Fikra Space Book Club — Baghdad Iraq AUgust 2013

Baghdad Hackerspace’s DIY Prosthetic Socket Project

Or How You and Your Friends Can Change the World

There were no explosions when Zaid lost his leg. Zaid’s leg was sawed off jaggedly in an Iraqi hospital during the many years of international sanctions. These same sanctions made it hard for Zaid to get insulin and meant his diet consisted mostly of carbohydrates — crappy food for a diabetic. Zaid blames influences outside of his control on the loss of his leg, and is too resigned to his fate to do much about it. “I’m afraid that the doctor wants to cut more of my leg off. It’s been hurting me…” he mentions to me during one of my visits to Baghdad last year. After visiting with my uncle and cousins and discussing an increasingly insane Iraq, Zaid stands up with help from his eldest son and walks me to the door as is traditional in Iraqi culture. He bids me farewell turns and winces as he walks back inside, and I hear him start to cry.

This is a story about silicone and disease, 3D printing and car bombs. But most of all it’s a story about a growing group of people who are connecting through the values of openness and creativity, and together form a community that, while it may be surrounded by death and destruction, through these ashes manufacture opportunity.

Let’s work together:

Iraq terrifies me as much as it inspires me. When I go I keep my time short since as an American I’m a great candidate for kidnappings, or worse — attack. Last October I was in Iraq for ten days working on creating a popup hackerspace, a place where a group of Iraqis can freely gather and share ideas with each other. The community started forming at a temporary space called YDI, where people began sharing tools and ideas in workshop settings, and it was there I saw the room to grow the community that could over time and iteration address the some of the many issues Iraq is facing.

I’d had been coming back regularly, and during my trip last February I went to visit Zaid with some of the core members of the Baghdad Hackerspace, called Fikra Space. This included Mujtaba and Salih, who joined me at Zaid’s house where together we scanned what’s left of his leg using 123D catch, a free 3D photo capturing tool from Autodesk. The idea is simple: you take a standard camera and take pictures with a high depth of field all around the object and use the software to stitch it together to create a 3D model. Since we knew we couldn’t take Zaid out of Iraq due to visa issues, we found the technology enabled us to instead take his physical information to prosthetists outside the country to start designing a solution.

But before finding a solution, we first had to acknowledge the problems we were facing:

1) Zaid’s transtibial amputation is a fairly common type of amputation for people who step on anti-personnel landmines and likewise for those with diabetic gangrene issues. A successful amputation leaves a flap of muscle that covers the bone, providing some cushioning, but unfortunately Zaid’s amputation left the raw bone right beneath the skin.

2) When Zaid puts his stump into the prosthetic it uses friction to grasp his leg through padding and a sock to ensure a tight fit. It fits well, but in order to move he must push with his stump on the prosthetic, the pressure of which is right on — you guessed it — his bone.

3) The next part of his gait involves putting his leg down and pushing on it, which pulls the skin around the bone upward causing great tenderness and pain. Pair this discomfort with the serious problem of infections resulting in more of his leg being amputated, and basic mobility becomes a huge challenge.

4) Of course, another serious implication of having pain while walking is that Zaid no longer walks very often, making it more likely for his other leg to be at risk of amputation due to the lack of blood circulation, something that is already a problem for diabetics. His other foot is already missing a few toes for this reason.

Point being, we needed to get Zaid moving pain free.

After discussing this problem with Joel Sadler from Stanford and co-inventor of the artificial joint called JaipurKnee, we realized that what Zaid really could use is a harness that takes the upward force off of the stump entirely and brings it up to his hips. Our first attempt was to use a leg brace for people with knee injuries, because the metal joint that ensures the reduction of upward forces on the knee would also prevent upward forces on his stump.

This worked reasonably well, but there were some challenges that ultimately limited mobility and therefore would not address our hope to have Zaid become more mobile. Another solution we discussed was to connect the leg brace up to a climbing harness that would sit snugly on his hips, taking any upward forces and direct them to the appropriate endpoint for the upward forces.

Continuing our research we were led to a 3D printed socket designed by David Sengeh, a doctorate student in the Biomechatronics Group at MIT. It uses multiple materials, considers the unique anatomy of specific amputations, and includes a perfectly fitting socket designed to put harder materials on the soft parts of the leg and softer materials on the hard parts. “Soft on bone, hard on muscle” is a simple way of understanding Sengeh’s work which reduces pressure on sensitive areas while transitioning weight bearing to muscle first. The design is made possible by 3D scanning and 3D printing technology.

This design had big potential, but we wanted to mimic a cheaper version of his process using DIY, hackable 3D printers, free tools like 123D Catch, and our hands rather than relying on MRIs and $500,000 multi-material Objet printers which as you can imagine, aren’t readily available in Iraq.

My most recent trip to Iraq was 10 days, and I really wanted to spend as much of it as possible prototyping and experimenting with the multi-material strategy, so I brought a 3D printed version of his stump as well as some silicone from Smooth-on to create a perfectly-fitting socket. But when I landed I had to stop and slow down.

I was not ready to get to work. Amongst a surge of violence, 400 Al-Qaida members were freed from prison in a double suicide bomb blast right before my arrival. When I landed at the airport, the first thing I encountered was a fistfight. Then on the way out I saw a man thrown by his hair and kicked into his car in the parking lot. We drove by dead bodies in the street given no acknowledgement beyond an offhand comment by my ten year old cousins as to them probably not being asleep due to the blood seeping out of them. As you can imagine, feelings of survival started to outweigh wanting to work on projects.

Ultimately it was the hackerspace community that got me through those initial feelings of fear, and excited enough to work on the prosthetics project. Fikra Space had organized an event the day after I landed in Iraq called “Book Night,” which was both an Iftar, or the breaking of the fast of Ramadan, and a book exchange event. It couldn’t have happened too soon. This ritual, which brought together both Shia’a and Sunni Muslims in a gathering where many people shared the ideas of Iraqi intellectuals and philosophers, really gave me hope in the young people of Iraq.

I was delighted to see that the community had grown since I was last there, and new people made up the organizing team of Fikra Space. Aws, an exceptionally active, young member, was really excited to get the prosthetic project moving and got me excited about the brainstorming and work ahead of us. After only one day we had a strategy. I had previously attempted a brace based solution and this time had returned with a 3D scanned and printed mold that was a perfect fit for Zaid’s stump. Now all we needed was a silicone slip to line it. The plan we devised was to coat the stump with window putty, which we could easily find at any hardware store in Baghdad, then pour a two part plaster mold over it.

But as with many things in life, it was easier said than done. The plaster was a complete failure: the closest thing we could find was Gyps, which is some sort of cement, and after spending a complete day trying to make it work, it never mixed smoothly enough and then wound up drying into a crumbly mess. Back to square one.

By this point I had only one last night to spend in Iraq. Mujtaba and Salih kept me company, but we were running out of materials and supplies. Luckily Sarah — Mustapha’s sister, suggested we try to use wax since they use it all the time at the dentist’s office where she works. So we now had a new strategy…again.

We went out and raided all the nearby grocery stores and bought all the candles we could find. Eventually we had enough to fill half of a gallon sized jar, and after a decent amount of time we had ourselves a decent wax mold that allowed us to make the slip. Luckily for me Zaid had come over so we were able to test it out. He wore it and immediately said something that we weren’t expecting: “Can it be any longer?”

Now, as exciting as the prospect of creating a custom fitting silicone slip was, we needed to really focus on the crux of the issue which was reducing some of Zaid’s pain. Mujtaba, Salih and I looked at each other. It was now at 1 AM and we had been working all day to get this silicone slip working. It seemed like all hope was lost. We were running out of silicone and I was leaving in a few hours.

On the bright side I recognized this as a perfect test. If I wanted to pass on the idea that they could do this project, I now had to I had to leave it to them to finish the work we started together.

And that was that. I had been trying to change my flight to stay longer in Baghdad because it seemed safer than risking catching a bus up to Irbil, which would put me in danger of highway bandits and kidnapping, but I could not be rerouted from Baghdad so I was going to have to make the dangerous trek North. As nervous about the ride up as I was, I left feeling happy knowing that the Fikra Space crew could handle the rest of the project and projects beyond it.

It took about a week for me to hear back from Mujtaba about what happened to the project but when he recounted the story I jumped with happiness: upon wearing the multi-material socket Zaid exclaims that it has reduced over 90% of his pain. This is incredible!

Now this is not the end of the story for Zaid. There is follow-up work to be done but the greatest success is that I don’t feel the need to be there anymore. There is a new crew in Baghdad, one which is becoming more self confident, more collaborative, and growing all the time. They are reaching out and finding more friends and allies in Iraq and abroad and it’s there I have hope that not only will Zaid have someone looking after him, but perhaps he and other likes him will start to notice that these are kids half his age using just their brains, the Internet, and each other to make progress in bettering his life. And if they can do it for him, why can’t he do it for himself?

This is the idea I hope infects you after reading this article. This is the idea that I believe is seeping into Iraq with initiatives like Fikra Space, and other spaces like it around the world. Initiatives like the Open Prosthetics Project and Instructables let people share their progress internationally. Zaid’s prosthetic is a work in progress, and bringing together the minds of makers to work on grassroots projects is as well. But they are proving it can not only be done, but it can be effective.

I really believe that more than helping one man, or discovering a cheap way to create multi-material prosthetic sockets that ease the pain of many amputees, this project, and the Fikra Space project shines the light on an attitude that can transform the world one life at a time. The idea that together we can dream a dream and be the team that breathes life into it. That after the resolve, all you need to change the world are the people and resources around you.

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Bilal Ghalib