Affordable artificial limbs available to Grenadians 

by Curlan Campbell 

• 654 individuals recorded as undergoing amputation between 2010 and 2017
• Healing process before a prosthetic fitting can be carried out is 4 to 6 months
• Prosthetic leg’s main structural components will usually last at least 10 years

The prosthetic design has come a long way from the days of amputees having to wear peg legs due to new technologies and improved materials, which has led to the development of highly specialised prosthetics. However, attaining these specialised prosthetics devices can cost between US$10,000 for a basic prosthesis and over US$70,000 for a computerised version.

The costs mean that even basic prosthetics are still out of reach for ordinary people. In Grenada, where the prevalence of limb amputation from complications due to diabetes is cause for concern, amputees struggle without financial support.

Prosthetics Engineer Gylfi Hilmisson believes that for amputees to get a leg up in life, there must be a solution to help drive down the cost. “This is a personal criticism of how modern capitalistic society economics inflates end-user costs of life-changing and sometimes life-saving services and products, making them un-obtainable to the average person in the name of profit,” he said.

Following a visit to Grenada in 2012 by his former colleague Ossur Kristinsson — founder of Össur prosthetics in Iceland — Hilmisson conceptualised providing affordable prosthetics in Grenada and established Attach a Leg Grenada (ALG), fitting 160 amputees over the past 13 years with a prosthesis. 40 amputees have been fitted with a prosthetic leg since 2020, and 24 people are on the waiting list.

“The healing process before a prosthetic fitting can be carried out is 4 to 6 months, depending on the patient’s physical condition, blood circulation and immune system efficiency. The General Hospital physiotherapy staff try the best they can to condition patients with general exercise instructions in preparation for a future living with a prosthesis. Surgeon skill in performing the amputation surgery is also important, facilitating a stump shape that is conducive to an eventual successful prosthetic fitting,” he explained.

Operating an organisation almost entirely reliant on self-funding, yearly fundraisers and kind donations, ALG can no longer be considered a fully funded humanitarian aid organisation providing a free service.

“The cost of establishing Attach a Leg over 4 years was paid for by myself. This personal intended retirement money used will never be retrieved,” said Hilmisson. “Most importantly, it became clear when relationships with the local population were developed that if something received has no monetary value to a person, that person tends to not respect it. What is to a certain extent a privilege becomes a cheap expectation. For an amputee to make full and proper use of a prosthesis, they have to want it for themselves and invest in it.”

Hilmisson explained that in Grenada, prosthetic parts and related materials are exempt from import duties as per the Grenada tax bracket. But this fact was not discovered or made clear to the organisation after acquiring the services of a professional broker who now handles its import customs procedures.

Prior to this, he said they did get concession permits for individual shipments of materials after considerable time-consuming efforts for stamps and signatures from several government ministries. Currently, ALG charges amputees seeking below-the-knee prostheses EC$3,000 while amputees seeking above-the-knee prostheses will be charged EC$4,500.

A prosthetic leg’s main structural components will usually last at least 10 years. The typical lifespan of the silicone liner interface and the prosthetic instep is about 2 years before needing to be replaced due to wear and tear and local climatic conditions. The organisation has provided affordable prostheses by keeping its overhead cost low, which has been challenging.

So what are the challenges faced by ALG to operate in Grenada? Hilmisson said keeping the organisation alive in the future will require having to relocate since its current location is not suitable for operation.“The challenge is not as specific to Grenada insomuch as it is maintaining the objective of non-profit and providing the service as close to cost as possible,” he said.

“To achieve this, overhead costs must be kept as low as possible. As a result, the office and workshop are located at my home residence in Mt Moritz. This of course, is not sustainable in the long run. Moving forward with the project of training a local candidate and cementing a future for ALG, the government could and possibly should contribute by contributing a workspace to operate out of, possibly in cooperation with the Grenada National Council for the Disabled (GNCD) with whom we have collaborated with prior. This would be the most valuable contribution by the government. Talks with officials in this regard are in the very early stages. The yearly mandatory work permit fee of EC$3,000 could be waived so that money could be used directly for the service.”

A surveillance of amputation in Grenada revealed 654 individuals — 370 (56.6%) males and 284 (43.4%) females — recorded as undergoing amputation at the General Hospital due to peripheral arterial disease (PAD) and diabetes, between 2010 and 2017.