"Yet for all the agonies and difficulties associated with arm loss, the bigger problem in low-income countries is when lower limb disability leads to loss of mobility. Wheelchairs are expensive and can be difficult to use when roads are pot-holed, streets are muddy and pavements are non-existent. Without a prosthetic limb, people struggle to fetch water, to prepare food and, above all, to work. This throws them back on their families and communities, intensifying any hardship and poverty."