A leg up in life

Assistant at prosthetics service, an amputee himself, hopes to offer same support he received

Barely two years ago, Mr Muhammad Fazli Hasri was a patient at Tan Tock Seng Hospital's (TTSH) Foot Care & Limb Design Centre.

Today, the 29-year-old works there, helping others to find a way to overcome their challenges, like he did when he walked out with a new artificial right limb.

Patients are usually surprised when he reveals that he is an amputee, because no one can tell unless he lifts up the hem of his pants.

As a technical assistant in the Prosthetics & Orthotics Service, Mr Fazli is part of a team which makes and assembles customised prosthetics and orthoses for people like himself who have lost limbs to injury or disease.

The centre is based at TTSH, a member of the National Healthcare Group. It is made up of the Prosthetics & Orthotics and Podiatry services. TTSH is the only provider of prosthetic and orthotic services in the public healthcare sector.

Senior prosthetist/orthotist Tsu- rayuki Murakami, 28, said: "We make artificial limbs for people with missing arms or legs to help them to be able to substitute the body function that they have lost."

Senior prosthetist/orthotist Tsurayuki Murakami marks out a patient’s stump anatomy to facilitate prosthetic fabrication. Amputees generally require a new prosthesis every three years. Children need replacements more frequently as they are growing. Prosthetic adjustments, repairs and component upgrading are also aspects of ongoing care that are carried out at the Foot Care & Limb Design Centre. ST PHOTO: NEO XIAOBIN

He added: "For orthotics, we manufacture custom braces for the lower legs, spine and head. These are bracings that help to improve the function that patients may have lost because of neurological or orthopaedic conditions, or sometimes due to diabetes as well."

Mr Murakami applying plaster of Paris to get a negative model of the left stump of Mr Tan Gim Siah, 64. From the negative model, a positive model is created in the plaster room where plaster is poured into the negative cast. Fabricating prostheses is an intricate procedure requiring a high degree of skill and technology. The prosthetic design is determined by the prosthetist/orthotist after considering the patient’s physical condition, activity level and functional needs. ST PHOTO: NEO XIAOBIN

The 10,764 sq ft centre - about the size of nine five-room Housing Board flats - sees more than 26,000 patient visits a year.

Mr Murakami works on a plaster rectification of a positive model of a patient’s amputated stump in the plaster modification room. Rectification is when forces are applied to pressure-tolerant areas of the stump to relieve pressure-sensitive areas. ST PHOTO: NEO XIAOBIN

From the first appointment with the patient, where casting is done and the fabrication process starts, it takes an average of two to four weeks before the prosthesis is ready to be fitted. Patients still have to go through rehabilitation gait training, which means learning how to walk again, to make sure they can use the prosthesis safely before they are allowed to take it home. This rehabilitation training can take three to six months, depending on the complexity of the case.

Mr Muhammad Fazli Hasri, a technical assistant in the Prosthetics & Orthotics Service, works on a patient’s prosthetic socket in the lamination room with senior technical assistant Prakash Krishnan. The socket is usually constructed in layers using resin. Technicians use different combinations of different materials, such as resin, pigment and hardener, during the lamination process to create a very strong and sturdy prosthetic socket, one that is able to tolerate high-impact forces when patients walk or run with the prosthesis. ST PHOTO: NEO XIAOBIN

For Mr Fazli, the second of three children who lives with his parents in a four-room HDB flat in Bukit Panjang, it all began after dinner on Aug 30, 2015. He was on his way from Melaka to Johor Baru on the North-South Expressway with four friends in a car. Asleep in the back, he dreamt they were tumbling through the air. In reality, it was the start of a nightmare.

Mr Murakami secures a polyurethane foam block on a metal rod to be placed in the 3-Axis Carver, which will carve out a model of a patient’s torso. Braces will then be made over the model. The technology is usually used for patients with spinal deformities such as scoliosis. ST PHOTO: NEO XIAOBIN

The driver had dozed off and hit a divider. The car overturned after rolling around "like a washing machine". While the others escaped with mainly minor injuries, Mr Fazli's right leg was stuck and almost crushed by the front seat. His leg, badly affected by bacteria, could not be saved despite multiple operations.

Mr Fazli and Mr Krishnan drape heated plastic around a mould – in this case a replica of a patient’s foot and ankle – in a specialised workshop. The mould is used as a reference to create a custom orthosis. Additional steps include grinding and the adding of buckles and straps. An orthosis or brace is a supportive device that has multiple uses, including to control body alignment during movement, and post-injury support and rehabilitation. ST PHOTO: NEO XIAOBIN

Fearing that the rot would spread above his right knee, he agreed to the doctor's recommendation for an amputation. Afterwards, he was referred to TTSH for a prosthetic leg to be fitted.

Mr Fazli cuts and polishes a brace in the grinding room, readying it for a patient’s fitting. The Foot Care & Limb Design Centre specialises in custom-made orthoses for the foot, ankle, knee and spine, as well as cranial helmets and sports orthoses. ST PHOTO: NEO XIAOBIN

"To be honest, when I was one of the patients, I felt so demoralised. I envied the ones with two legs who could walk normally," said Mr Fazli.

Completed prostheses line the shelves in the workshop at the centre as Mr Fazli works on a customised brace. Completed prostheses have a foam covering to protect the parts and improve their aesthetic appearance. ST PHOTO: NEO XIAOBIN

As he had studied electrical engineering and mechanical technology at the Institute of Technical Education, he was recommended by his prosthetist to work at the centre. Grateful for the opportunity, he started there this year.

Mr Tan Gim Siah tries out his prosthetic leg for the first time, watched over by Mr Murakami. Mr Tan had his lower left leg amputated in December last year because of infection from diabetes. During the fitting, prosthetists will check the socket to make sure the patient is comfortable with the fit. Then they will continue the process by aligning the prosthesis – addressing things like the height of the prosthesis, and the alignment from the front and side views of the patient – making sure that the gait is as natural as possible so that patients can walk smoothly. ST PHOTO: NEO XIAOBIN

With support from his fiancee, friends, family and colleagues, Mr Fazli tries to look forward. He also hopes to offer the same support he received to other patients because he knows what it feels like.

Madam Tri Widianti (left), 32, takes her son Kylan Chia to his first appointment with senior prosthetist/orthotist Rie Nagai, following a fitting for a baby helmet at the Foot Care & Limb Design Centre. Six-month-old Kylan’s head shape is not symmetrical, so helmet treatment is used to make it more symmetrical and rounder. The helmet is used to reshape the skull by applying pressure to the high spots of the head, while leaving space for the flattened areas to grow into. ST PHOTO: NEO XIAOBIN

"We try to show people that we are just 'lightly abled' - not disabled," he said.

A sporty person who likes to surf, swim, cycle and play soccer, he hopes to represent Singapore in the Paralympics in future.

Mr Fazli swims at Senja-Cashew Community Club once a week during the weekend. Despite having a prosthetic leg, the sports enthusiast enjoys surfing and goes to Desaru in Johor Baru and other hidden beaches in Indonesia to surf. He will be going to Sri Lanka later this year for a surfing trip. At home, he ensures that he exercises three times a week by lifting weights and doing other aerobic activities. ST PHOTO: NEO XIAOBIN

He said: "For those who have lost a limb, do not be demoralised. It does not change who you are, whether you have one leg or two."

VIDEO: Watch Muhammad Fazli Hasri as he shares more about his work at the Foot Care & Limb Design Centre. str.sg/flc

A version of this article appeared in the print edition of The Straits Times on May 22, 2017, with the headline 'A leg up in life'. Print Edition | Subscribe