The prosthetist who makes people whole again

“The opportunity for job satisfaction in my profession is there virtually every day,” says Canadian Kees Beek. Beek is a prosthetist living and practising in Cranbrook, British Columbia. He is the professional who tailors, moulds, and creates a prosthesis to take the place of a missing limb for all levels of amputations.

“Surgeons do their work and perform the amputations hopingto leave or save as much of the limbas possible for optimal function,” he explains. “But depending on the trauma, sometimes the surgeons are not able to leave a very functional residual limb, which makes it more difficult both for both me and the patient.”

A residual limb is considered more functional when an amputation is performed below a joint, whether below the elbow or knee.

“There are all different complexities and components that can go into making a prosthesis,” Beek says. “For example, geriatric patients who lose a leg due to circulatory complications have little demands as their goal is to be independent and ambulatory within their own home or community versus having to chase after a child or run around the block for exercise.”

The process of creating a prosthesis can get complicated. “Sometimes, I think — wow, what am I up against here?” Beek says. “I’m trying to replace [a part of] or to restore function to such an incredibly complex being, dealing with man-made things that are really so far inferior to the original. But I still have to make the best of what is available and embrace the new developments and technology.”

After 30 years of work in this profession, Beek reflects on the great advancements of technology and recalls how when he first began — since the familiar “wooden leg”. “It’s a career that has evolved from a trade to a profession,” he says.

With a chuckle, he notes, “We were once called ‘limb-carvers’ and that is because we carved sockets out of wood and basically fit them on to a residual limb. Plastics and laminate materials then replaced the wood, and today we are using carbon-fibre components.”

A prosthetist’s job sometimes involves seeing a patient for the rest of his or her life, especially when dealing with younger amputees whose growth necessitates constant modifications and adjustments.

The latest advancements in his field, Kees says, include “computer controlled artificial feet that have come into the market within the past five years or so. These feet are almost bionic! They have small motors, whether in the foot or knee joint, and they are programmed in such a way that they can react to forces placed on them.

“I hesitate to make it so simple — but as an example, there are sensors within the prosthetic foot that sense and read the forces exerted on the foot depending on whether one is walking uphill or going downhill.”

He adds that over the past 20 years, “fantastic” advances in the material have improved the weight and strength of prosthetic devices, especially with the introduction of carbon fibre and titanium.

“The most advanced technology is the computerised knee,” Beek says. “This has tremendously changed the quality of life for above-the-knee amputees, who, before development of this technology, had to deal with a single-pivot hinge that could not behave dynamically. By that I am referring to the ability of giving resistance when needed or no resistance when appropriate, whether in deep snow or thick grass.

“Say that you want to kick a soccer ball with your son — if it were a regular free hinge, you would bring your leg forward and the inertia would keep your foot back, whereas a computerised knee will read this act and prompt the knee to stay stiff, and then loosen it again instantaneously. It’s really cool!”

Beek is quick to add a reminder that all of what is being created with the latest technology is simply nothing more than an act of mimicking the original.

“It’s mind-boggling,” he says, “The complexity of the human organism is unbelievable. The simple act of taking five steps down a hallway is in reality so ridiculously complicated, with so many subtleties. It is absolutely astonishing how it all comes together, seldom anything going wrong, even in the developmental stages. It is just amazing!”

On an emotional note, he says, “I usually tell my patients, ‘Within a year, my prediction is that you are going to meet somebody new whom you haven’t met before and they will not be able to tell that you are an amputee.’ Their response is always: ‘There is no way that’s going to happen; everyone will see that I am limping or walking with an artificial limb.’”

But the feeling is indescribable, Beek says, when an amputee approaches him and says, “Somebody came to me today and said that they did not know that I was an amputee and they knocked on my leg, looked at me and said ‘We can’t believe it.’”

In Canada, the funding for a basic prosthesis is covered by Canadian Health Care. Additionally, an initiative was established by an organisation called WarAmps, created after the First World War, to help rehabilitate veterans who had sustained amputations. The organisation solicited donations from the public and paid for extra expenses such as speciality artificial limbs. As the number of war amputees drastically decreased, the organisation changed its mandate, focusing on child amputees and launching the Child Amputee Program (CHAMP). Foster support is extended to child amputees all across Canada where CHAMP covers the extra costs (above the basic that is covered by health care) and for speciality prostheses. For example, a regular prosthesis that a child would use for everyday purposes may not be appropriate for swimming in a pool or fishing in a lake, so CHAMP pays for a speciality prosthesis. “Today, I am working on a sledge hockey arm for a child who desires to join his class in playing hockey,” Beek says. In addition, CHAMP also provides emotional support to the children and helps them develop a positive approach to challenges.

Reflecting on a moving and inspiring incident, Beek shares a story about a boy whose family immigrated to Canada as refugees from Myanmar. He describes how this boy was born missing all four limbs from above the elbow and above the knee. “It still amazes me how he can get around without anything; nothing stops him,” Beek says.

It was Beek who took on the task of creating prosthetics for this 12-year-old. The legs were made shorter at the beginning so that this boy can get an idea of what it is to be balanced on legs. Then the legs were adjusted to the normal length. “He is an amazing young man — too agreeable! I have never seen him complain. You ask him if his legs are bothering him or if there is anything that he would like changed, and his reply is always, ‘No, it’s all good.’”

Recently, Beek was approached by one of the boy’s teachers who asked him if it would be possible to create something to help the boy with using the computer keyboard. Beek ended up making arm sockets for this boy so that he can type like everyone else in the classroom.

“He is now skiing too!” Beek then says with beaming excitement. “I have created skis for him and I have taken him skiing myself!

“I feel very fortunate to have stumbled into this work. I really didn’t know what I wanted to do after high school. I knew that I liked working with my hands and making things, but I wasn’t interested in a traditional trade, such as becoming a carpenter, although I would give carpentry a second thought as I think it’s a great profession. However, I find that my profession combines working with your head, hands and people too. There is gratification on a daily basis. It’s pretty easy to feel good about getting somebody up and walking. Those patients think they are never going to be able to walk again, that it’s the beginning of the end for them. Then, when they do finally stand up and take a few steps, it’s like all of a sudden that light at the end of the tunnel is there when it wasn’t there before. It’s great!”

Ghada Al Atrash holds a masters degree in English and teaches at a college in Abu Dhabi.