Wheelchair History Made in Uganda
(The Second¹ of an Occasional Series on Wheelchair History)

by Marc Krizack (krizack@sfsu.edu)
 

In this New Millennium, the idea of building good quality, low-cost wheelchairs in developing countries from locally available materials is old hat. Since the early 1980's, Ralf Hotchkiss and his organization, Whirlwind Wheelchair International (formerly the Wheeled Mobility Center), have worked in more than 25 countries around the world.  Since then, organizations such as Handicap International, headquartered in Brussels, Belgium, Motivation based in Bristol, England, and the Vietnam Veterans of America Foundation in Washington, DC have gotten involved in promoting the local manufacture of appropriate wheelchairs in developing countries.  In addition, many small businesses and disability organizations have taken the lead in their own countries in further developing local wheelchair design and manufacture.  Yet the very first project, even before Hotchkiss, to develop a locally-built, locally more appropriate wheelchair took place in Uganda, the brainchild of orthopaedic surgeon Dr. Ronald Lawrie (R.L.) Huckstep.

Dr. Ronald Huckstep
Ronald Lawrie Huckstep  was born in England in 1926. He graduated from the Middlesex Hospital, London in 1952. He then worked in Kampala, Uganda where he contributed greatly to the world's understanding of poliomyelitis. There he performed operations to improve the lives of people with severe congenital as well as acquired impairments. Huckstep's ingenuity also led him to develop many splints and other useful devices, as well as new methods for fracture fixation. He became Professor of  Traumatic and Orthopaedic Surgery at the University of New South Wales (Australia) in 1973.

Around 1967, while in Uganda, Huckstep designed a wheelchair made from old chair frames and bicycle parts. This was the first fully durable, tubular wheelchair built in 3rd world countries.  The cost of the materials varied between $50 and $100.  By 1975, more than one thousand had been produced.  In 1975, Huckstep published a manual on "Simple Wheelchairs and other Vehicles" in which he discussed his work in Uganda.

Huckstep recognized that imported wheelchairs were usually too expensive, broke down easily, and were difficult to repair because of a lack of spare parts.  He decided to  make his initial prototypes out of old broken metal frame chairs.  These were repaired by welding, and a supporting frame was added for the wheels. This was necessary because the wheels he used were bicycle wheels which needed to be supported on both sides of the hub.  Canvas seats and backs were made out of old canvas mail bags.  Caster wheels, or as he called them, "bogie" wheels, were taken off old hospital carts.  Wooden chock blocks were used for brakes. More sophisticated versions of this chair were developed from this initial prototype.

Huckstep's Design Considerations
Huckstep knew that a good wheelchair in Uganda, or anywhere in the developing world for that matter, needed to be cheap. In fact, for Huckstep, cost seems to have been the overriding design criteria.  That meant that a wheelchair needed to be made from locally available materials and strong enough to stand up under tough conditions, including mud, dust, water, and rough roads.  But he also knew that its design needed to be simple enough to be manufactured locally with semi-skilled labor.

Huckstep also grappled with the various compromises that have to be made when designing a wheelchair that is to be independently operated rather than pushed.  On the one hand, a chair needed to be low enough to the ground so that the user could climb in and out of it fairly easily, yet high enough to clear potholes and small drains.   The narrowest possible chair is desirable so the rider can go down small paths and through the common narrow doorways in houses, yet in order to use available bicycle wheels, the frame had to be wider than a standard wheelchair to accommodate the outer axle supports.  It was Huckstep's opinion that this was an acceptable trade-off because the cost of the wheelchair would be much higher if bicycle wheels could not be used.   Because of this design decision, the Huckstep is essentially an outdoor wheelchair.

Today, most 3rd world wheelchairs are built using large wheels which are mounted on a hub which spins on a fixed axle and needs to be supported only on the inside.  This may be a function of wheelchair riders making their own decisions regarding the features they want in a wheelchair.  Or it may be that a hub that can be made from locally available materials has been around since about 1982.
 
 

Rigid or foldable?
Huckstep also confronted the issue of foldability.  In general, non-foldable wheelchairs, known as "rigid" wheelchairs, are less expensive to produce and tend to be stronger.  The latter fact is especially true when compared to standard hospital-style wheelchairs.    However, a foldable wheelchair is much easier to transport on buses.  In this instance, Huckstep came down on the side of a non-foldable wheelchair.  He reasoned that since Uganda had few private cars, the opportunities for folding a chair for transport were few.  He also argued that most taxis and buses had roof racks, so a non-folding chair could easily be carried on the roof.  Hotchkiss, who generally designs chairs that fold, noted that "a bus driver will usually charge double or triple to load a person's non-folding wheelchair on top of the bus."  He says that the Huckstep chair is not allowed on many forms of intercity transportation.

Advantages of Huckstep design
Despite advances in wheelchair design, the Huckstep continues to offer a number of advantages.  The relatively long wheel base allows it to descend most curbs and to climb small curbs.  The three-wheel design, with the two large wheels in the front and the third bogie (caster) wheel trailing in the back center, maintains good traction over rough but relatively level ground.  This design keeps both of the large wheels on the ground at all times.  A single trailing wheel not only becomes obstructed less, but can also be tilted out of a pothole. It also acts as a prop to prevent the wheelchair tilting backwards when going up hills.

The Huckstep also continues to cost less than folding wheelchairs in part because it is easier to fabricate.  Many of these savings also translate into lower start-up costs for a small wheelchair building business.  The use of old chairs as the main frame has the advantage that the basic chair is available without having to build jigs or purchase a tubing bender. The use of off-the-shelf bicycle wheels means there is no need to make a hub or spoke the large wheels, as with the Hotchkiss Whirlwind.  The Huckstep's plywood seat and back require no sewing of material. "In general," noted Hotchkiss, "less training of production workers is required with the Huckstep than with a chair like the Whirlwind."  Hotchkiss estimates that when produced in quantity, the Huckstep might be 20% cheaper than the Whirlwind.

Disadvantages
Most of the Huckstep's main disadvantages seem to stem from the large wheels being located in the front.  They can make it difficult for people with significant disabilities to transfer in and out of the wheelchair.  They make it impossible to pull up close to a table or a work bench.  Front wheel drive tends to slip going uphill over sandy soil, and it can be more difficult for a person to push himself than if the wheels were located in the rear.

The Huckstep has two other problematic features.  The fixed footrests cannot be raised over obstacles,  limiting its use for taller people and making it more difficult for a person assisting the wheelchair rider.   The hard plywood is very conducive to pressure sores for people with spinal cord injuries, although less of a problem for those people with sensation in their legs and buttocks.   Hotchkiss noted that in Uganda there is no procedure for prescribing wheelchairs, so if a spinal cord injured person is given a Huckstep, that's the chair they're stuck with.

Dr. Huckstep has not been unaware of this problem. When a Huckstep wheelchair is to be given to a paraplegic, Dr. Huckstep would require that the seat and back be padded with foam or some other suitable padding covered by waterproof material to hold it in place. However, many spinal cord injured persons in Uganda receive the Huckstep without padding. The chair is currently built in the rehabilitation wing of a government hospital.

Revolutionary for its time
Although there have been many advances in low-cost, appropriate technology wheelchair design since the mid-1960's, the Huckstep was truly revolutionary for its time.  It was the first reliable mode of independent mobility for many disabled Ugandans.  By allowing disability activists to get out into society  it may well have been the most significant factor in propelling the Ugandan disability rights movement to the position it enjoys today at the forefront of the disability rights movement in Africa.
 

¹The first article in this series appeared in DisabilityWorld under the title "Smithsonian Exhibit on Disability Rights Leaves Gap in Technology."