International Wheelchair Donors and Producers Seek Common Ground in a Global Hamlet

by Marc Krizack (krizack@sfsu.edu)

To build or not to build, that is the question that is on the minds of organizations that provide low cost wheelchairs in developing countries.  Whether 'tis nobler in the mind to suffer the slings and arrows of outrageous fortune in trying to develop small sustainable wheelchair businesses or to take arms against a sea of troubles and thereby end them by donating wheelchairs collected in the United States. This, in essence,  was the subject of a roundtable discussion at the recent RESNA 2000 conference in Orlando, Florida, USA.

(RESNA used to mean Rehabilitation Engineering Society of North America,  but since has expanded conceptually and geographically beyond these parameters, while retaining its well-known acronym.)

Background
Chaired by rehab engineer Matt McCambridge of  the Santa Cruz, California (USA) company Beneficial Designs, the session brought together representatives from that organization and from  Whirlwind Wheelchair International (WWI), Hope Haven, Inc., and Turner Mobility.  A representative from Joni and Friends, who had to leave the conference early, participated in pre-roundtable discussions.  WWI promotes small, local wheelchair building shops in developing countries.  Hope Haven, Inc. and Joni and Friends, both Christian-based organizations, have well-developed international programs through which they collect, refurbish, transport and donate wheelchairs to people in need in developing countries.  Hudson Moore of Turner Mobility has been involved with wheelchair donations but is currently designing a protoype wheelchair that involves no welds and could be inexpensively produced in developing countries.  Peter Axelson and Denise Chesney Yamada of Beneficial Designs participated. They were the 1999-2000 co-chairs of RESNA's Special Interest Group 17 (SIG-17), which provides a forum for persons who are actively interested in providing appropriate rehabilitation technology and services to people in third world and other limited-resource countries.

Impact of donated chairs
The Roundtable was a continuation of earlier discussions aimed at developing effective forms of cooperation among the various organizations.  Wheelchair producers such as WWI and the British group, Motivation,  have been interested in protecting nascent wheelchair building shops from competition with cheap or free donated wheelchairs.  Organizations such as Hope Haven feel that because the need for wheelchairs far outstrips the production capacity of the small wheelchair shops,  people with disabilities who need them should not be denied.  WWI's Marc Krizack noted, "If hundreds of donated wheelchairs are given away to poor people in a small shop's geographic market, most of the remaining families with a disabled member will not spend their own scarce resources on a wheelchair but will wait in the hope that there will be more free wheelchairs."   Mark Richard,  Hope Haven Operations Manager, noted that there are a number of environments, such as hospitals, in which donated hospital chairs are the most appropriate and would not likely take a market away from the locally built chairs which tend to be designed for more active use.  Urban areas, where repair facilities are more common, would be more appropriate places for donated chairs than rural areas where the parts to repair chairs would generally be lacking.

Creative suggestions
Richard offered some creative ways to avoid the problem of competition between imported and locally built wheelchairs.  Richard suggested that organizations which donate wheelchairs could send them to the local shops to be refurbished and/or assembled, thus providing an income to help sustain these shops.  Richard also noted that greater communication between wheelchair producer and donor organizations would go a long way toward alleviating the problem.

Principles of responsible wheelchair provision
Everyone agreed to what McCambridge has called "General Principles of Responsible Wheelchair Provision."  Whether chairs are donated or locally built, additional services must accompany each wheelchair distributed.   Each recipient of a chair must have her individual mobility and seating needs assessed in order to provide the greatest degree of independence.  Whirlwind Wheelchair and Motivation have long emphasized that a free bad wheelchair might be worse than no wheelchair at all if it results in a pressure sore.  Pressures sores can be very difficult to heal.  They can lead to infections and, not infrequently, to death.

Some examples of responsible wheelchair provision include special seating and the provision of wheelchair cushions.  In a paper presented to the RESNA 2000 Conference, McCambridge discussed additional requisites of responsible wheelchair provision which he synthesized from surveys and interviews with the provider organizations.  "The rider must receive training in pressure ulcer management and the use and care of a wheelchair," writes McCambridge.  "Provisions must be made to ensure that the chair can be repaired, and follow up assessment should be done to determine whether the equipment meets the person's needs."

Richard and Krizack agreed to begin work on developing a set of guidelines to coordinate the provision of free and low cost wheelchairs in developing countries.  The group plans to next meet in November in Guatemala City, Guatemala at the 2nd Annual Conference of the Association of Mobility Providers.