If you were to spot Tanzeela in her classroom or on a bus, you wouldn’t notice anything out of the ordinary. Beneath her dupatta, however, the 22 year old hides something she’s struggled with all her life: a partially-missing arm which she was born with. “I never show it [the arm] to anyone. At home I don’t care but I always keep it hidden in public,” she says. While she feels she manages fine with one arm, she points out that she often feels “something is missing”.

Soon, however, her life might completely change. She’s waiting her turn to receive a robotic arm from Bioniks, a Karachi-based spin-off of a company which specialises in 3-D technology. Their claim to fame: the first private, non-profit company in Pakistan to design and produce robotic arms. When I meet Ovais Hussain Qureshi, Head of Bioniks, at his office, he shows me a video that Tanzeela’s mother has shot and sent to Qureshi. The 22 year old is bent down and ironing clothes with one arm. “We do this so we can see people’s movements and have a better idea of what we should design for them,” he says.

Tanzeela is one of many clients Qureshi and his team are working with. “One of our goals is to make prosthetics more acceptable in Pakistan,” says Qureshi. “We’re currently working on a system where we can measure patients online or remotely via Skype or webcam and then mail them the prosthetic limb. We have many inquiries from people abroad, from places such as the United States, Bahrain and Indonesia, so it makes sense to explore this option.”

3-D printing has been around for decades. But now a Pakistani non-profit is using it to provide prosthetics to people with disabilities and causing revolutions in their lives

It’s not surprising that Bioniks is fielding so much interest both at home and abroad. With so many people with disabilities worldwide, there is a great need for robotic arms and prosthetic limbs. According to the World Health Organisation, which defines disability as an “umbrella term for impairments, activity limitations and participation restrictions,” 15 percent of the world has some form of disability including 110 million to 190 million people who have “significant difficulties in functioning” in their daily lives.

Experts can’t agree on the number of people with disabilities in Pakistan but according to a 2014 report, Moving from the Margins: Mainstreaming Persons with Disabilities in Pakistan, prepared by the Economist Intelligence Unit for the British Council, 27 million people in Pakistan have a physical or intellectual disability. The report points out that a lack of effort by the government to accommodate and include people with disabilities in the economy could be costing the country between 4.9 percent and 6.3 percent of its GDP each year. For those who suffer from a disability, however, the greater cost is the emotional toll and the social trauma it brings.

Anas Niaz, Bionik’s techno-commercial director, says he often sees recipients of robotic arms, especially children, become more confident. “When we asked Mustafa, one of our clients, what kind of arm he wanted, he said he wanted a ‘boot-wala arm’ because children made fun of him and he wanted something to defend himself with. But since he has received the arm, his confidence has increased immensely. His family was reluctant to let him leave the house before but now they do; he’s more social and has also made friends. They [his friends] find his robotic arm ‘cool’.”

The story is no different for Saqib, a fifth-grader at Islamia Collegiate School hailing from the tribal area of Orakzai Agency. The 12 year old, who was born without a foot and an arm, often struggled to have a positive outlook on life, according to his brother Adnan. “Times have changed,” Saqib says of his post-robotic-arm days. Like many young boys in Pakistan, Saqib is most excited about being able to participate in sports. “Now I can play cricket. I am a good batsman and have scored 50 in a match,” he says proudly.

A video shot by Adnan of Saqib captures the pure joy of being able to use both arms. In the video, the two brothers are at a friend’s shop. Saqib stands behind a glass counter and reaches out for a stuffed toy with his white plastic robotic arm and moves it to the other side. He reaches out for another toy and does the same, and then grabs a rag and wipes the counter. The entire time he’s grinning as if he has won a spot on the national cricket team.

OLD IDEAS, NEW APPLICATIONS

Aside from robotic limbs, Bioniks is working on a range of products such as surgical models, prosthetics for animals and plastic casts that could potentially revolutionise Pakistan’s healthcare and veterinary industry.

“Times have changed,” Saqib says of his post-robotic-arm days. Like many young boys in Pakistan, Saqib is most excited about being able to participate in sports.

The 3-D technology Bioniks uses is not new; it has been around since the early 1980s, but its use on a more commercial and larger-scale began a decade ago. The last 10 years has seen a string of firsts in 3-D. Thomas Boland of Clemson University patented the use of inkjet printing for cells in 2003; 3-D printing has since been used to make everything from skin to bladders. Visitors to the 2014 International Manufacturing Technology Show in Chicago saw the world’s first 3-D printed vehicle — the electric car, dubbed the ‘Strati’ (the Italian word for layer), took 44 hours to be made. Similarly, in October of last year, Netherlands announced that it had made the world’s first 3-D printed concrete bridge; the eight-metre bicycle bridge in Gemert took three months to make and can bear a load of five tonnes.

The appeal of a 3-D printing is that it is easy to make — all you need is a computer and a 3-D printer. The product can be designed using software called Computer-Aided Design or CAD, with a scanner that produces a 3-D image of it, or with a digital camera and photogrammetry software.

The technology also shortens the time it takes to make something and lowers its cost. Take robotic arms for instance. The starting price of a robotic arm in Western countries ranges from 7,000-10,000 US dollars and can cost more than that. Those designed and produced by Bioniks, however, start at 30,000 rupees — a fraction of the international price. So far, 10 to 12 customers have been provided with robotic arms but Qureshi and Niaz say they are working with more clients. Being a non-profit, they point out that they don’t want to sell the prosthetics at a high price and often work with donors and non-governmental organisations to fund their clients’ prosthetics. “Our goal is to provide them free of cost if possible,” says Qureshi.

The low cost and the ease with which it can be attached also makes having a functioning prosthetic within the reach of many Pakistanis. Till now, most amputees or those born with a congenital defect only had the option of an artificial limb. The robotic arm, however, unlike a mechanical one, can be also be used by people who don’t have an elbow — it simply has to be strapped on with Velcro straps. It’s also lighter: a robotic arm weighs 600 grammes whereas a mechanical one weighs around 1.5 kilogrammes. To move the robotic arm, the recipient simply has to think of what it wants the arm to do — electromyography censors then detect the electrical signals from the muscles which move the robotic arm and its fingers.

IS PAKISTANI MEDICINE TURNING A NEW CORNER?

“If you have a model it becomes easier,” says Dr Zulfiqar Ali Mastoi, the first surgeon in Pakistan to use the 3-D surgical models created by Bioniks. Last year, the professor of orthopaedics at the Peoples University of Medical and Health Sciences in Nawabshah was working on a plan to remove a tumour from the distal femur (thigh bone) of one his patients. However, he was concerned about how complicated the surgery could be and wanted something that would help him plan it better. Around that time, he came across a segment on Bioniks on TV. “I realised I knew someone who works there!” he says. “I got Anas’s number from his father and when Anas came here from Karachi, we had four to five meetings.”

Surgeons in the West have used 3-D models to plan operations since the 1990s so it seems strange that Pakistan’s surgeons still don’t use them. Mastoi says this might have something to do with additional costs. “Hospitals don’t use it because it is expensive. And every patient can’t afford it but it does make [surgical] planning better.” Nevertheless, Niaz says he has approached a few hospitals in Karachi and they seem highly interested.

Another innovation that may soon be available to patients is a plastic plaster — an alternative to the traditional gypsum plaster (commonly known as plaster of paris) used to heal bone fractures. The open-lattice structure is 3-D printed, often in two parts, and is personalised based on the patient’s fracture. Not only is it lighter than the traditional cast, it is more comfortable and breathable. “We’re currently working on a cast for a client whose shoulder is barely attached to his arm because of his decades-long battle with muscle cancer,” says Niaz. “The doctors told him they can’t do anything for him so he approached us.”

Tanzeela, meanwhile, is still waiting to get a robotic arm. The last time I talked to her and her father over the phone, they had both just met with Qureshi who had travelled to Islamabad for work. Tanzeela had been measured for her new prosthetic by a Bioniks team, which she tells me, was the “strangest experience in my life since I never show my arm to anyone”.

What will it mean for her to get an arm? “I can’t do a lot of the work around the house and I find some things challenging at work, too, like my writing is good but I find it hard to write on the chalkboard with one arm,” she says. “Once I get this [robotic arm], my life will not be the same.”

Published in Dawn, EOS, February 4th, 2018