K. A. TKACHENKO

Candidate of Economic Sciences

Institute of Africa, Russian Academy of Sciences

Keywords: armed conflicts in Africa, rehabilitation of conflict areas, cripples, amputees, innovative prosthetics technologies, crowdfunding*

Rehabilitation of the population of vast regions of Africa that have suffered as a result of numerous internal armed conflicts and wars over a long period of their recent history (since the middle of the XX century) is an urgent problem. Its humanitarian significance and public appeal cannot be overestimated. Its significance is no less than that of other challenges of the 21st century. We will touch on only one important aspect of it - prosthetics of numerous cripples.

Tens of millions of Africans from about three dozen countries of the Black continent have become victims of wars and conflicts - killed, crippled, refugees, subjected to various forms of physical violence, etc. In African States-and there were more than a dozen and a half of them affected by large-scale armed conflicts in the XX-XXI centuries-the total number of victims exceeded 15 million people. According to world organizations - the Red Cross, as well as Human Rights Watch, hundreds of thousands of crippled people lost their limbs among the huge number of victims.¹ Only in South Sudan there are 50 thousand of them.

Today, more and more high-tech models of prostheses are being created for people who have undergone amputation, and these achievements in orthopedics and traumatology are regularly reported in the media.

Most often, these reports are linked to famous athletes, such as swimmer Natalie du Toit, mountain climber Stan Andrews, who conquered Kilimanjaro, or famous runner Oscar Pistorius (all three are from South Africa). Amputation, which led to physical limitations, although it became a heavy burden for these people in their new life, but did not prevent them from achieving brilliant results in world - class competitions-at the Olympic and Paralympic Games.²

Undoubtedly, the success of Paralympic athletes has helped many people with disabilities to believe in their abilities and realize that amputation of legs or arms is not necessarily a sentence to life only in a wheelchair.

However, the complex bionic prostheses used by athletes are available to very few people in the world due to their high cost. For example, "artificial legs" manufactured by Ossur and Otto Bock-recognized leaders in the field of prosthetics, cost from $10 thousand to $60 thousand. ³

Plus regular expenses for their maintenance and replacement of worn parts.

Although a bionic prosthesis can significantly make life easier for a disabled person, there are only three ways to become its owner:

- find a sponsor (this is realistic for budding athletes who have made their way into big-time sports);

- participate in a program of assistance for injured servicemen funded by the Ministry of Defense (unfortunately, only the military budget of an industrially developed country with a powerful scientific and technical complex can afford such programs);

- crowdfunding via social networks (if the disabled person has a computer).

A significant portion of the African population and the vast majority of sub-Saharan Africans live below the poverty line, with an average annual income of less than $900. And for them, the opportunity to purchase a functional prosthesis was not available until recently.

The majority of disabled people living on the African continent, particularly those severely maimed by the war in Sierra Leone and South Sudan, face the fate of life-long dependents, unable to get any work and be full-fledged members of society.

Thus, more than 27,000 Sierra Leoneans were left without limbs as a result of brutal axe amputations carried out by soldiers of the Revolutionary United Front in order to deprive them of the opportunity to vote in the elections - to put their signature ⁴. The poor were condemned to a desperate search for work, or to exile from the community and begging.

A similar fate awaited Daniel Omar , a young shepherd from South Sudan. In 2012, as a result of the bombing, Daniel lost both hands. In a young country that has gone through a civil war, has no social programs to help people with disabilities, and where more than half of the population lives below the poverty line,being left without hands means living only as long as your relatives are able to feed a dependent.

"Without hands, I can't do anything. If I could have died then, I would have died better, " Omar told reporters.⁵

* Crowdfunding ("people's funding", from the English crowd - "crowd", funding - "financing") is a collective collaboration of people (donors) who voluntarily pool their money or other resources, usually via the Internet, to support the efforts of other people or organizations (recipients) (approx. author's note).

Thanks to the press, Mick Ebeling, an entrepreneur from California and founder of the non - profit organization Not Impossible, which helps people who find themselves in such a desperate situation, to feel the joy of life again, found out about Daniel's problem. At the end of 2013 Ebeling equipped a hospital in South Sudan with a laboratory equipped with a special 3D printer* for printing prosthetic components, and also instructed staff and patients.⁶

The equipment provided by Ebeling allows you to make a prosthesis, the total cost of parts of which does not exceed $100. Unlike bionic analogues, which cost hundreds of times more, this price, although very high for residents of Sudan, is still feasible. So one of the results of the Ebeling program was that Daniel was able to support himself for the first time since the tragedy.

The 3D-printed prosthesis, while not as sophisticated and multi-functional as the bionic one, allows a disabled person without limbs to lead a life less dependent on outside help. A patient using a prosthesis, if any part is broken, just contact a clinic equipped with a 3D printer, where they will enter the parameters of the necessary part into a computer program and print a new part, which will require minimal material costs. This technology is fundamentally different from the technology of creating bionic prostheses, where a new part would have to be manufactured at the factory, usually in a single copy, and this would be the main reason for its exorbitant price.

The cost of high-tech prosthetics is due to the fact that their production is not put on the conveyor belt, as well as the lack of intense competition between manufacturers of bionic prostheses. Every company working in the field of prosthetics simply cannot afford to improve prosthetics technology at the speed, for example, of updating mobile phones. After all, the weak dynamics of the prosthesis market does not give the necessary impetus to regular improvement of the technology. Prosthetic manufacturers are encouraged to do this only by initiative programs of research institutes, or individual state projects with appropriate cash injections.

The current situation can be compared to the automotive market before the invention of the conveyor belt by Henry Ford, when cars were made to order, every detail was unique, piece-by-piece, which made the final product completely inaccessible to the mass consumer. The introduction of the conveyor significantly simplified the assembly process and allowed opening the automotive market to the masses.

The prosthetics industry is experiencing a similar "tipping point" right now. However, "industry" is a big word, because we are still talking about unprofitable piece production with virtually no intra-industry competition and weakly pulsating modernization, which is completely dependent on state or big business sponsorship.

The problem can be solved by the transformation of the industry from a clumsy piece-made model to mobile in-line production, where changes to the design do not require re-equipment of the factory machine for an individual prosthesis or manual assembly. It is 3D printing that opens up such an opportunity, allowing you to effectively combine mass production, the possibility of individualizing each prosthesis and the low cost of consumables.

At the same time, a person is completely excluded from the production itself - the whole process is one hundred percent automated. All that is required from the operator is to enter the parameters of the required part in the computer program, fill up the consumables and start the printing process.

Currently, the supply of 3D printers to hospitals in Sudan, Sierra Leone or any other African country, with the possible exception of the Republic of South Africa, depends entirely on the initiative of individual philanthropists such as Mick Ebeling. The funds allocated to medicine are sorely lacking for prosthetics, as well as for the fight against many lethal diseases, such as AIDS and Ebola.⁷

Therefore, it is critical to promote bioprinting technology at the level of joint projects in Europe and Africa that affect health care, in order to encourage countries with advanced medicine to participate in the modernization of hospitals in the African continent. In particular, in equipping them with bioprinters and training medical staff.

And African governments are faced with the task of helping thousands of disabled people - victims of military clashes, waiting for years for disability benefits, living on dependent relatives or simply dying without help.

* A peripheral device that uses the method of layer-by-layer creation of a physical object based on a digital 3D model. In foreign literature, this type of device is also called fabbers, and the process of three-dimensional printing is called rapid prototyping (author's note).

¹ Human Rights Watch Reports. 2009-2013; Modern Africa. Metamorphoses of political power, Moscow, 2009, p. 227; International Red Cross. Annual Report. 2013.

^{Natalie du Toit} 2 - http://www.southafrica.net/za/en/articles/entry/article-southafrica.net-natalie-du-toit

³ Human Rights Please Help! - https://www.change.org/p/physically-disabled-persons-vers-otto-bock-ossur-human-rights-please-help-force-otto-bock-ossur-to-sale-to-public-and-to-list-prices-publicly-stop-the-monopoly

⁴ Revolutionary United Front (RUF) - http://global.britannica.com/topic/Revolutionary-United-Front

⁵ 3D-printed prosthetics: How a $100 arm is giving hope to Sudan's 50,000 war amputees - http://www.independent.co.uk/life-style/gadgets-and-tech/news/3dprinted-prosthetics-how-a-100-arm-is-giving-hope-to-sudans-50000-war-amputees-9071708.html

⁶ Project Daniel: 3D Printing Prosthetic Arms for Children in Sudan - http://www.notimpossiblenow.com/labs/project-daniel

⁷ For more information, see: Melnikov V. A. "Death named Ebola" / / Asia and Africa today. 2014, N 11. (Melnikov V.A. 2014. "Smeit po imeni Ebola" // Aziya i Afrika segodnya. N 11) (in Russian); Melnikov V. A. "Ebola" recedes, but... / / Asia and Africa Today. 2015, N 5. (Melnikov V.A. "Ebola" otstupaet, no... // Aziya i Afrika segodnya. N 5) (in Russian)

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