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By Damitha Hemachandra (Reproduced from the Daily Mirror of October 24, 2001) How many times have you seen a man or a woman with a physical impairment, get into a bus or stand near a bus stop, begging for a few rupees to assist themselves and their families? Have you ever wondered whether this should be their fate, with injured pride and dignity, begging for assistance because they lost a limb? Sri Lanka has 290,000 people who have lost their hands and feet to the ongoing war of 17 years. Another 920 lose their limbs yearly due to accidents and medical reasons. No matter how huge the numbers seem, Sri Lankan society is just not ready to admit the fact that physical impairment is no reason for these people to lead a life that is different from ours. The Sri Lankan social structure is yet to be modified to make space for a population with physical impairment to lead a normal life. Rupapala lost his right foot during a motorbike accident in 1978 and since then he has been growing vegetables to support his family. “It was a living hell during the first few years with no one to support me. I used crutches and a wheel chair and travelling was almost impossible,” he said. “I had to travel with my wife to all the places I went to, as I could not enter many of the buildings. No one would pay any attention as I am a disabled person,” he said. The situation is the same today after nearly 23 years. Public transport as well as private buses, do not have facilities for a disabled person to travel. Although there is a different seat for the physically impaired, the steps in buses make it difficult for the physically impaired to get into the bus. Almost every building is without a slanted route for wheel chairs to enter and the physically impaired person has to use crutches to enter a building, which in turn makes him depend on another person. The situation could be worse for a person without hands. In Sri Lanka, private and public institutions are designed for people with a normal physical structure making it impossible for a person with a physical impairment to be independent. Children can be most unfortunate if they are physically impaired. Under the Sri Lankan educational system, there are different schools for the physically handicapped “as if they have different IQ status,” explains a former director of the National Institute of Education. A disabled child should be able to study in a normal school with normal children, sit for exams like others, seek higher education with them and in short ‘should be able to dream normal dreams like a normal child.’ Is this possible in Sri Lanka today? Can a physically handicapped child dream of being a lawyer or a doctor in Sri Lanka? Is any private or public institution making an attempt to employ a physically disabled person at their institution? If you became handicapped today while you were employed, you could find yourself out of work and struggling to make ends meet, just like Rupapala did 23 years ago.
During the last 15 years, the Jaipur Foot Programme has produced 15,000 artificial limbs for Sri Lankans who are physically impaired. Today, it is the only such place Sri Lanka can boast of. “Most of the limbs are supplied free to the patients if we can find a donor. Soldiers, who lose their limbs at the battlefront receive government assistance to get an artificial limb but other individuals do not get any assistance from the government,” said the secretary of the Jaipur Foot Association, C. Siriwardhana. The patients are supplied free accommodation and food as long as the treatment lasts inclusive of the fixing of the artificial limb. Rupapala remembers the first time he received an artificial leg. “The physiotherapist made me do a lot of exercise to make my limb gain the right shape,” he said. According to the manager in charge of artificial limb production at the Jaipur Foot Association, M.N.K. Karunasena, this is done to prepare the stump and to make the stump into the right shape for the artificial limb. “The lower end of the stump or the limb should be smaller or thinner than the upper end of the stump and should be without contraction,” he explained. The patient has to do various exercises before the process of designing or making an artificial limb. When the stump is the right shape, the mould of the stump is taken using Plaster of Paris. This mould is used to make the hard socket and the soft socket of the limb. According to Mr. Karunasena, the soft socket is made out of soft rubber while the hard socket is made out of material ranging from aluminium or plastic. After preparing the limb, the patient’s foot is prepared according to the right size. “If a patient has one remaining natural foot, we use its size to guide us with the artificial one but if he or she has lost both, we might have to decide the best size we think the patient would be able to manage with,” he said. After preparing the limb, he or she has to be trained for a better walking style or method. This can take three days to three weeks depending on the situation of he patient. Rupapala was at the Jaipur Foot Centre for the fourth time to get his artificial limb fixed.” The limb may break after a few years of use,” he said. “Then I have to come back for another one.” There were other beginners limping their way trying to walk with their new artificial limb. One was Kithsiri who lost his leg in a landmine explosion last year. He was walking with a smile on his face trying to brave the pain. “It is hard to walk during the first few days, especially as this is my first artificial leg,” he said. “I have finished my 12 years in the army and I am planning to return to a normal life with the help of the training I receive at Ranavirusevena,” he said. Soldiers who lose their limbs at the battlefront receive more facilities and also training at Ranavirusevena compared to a normal civilian who might have lost his or her leg or hand from an accident.
Today everyone has to travel to Colombo to get an artificial limb. Think of a person living in Anuradhapura or Polonnaruwa or a landmine victim from Vuvuniya. They might have to travel 24 hours to get to Colombo then stay in Colombo at least for another two to three weeks for physiotherapy and limb preparation and spend another 24 hours to get back home. Sometimes these people travel all the way to Colombo just to get their artificial limb fixed or repaired which only takes about two hours. To make life a little bit easier for the patients living far away from the capital, the Jaipur Foot Association began a mobile service last month. “Our first mission was held at Polonnaruwa and we attended to nearly 50 patients within a week,” Mr. Siriwardhana explained. Forty-one new patients received artificial limbs. “If someone can obtain an artificial limb within three days without undergoing hardship and not having been away from their homes, that would be our dream come true,” he said. “This could be easily done if the government takes the necessary steps to combine the Artificial Limb Programme with the general hospitals around the country.” But the government is more of a hindrance than of help today. Equipment and items necessary to manufacture Jaipur artificial limbs are imported under heavy taxation and few or no support is shown from the side of the government to the Jaipur Foot Programme. “There is no programme available to support the physically disabled in Sri Lanka, no social security, nothing,” a volunteer at the Jaipur Foot Centre said. “Every little bit of work is done by NGOs and social workers.” Meanwhile, the physically impaired are left to fight their battle alone and cope with social stigma and indifference. The legal framework of the country does little to ensure the human rights and special rights of the disabled. The regulations and rules are merely left to the books due to the ignorance of the people. With a huge deficit in social support for the physically impaired population, life flows painfully for Rupapala, Kithsiri and thousands of others like them. “If I only knew that my employer did not have the right to sack me just because I lost my limb, I would have fought for my rights,” Rupapala explains. But after 23 years it really does not matter anymore. The little garden with the vegetable patches will always be a strength to him.
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