Two Afghan surgeons have developed a bone reconstruction tool that has slashed recovery time and cost for patients in therapy. While cheaper imitations have appeared, a leading medical multinational has acquired the patent and plans to mass produce 'Afghan Device'. Masood Momin reports.
The nuts and bolts: materials used to make local variants of Afghan Device (Photos: Dr. Ismail Wardak)
Made of nuts and bolts and shaped like a bow, Afghan Device looks more like a miniature musical instrument than a medical tool. But for patients suffering from fractures and fragmentation of the kneecap and elbow, its promise of fast healing is music to their ears.
This orthopaedic healing solution was invented by two Afghan doctors, Mohammed Wardak and Abdulrazaq Siawash, and is making waves in the medical world. Although still in the prototype stage, it is already being introduced in hospitals in the developing world. The rights have even been snapped up by a global manufacturer.
Its attraction lies in the significant reduction of the healing period and strain on patients.
Yet the advantages of Afghan Device over traditional healing techniques are multifold, says Wardak, who works as chief traumatologist at the Afghan National Army Central Hospital in Kabul. “The common method now used to treat small bones is very flawed when compared with how our invention works, requiring a person to be operated twice," he says. "But with our method only one operation is needed and it is so minimal that the skin sometimes may not even be cut.”
Reducing the treatment period is one of the greatest achievements: “In the past, people who underwent surgery had to stay away from hard work for six months. But under our method, they completely recover in six weeks.”
Ahmad Jawad recovered in less. "I had this device on for twenty-six days," says Wardak's former patient at the Martyr Sardar Muhammad Daud Hospital. In under four weeks, the knee fracture Jawad was carrying has completely healed: "I can now run and I have no pain in my knee whatsoever,” he says.
Ahmad Jawad, a patient with a knee fracture, shows the minimal dimensions of Afghan Device in action.
Accolades have been coming in from other parts of the country too. Dr Naseer Latif runs a private clinic in Herat Province and has been treating patients using Afghan Device for the last five years.
"Before the invention of Afghan Device we had big problems in treating patients who had patella and olecranon (kneecap and elbow) fractures,” says the doctor. “The classic method took five months, but with Afghan Device, patients heal in 45 days,” he confirmed.
Traditional bone healing therapies were also more expensive, according to Latif. “Classic treatments cost 700 dollars per patient. With Afghan Device, patients can be healed for as little as 200 dollars,” the bone-marrow specialist told Afghanistan Today.
UK-based Smith & Nephew, a leading multinational orthopaedic reconstruction company, recently acquired the commercial rights for Afghan Device and is developing the patent. The company has so far produced 60 prototypes, says Wardak, although the licenced device is not yet available on the open market.
Each device costs 200 dollars to produce. If it is now mass produced to international standards, the orthopaedic aids could go for up to five times more, he believes. But unlicenced manufacturers have latched onto its potential: Cheaper variants produced in Pakistan and India sell for 10-20 dollars.
Afghan Device compresses fractures applying various levels of tension over the healing period. Smith & Nephew outlined the method in a recent statement: “Traction is applied to the skin medially and laterally to prevent the wires from applying tension to the skin. Two 1.6mm wires are passed horizontally through the proximal fragment and two additional wires placed in the distal fragment. The pairs of wires may be passed in parallel or cross pattern. It is important that the wire pairs be as far from the fracture line as possible to form a bow. Tensioning the device then produces compression of the fracture.”
'In the past, people who underwent surgery had to stay away from hard work for six months. But under our method, they completely recover in six weeks." Afghan Device inventor Dr Ismail Wardak
While the medical jargon seems protracted, the device itself, which resembles a bow-like vice, is surprisingly simple. But it has taken years to perfect,
“We started working on the first version in 2000," said Wardak. "At that time, it was primitively fashioned from low quality iron, but in 2004 manufacture was standardized."
Then, after various phases of registration and legal processes, the device was approved by the United States Food and Drug Administration (FDA).
The device's two inventors met in 1983, when Wardak entered Kabul Medical University and studied under Dr Abdulrazaq Siawash. Their student-professor rapport developed into a professional relationship which later led them to collaborate on Afghan Device.
Since then, their work has received recognition at more than 15 international medical conferences and in numerous international journals. According to Wardak, around 300 people with fractures in their knees and elbows have been treated using their invention, and he estimates that around 80 per cent of orthopaedic doctors are now familiar with the device.
Dr Wardak is awarded the Baryaal Medal by President Karzai
Despite not being officially available on the open market yet, variants have crept into service in many hospitals in Afghanistan, including the major cities of Herat, Mazar-e Sharif and Jalalabad. Smith & Nephew has also donated 30 Afghan Devices to developing world hospitals outside of Afghanistan.
Further recognition came in the form of the first-class Baryaal Medal, Afghanistan’s highest honour, awarded to the pair by President Hamid Karzai at a recent ceremony. As a return gesture, the doctors built a special gold-leafed Afghan Device for the president, who gave it for permanent exhibition at the city's museum of medical history.
Karzai hailed the pair's work as more than just an antidote to bone fragments: “The youth of Afghanistan should learn from these doctors, they should regard them as role models and follow their example," said Karzai. "This would help the country move towards development and growth and away from misery.”