I confess that much of this post is taken from others more profound than myself, but this case study remains one of my favourite examples of agile product development with a true user and human-centric approach. It was not something I had heard of until recently, but I wanted to share it with you as in our fast-paced business world, it is a reminder to get ‘back to basics’. I give you the Jaipur Foot.
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People who live inside the worlds many war zones from Afghanistan to Rwanda may never have heard of New York or Paris, but they are likely to know of a town in northern India called Jaipur. Jaipur is famous in strife-torn areas as the birthplace of an extraordinary prosthesis or artificial limb known as the Jaipur Foot that has revolutionized life for millions of landmine amputees. The beauty of the Jaipur Foot is its lightness and mobility – those who wear it can run, climb trees and pedal bicycles – and its low price.
— Tim McGirk, correspondent, TIME
Here is the story of the Jaipur foot, as told by a Harvard Business School Professor…
The Jaipur Foot’s story began with a chance meeting between Ram Chandra Sharma, a sculptor adept at recreating human likeness, and Dr. Pramod Karan Sethi, an orthopedic surgeon. During occupational therapy classes for polio-afflicted children at the Swai Man Singh (SMS) hospital in Jaipur, Sharma saw Sethi working with accident victims who had lost their limbs. He observed that few patients were fitted with artificial limbs—the SMS Hospital produced only five or six such limbs per year based on American and German designs, as it was a time and skill-intensive process, and imported limbs were expensive. Sharma also noticed that there was limited acceptance for such limbs as they did not permit much mobility and could only be used with an attached shoe.
Although these artificial limbs were working well in the West, they were found inappropriate for Indian amputees. This was largely on account of the vocational and socio-cultural needs for which the amputees had to squat, sit cross-legged, negotiate rugged terrain, walk barefoot, etc. None of these postures and activities were needed of the western amputee. In addition, everybody in the West wears shoes, so the cosmetic appearance of the foot was not a consideration, as it would be concealed within the shoe. In India a lot of people do not wear shoes during activities such as visiting places of worship where the foot is often exposed.
Sharma, vexed by the pain and discomfort that the artificial limbs caused Sethi’s patients, was convinced that he could use his sculpting skills to model an artificial foot that looked and functioned more like a human foot. He approached Sethi with his idea and over the next two years, the two along with Dr. S.C. Kasliwal and Dr. Mahesh Udawat from the SMS Hospital, worked on developing several alternatives. However, their material choices made the resulting limbs too flimsy or bulky. Apart from trying to design a flexible foot, the three doctors and Sharma focused on socio-cultural needs. Most amputees were poor and engaged in physical labour. Hence, the loss of a limb affected their livelihood. They required a low-cost prosthesis that could be manufactured and fitted quickly—using a simple process and locally available materials.
One day, while getting his bicycle’s flat tire repaired, Sharma noticed a mechanic retreading a truck tire with vulcanised rubber. This sparked an idea and Sharma requested the mechanic to cast a foot using vulcanised rubber. Although the resulting foot was more flexible than earlier models, it shredded a few days later.
The doctors and Sharma had also been working on refining the Solid Ankle Cushion Heel (SACH) foot, a Western design that consisted of a rigid wooden block covered in rubber. As the wooden block ran from ankle to instep, it permitted almost no flexibility. While tinkering with its design, the duo took wedges off, converting the single wooden block into two to increase flexibility.
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Merging the idea of the vulcanised rubber foot and the re-worked SACH foot, the three doctors and Sharma wrapped the separated wooden block in light rubber and vulcanized the resulting structure to form the first successful design of the Jaipur Foot—the only non-articulated (without moving joints) artificial foot that allowed several types of movements. For instance, the Jaipur Foot could flex during squatting or climbing slopes and rotate inward while sitting cross-legged. To make the foot wearable for both above and below-the-knee amputees, either, a shank and brace or a shank, brace, and knee joint, were used to connect the foot to the patient’s limb At this time, production cost of the Jaipur Foot was less than $5.
Further improvements led to a design with three pieces—wooden ankle piece, sponge rubber forefoot, and heel—that were wrapped in rubber and vulcanized in an aluminum casting. Mukul described the process, “It wasn’t research in a very formal sense, but it was all based on user feedback. So the patient-centric approach started from the beginning, it was all about what the patients want, how they want it, what they approve of, what is appropriate for them.” The Jaipur Foot won a lot of international recognition as it found use among landmine and war victims.
Vinod Rawat, a patient who had lost his foot as a child, described the experience of being fitted with the prosthesis, “One hour later, I was walking without crutches. Now I run the Mumbai Marathon, I climb mountains, I ride motorbikes.”
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Whilst I’m aware this differs hugely from my usual posts, the story of the Jaipur Foot reminds me time and time again about the importance of feedback, collaboration and agile development. Shouldn’t we be applying its methods of collaboration, innovation and feedback to our businesses practices, our customers and our employees? There is no ‘one size fits all’ approach to business, and the Jaipur Foot case study reiterates the importance of constantly trialing and testing new techniques, really listening to individual needs and going back to basics to respond in order to consistently better what product you have – regardless of whether that’s your people or your product.
Fast-forward to and over 22,000 Jaipur Foot limbs were fitted annually to those who would otherwise never have been able to afford a prosthetic. It retains a low cost at around $45 (the cost of modern prostheses can range from $10,000 to $100,000) and it continues to still undergo innovation and remains a not-for-profit organisation to this day. Not only inspiring, this is, in my mind, true testament to real product development and something all businesses could learn something from.
If you get a chance, I would urge you to read the full Jaipur Foot story, there is so much more to it that what I’ve crammed in to this post.
Mark.
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