LegBank was initiated in June 2104 by social business developers from ProPortion, in order to increase access to affordable, qualitative prostheses to low-income amputees in upcoming economies, starting in Colombia. Colombia is the country with the highest number of land mine victims in the world (Unicef). Often they live in rural areas and have low access to prosthetic care, just like Jair from the Urabá region in Colombia on the photo.
In the nearby future, LegBank aims to scale to other countries, reaching amputees that are part of the 30 million people living in low-income countries, with limited or no access to prosthetic provision.
LegBank aims to increase access to affordable, qualitative prostheses to low-income amputees in upcoming economies, starting in Colombia.
ProPortion started exploring the stakeholders; potential customer segments, potential partners, government bodies, peers, etc. By further exploring their stakes, desires and needs, we got a better sense of the context and the problem behind the problem. During four months, ProPortion studied the orthopedic market and health system in Colombia with help of many Colombian stakeholders and six amazing TU Delft engineers. We organized creative sessions at universities, visited and interviewed specialists at orthopedic clinics, the Ministry of Health and Social Affairs, several NGOs, health care companies, etc. Also we spoke to several amputees; about the quality of their prostheses, the barriers they faced to obtain them. We got to know about cases when amputees had to wait up to 2 years before they got a prosthesis. Some even didn't get theirs at all. This helped us to better to identify opportunities for improvement.
The lady in this picture, Saphir, is a diabetes patient, which is also a great cause of the many amputees in Colombia.
Through our research we understood there are two reasons why so many people world wide have bad access to quality prosthetic care.
Firstly, making a prosthesis requires a lot of experience, time and money. Especially to make the socket. A prosthetic socket connects the person’s residual limb (stump) with the rest of the prosthesis and is crucial for walking without pain. It is unique for every person. Currently, most sockets are designed and handcrafted through procedures that are highly individual, inconsistent and based on the skills and expertise of clinicians. This makes them labour intensive and expensive. A rural amputee with a small yearly income can hardly purchase a prosthesis that has to be renewed approximately every three years.
Secondly, worldwide we lack 180.000 prosthetists and technicians to address the current demand for orthopedic services. The available technicians work in main cities, distant from rural patients.
While comparing all current solutions on their technically and ergonomically feasibility, financially viability and desirability, we invented the LegBank.
It consists of a product and a scalable business model.
Researchers from the University of Strathclyde (Glasgow) have, in close collaboration with design engineers from design agency Reggs, developed a casting device for use by orthopaedic specialists to perfectly capture the shape and volume of residual limbs, for the production of well-fitting transtibial prosthetic sockets.
1. It captures the shape and volume of the residual limbs with high accuracy
2. It has potential to decrease the time to make prosthetic sockets and prosthesis delivery by reducing rectification times up to 75%. This represents a huge benefit for the patient, because it means less traveling time.
3. It is easy to use and simplifies the casting process into well-defined steps while increasing efficiency.
4. Patient fit and comfort increase
The Majicast was originally invented by Arjan Buis from the Strathclyde University in Glasgow in 2005. Over the last years it was used to supply 300 prostheses to war victims in North Iraq, and it was tested in Tanzania.
Picture: engineer Karin Dijkstra from Reggs learns how to make a prosthetic socket by hand at Orthopedic centre de Hoogstraat, that has invested in a major part of the product development.
The Majicast is an instrument with the potential to revolutionize the way that orthopaedic specialists produce prosthetic sockets. Innovative Dutch and British engineering has produced a device that accurately reflects the contours of a patient’s unique shape and volume of their residual limbs. The result is a tailor made fit that increases comfort and reduces the necessity for further modification in the future.
The Majicast captures the unique shape of lower residual limbs with the use of plaster bandages or other direct casting material. Once the casting material is applied, the clinician instructs the patient to insert the limb in the Majicast, and then to transfer his/her full body weight to the inserted limb while remaining in a standing position.
This creates an advantageous hydrostatic loading condition. Hence the resulting lower limb cast captures the actual anatomy of a patient’s residual limb. This is how the perfect fit is achieved: by producing accurate lower limb impressions in order to efficiently produce comfortable prosthetic sockets.
The working principle behind the Majicast is hydrostatic pressure. This means that water pressure is used for modeling the casting material, by deforming the soft tissue of the residual limb under a uniform load. This results in a corrected soft tissue displacement that allows capturing an accurate impression of the volume and bone structures of the residual limb for creating and fitting total surface bearing (TSB) sockets. Using a standardized, easily documented procedure, the Majicast is proven to provide accurate and consistent results, making it possible to eliminate the need for modification of the resultant positive mold, reducing prosthesis delivery times and socket manufacturing costs.
Prosthetic sockets produced as a result of the Majicast process can increase user comfort, stability and fit; achieved by reduced shear and friction at the socket/residual limb interface which leads to improved control of the prosthesis and increased patient satisfaction.
On the picture you see how we make a prosthetic socket in Colombia with our first prototype in December 2014.
Over de last year Amsterdam-based design-agency Reggs started engineering the optimized Majicast. In March 2016 we did a couple of tests with the first optimised prototype and the results were good. In may 2016 we will bring it to Colombia in order to do a demonstration project and train prosthetists to use it.
In order to reach urban amputees, we first target as prospective purchasers those organizations and professionals already working within the field of orthopedics. They are in business and have the capital to invest. This way we create the highest chances of revenue generation and short term profitability, enabling us to ramp-up the creation of orthopedic centers in the rural areas and decentralise prosthetic care.
To create more visibility, together with Laboratorio Gilete (Bogotá, Colombia) – the biggest distributor of orthopaedic products in Colombia, that can help us to distribute the Majicast, we are currently preparing a demonstration project that will take place May 2016, in which we will show the working of the Majicast to professionals working within the field of orthopaedics; education centre, CPO’s and health insurance companies.
In order to reach rural amputees we especially aim to pilot three orthopedic clinics in rural Colombia. We will work with former students from the National Prosthetics educational program looking for self-employed job opportunities in rural areas. We support them with legal support for contracting with EPSs (Colombian healthcare insurance companies), entrepreneurial and technical skills through practical experience to setup their own businesses and a certification attesting their knowledge and skills in the Majicast technique.
Colombia is a big country, and we understood we had to come up with a methodology on how to select the best locations to pilot the three clinics. Inspired by Gonne Beekman, a postdoc researcher conducting large scale impact evaluations from Wageningen University, we decided to plot and compare different parameters on a state level, in order to narrow down our search and create a short-list of potential locations. These parameters included: safety, need for orthopaedic services, accessibility, and current availability of orthopaedic service providers.
This information we are currently checking with local and international partners and organizations with experience in the field of prosthetics and rehabilitation in Colombia such as Liliane Fonds, ICRC, Mercy Corps and Gilete. By opening to collaborate with other stakeholders, an informed decision is expected to be made on where and how to proceed in the coming months.
LegBank was broadcasted at the BBC.
LegBank is a social business that involves a low-cost, low-tech, low-skilled orthopedic product-service solution that can be easily decentralised and integrated in existing health systems worldwide. We are right now piloting in Colombia.
A more sustainable and fairer society, that is the ideal vision of the Dutch based ASN Bank since the banks inception in 1960. Therefore it organises the World Award for Social Entrepreneurship since 2009. The aim of this prestigious award is to support projects with a very high potential and considerable global impact.
Five theme based awards, sustainable energy, education, fair trade, social cohesion and healthcare and wellbeing, were presented on the 19th November of 2015. LegBank was 1 out of 12 finalists left and secured the award for the healthcare and wellbeing theme.
At the end of 2015 Cordaid organised the second edition of the Cordaid Social AdVenture, targeting high value social entrepreneurial initiatives. The event took place on December 8 2015 in The Hague, the Netherlands. During the event 3 prizes could be won with value of €2500, €5000 & €7500 respectively. During the eventon the 8th of December 2015 11 finalists pitched their ideas.
The legbank initiative, presented by Merel Rumping from ProPortion, went home with two awards, one for the first prize and one for the jury prize.
On the 26th of January we were honoured to pitch ‘LegBank’ to Mr. Bill Gates in person!
Not only Bill Gates was excited about the LegBank story and offered his willingness to see how he can support us in achieving our big ambitions, the media seemed to love LegBank as well. Subsequently, LegBank appeared on the NOS News (primetime Dutch news 8pm!) in a Talkshow at RTL-z, several times on the radio (Business News Radio, Radio1, NOS radio) and in many newspapers (Algemeen DagBlad, Trouw, NRC, het Noord Hollands Dagblad) and magazines; OneWorld, Linda, voordewereldvanmorgen, ViceVersa, etc.
ProPortion (2008) initiated LegBank in 2014. Since then it has been collaborating with several partners.
About the University of Strathclyde (1796) The National Centre for Prosthetics and Orthotics (NCPO) and the Biomedical Engineering Department of the Strathclyde University in Glasgow (UK) are internationally recognized centers of excellence for education and research at the interface between engineering and life sciences. Strathclyde is in charge of the educational component in LegBank, training the partners in Colombia that will work with the Majicast. Also, their involvement guarantees scientific justification of the Majicast to gain trust among clients and distributor. Dr. Buis works for Strathclyde and invented the basic principle of the Majicast.
About Reggs, Amsterdam (1968) is an interdisciplinary design agency with a team of 25 professionals specialized in user interface design and product engineering, with experience in medical design. Karin Dijkstra and Wolter Prinsen are in charge of Majicast embodiment design and engineering, product contextualization and user evaluation with the Majicast, both in the Netherlands and Colombia.
About de Hoogstraat Orthopedietechniek, Utrecht (1946) is an expert adviser on the needs of amputees in terms of clinical requirements and mobility solutions to maintain a high quality of life. De Hoogstraat’s expertise is important for clinical justification of the Majicast. Marcel Conradi, director of de Hoogstraat, has worked as a Prosthetist/Orthotist for over 30 years. He is supporting testing and user evaluation protocols, both in the Netherlands and Colombia.
Delft University of Technology (1863) is the largest and oldest Dutch public technological university, located in Delft, Netherlands. LegBank has been lucky to work with 8 great master students from the Faculty of Industrial Design Engineering at TUDelft during its conceptualizing and development phases. Their contributions constituted important stepping stones of what LegBank is and aims to become.