers prove to be a far bigger obstacle in the orthopaedic workshop of APD, where about ten employees work to provide the trainees, students and external handicapped people with orthopaedic aids. Mostly confronted with very severe cases of typically club feet, polio and cerebral palsy, the standard treatment consists of the manufacturing of stiff PP calipers in variable heights and ranges of movement.Part of the team is Satish, my Indian colleague in the narrower sense. He mainly manufactures thongs and sandals of a particular soft material, which might partly be due to the Indian culture, but mostly to lack of knowledge in reagrd to the manifacturing of custom-made medical grade footwear and corrective or bedding insoles.

One of the first impressions that remains with me is that of the reverence with which I get treated as a white person. Observing the processes in the workshop I soon discover that basic materials such as PP, metal, two kinds of padding, leather and one or two kinds of sole and build-up material as well as a poor knoweledge of anatomy and pathology are available. But on the whole the lack of quality and awareness about pathologies and correspondent treatment techniqes is alarming. On the other hand it is wonderful to see how people try to make do with the scarcity to provide support, which still mostly makes an essential differnence in the life of the patients. Having intended to play an assistant role originally, I therefore let myself be persuaded by the physiotherapists to give weekly lessons as well as to try own patient treatments. In the latter case it soon becomes evident that custom-made medical grade footwear is not an option due to money, material and experience restrictions. Instead I try to realize treatments on the cutting edge to orthopaedic technology through PP orthoses or calipers that are moulded over plaster models.

Although these unfamiliar techniques like the manufacturing of the plaster mould and the moulding of the PP by hand costs quite some beads of perspiration, it is an enriching experience. Especially the funny moments when I as the “teacher” need to question my Indian colleagues about such trivial questions such as how to fix velcros on the PP are very memorable.

This question answered, I give weekly lessons for about one to two hours, which are provided with the aid of Powerpoint and a translator. Starting with basic knowledge about foot anatomy and an overview over orthopaedic elements we work through the major foot deformities and roughly discuss treatment options for each. Because of the high number of diabetics and the need for practical sessions a lecture about Diabetes as well as a few separate practical lessons are included.

On the whole it was an exciting and partially wonderful, but also a very tough time because of the cultural differences, the gravity of the cases and the limited options of treatment. Most of all I learned how essential communication is as it is the basis for the construction of trust. In particular the poor awareness of the problems of orthopaedic (shoe) technology and disability issues are an obstacle that is not to be underestimated. In this regard these were experiences that go far beyond the simple living of Indian culture and mean a mutual enrichment.

by Miriam Fricke