Healing touch

The plight of Ali Ismaeel Abbas has affected people's consciences deeply. But prosthetics could help him, and others who have lost limbs, to adapt and to rebuild their lives. Julia Stuart reports

Like the photograph of Kim Phuc, the naked nine-year-old screaming with agony from burns inflicted by a napalm attack during the Vietnam War, the image of Ali Ismaeel Abbas will be the one that most people will remember of the second Gulf War. Photographed lying on a grim hospital bed in Baghdad trying not to cry, the 12-year-old's arms have been reduced to bandaged stumps following a bomb attack on his home, which also claimed the lives of his parents. "Do you think the doctors can get me another pair of hands? If I don't get a pair of hands, I will commit suicide," he told reporters.

Within days of the picture's publication in the British press, a number of funds were set up to channel donations from a public desperate to help pay for his treatment. Ali's Fund for the Limbless of Iraq, launched last week by the Limbless Association, based at Queen Mary's Hospital in Roehampton, London, already stands at £140,000. Doctors and prosthetists at the hospital, a centre of excellence, have agreed to treat him for free and RSL Steeper, which supplies the hospital with prosthetics, will give him equipment at half-price.

There is, however, the possibility that Ali, who was left with 60 per cent burns and is at high risk of septicaemia, will not survive to reap the benefits of such generosity. In that event, any money sent to Roehampton will be used to help other Iraqi children.

The association has written to the Government asking that the MoD allow the boy to be moved initially to Saudi Arabia or Kuwait, where he will receive better treatment than in Baghdad. "In the short term, to uproot him and bring him to England would probably be psychologically quite damaging for him. He can't speak the language and he won't know anyone," said Kiera Roche, the strategic development manager for the Limbless Association. "Once he's up and running and healthy again, it would make sense for him to come to somewhere like Roehampton for his longer-term treatment."

Nick Hillsdon, an upper-extremity senior prosthetist at Queen Mary's, has treated three other patients who have lost both arms above the elbow. "The essential things – dressing themselves, feeding themselves and going to the toilet independently – those are the most important factors. Once they have managed that, they can go on and do all sorts of activities. One patient lost both his arms playing on the railways when he was 11, and he has two high-level amputations just below his shoulder. He's working as a professor in Italy at the moment. He can do everything."

Some patients are ready to be fitted with a prosthesis three or four weeks after their operation, but for others it can take up to a year. Ali would probably be given only one artificial arm to begin with, so that he could get used to it. A plaster cast would be made of the stump and a socket made. It would fit over the shoulder and be held in place by straps, with a small pulley system to operate the arm. Pulling the shoulder forward would make it bend at the elbow and raising it would lock the elbow into position. Another strap would activate the terminal device – either a mechanical or electric hand or a split hook. While patients may initially consider a hook unsightly, they are more functional than artificial hands, which have passive small and ring fingers that can get in the way when trying to pick things up. The fingers' rounded ends also means they grip less effectively than a hook. One patient at Roehampton, a businessman, uses a split hook on one side and a cosmetic hand on the other side so he can shake people's hand. The hand or hook can be removed and replaced with a range of appliances to improve the patient's quality of life, such as golfing, snooker and fishing attachments.

There is a possibility that Ali could eventually be fitted with electric arms, rather than two mechanical ones, which would be operated by electrodes in the sockets. They are, however, more tricky to use and almost twice as heavy because of the batteries.

There are 62,000 limbless people in the UK, the majority of whom are over 60 and suffer from heart disease, vascular problems or diabetes. There are 20 leg amputees to every arm amputee.

"Sometimes patients are amazed at what we can do," said Hillsdon. "Others say, 'I thought we'd do a lot better than that in this day and age, we got a man on the Moon.' People often look for their own hand back, and it's difficult when you give them something that's never going to be the same."

Most, however, are amazingly adaptive. "People can use their legs to do all sorts of things. I've seen a girl come in pushing a pram, sit down, slip off her shoes, take the baby out of the pram with her feet, put it on the floor and change its nappy. It was amazing to see. People can do all sorts of things if they are in that situation."

Most patients are treated on the NHS. A few, however, choose to be treated privately. "The major difference with going private is that you'd probably have more time spent with a clinician and be able more freely to move to the high end of the component market," said Tim Moore, the marketing director for RSL Steeper, who himself has an artificial lower left arm. "You'd be able to choose something that perhaps was not so run-of-the-mill. If you want the very latest gizmo that has come out, which may not even be applicable for you, but you want it just as you want a flashy car, then you would be able to get it privately." Most patients who decide to pay for their treatment do so because their local centre does not offer high-definition silicone, a more lifelike material that covers the device and is matched to the colour of their skin, and can include veins, wrinkles, freckles and real hair. A below-elbow arm prosthesis, for example, would cost a private patient about £3,500, which would include the device, high-definition silicone and the fitting. An electric one would be even more expensive.

For Ali, at least the cost of his treatment won't be one of the many hurdles he'll now have to face. Roche, who lost her right leg almost two years ago in a motorbike crash on holiday in France, said: "Ali will get over the dark stage. I think most people do go through one, but once he's seen what he can be capable of, he will start to see the good side of life again. With the right technology you can do almost everything that you could have done before. You just do it differently and probably slower."

People wanting to make a donation should make a cheque out to the Limbless Association ALI Fund and sent it to The Limbless Association, Roehampton Rehabilitation Centre, Roehampton Lane, London SW15 5PR