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Wheelchairs in developing nations

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A patient in Haiti using a Whirwind Wheelchair. Photo Courtesy of http://www.whirlwindwheelchair.org/
A patient in Haiti using a Whirwind Wheelchair. Photo Courtesy of http://www.whirlwindwheelchair.org/

Contents

Background

Approximately 600 million people in the world have some type of disability, 80% of those live in low-income countries and 20 million people are in need of a wheelchair. The WHO estimates that only 5-15 % of those who need assistive devices have access to them. These numbers are only expected to increase with the number of people with disabilities increasing and the advancements in healthcare prolonging life. Many organizations have made wheelchairs available for distribution to end-users in these countries by various methods. However, wheelchairs used in these settings have special design and patient considerations that must be evaluated (Hsu, Michael, Fisk, 2008).


Acquisition of Wheelchairs

There are a number of ways to acquire wheelchairs for use in developing nations and each method has its strengths and weaknesses. These methods include: utilizing donations from industrialized nations, mass production and export of free wheelchairs and production from local workshops.

Donations

Many organizations donate new or gently used hospital wheelchairs or they accept donations to purchase wheelchairs for export to developing nations.


Advantages

There are many organizations available that raise money to purchase wheelchairs for donation or accept wheelchairs for donation. These wheelchairs are recycled at a low-cost typically through volunteer organizations. These donations can be delivered quickly and in relatively large quantities.


Disadvantages
A standard hospital wheelchair.Photo Courtesy of http://bradfordmedicalsupply.com/
A standard hospital wheelchair.Photo Courtesy of http://bradfordmedicalsupply.com/

The Proper fit of a wheelchair is important in reducing the chance of an individual acquiring secondary complications. These donated wheelchairs are not individually fit and the end-user has not undergone a Seating and wheeled mobility evaluation. These steps are especially important for wheelchair donations to children because of their activity level and potential for growth. The wheelchairs that are often donated were previously for use in a hospital or indoor setting and choices are often not available for individual needs. These donated wheelchairs are also not suitable to harsh conditions and may break easily. Because they are often donated as whole wheelchairs, repairs/parts are either unavailable or expensive. These devices are often donated from organizations within industrialized nations which does not include follow-up support. The influx of donations may put local wheelchair producers out of business and shipping these items to remote areas is often expensive.

Mass Production

Another method that provides wheelchairs to those in need is by mass producing them in other countries then exporting them to developing nations. This method of wheelchair acquisition also has its advantages and disadvantages.


Advantages

Since these wheelchairs are mass produced for the intention of distribution to low-income nations, special design features have been considered previous to production. These wheelchairs are also available at a lower cost because of they are produced in large quantities and they can be exported and produced relatively quickly. When the components are mass produced and are adjustable, they are even more effective in providing those in need with effective devices.


Disadvantages

Although some design considerations have been evaluated, some aspects of the devices are still not individualized which could lead to secondary health complications. These devices are often produced outside of the target country and appropriate follow-up is not available. This also includes the lack of available replacement parts and repair capabilities (Hsu, Michael, Fisk, 2008). This method is not a sustainable method for wheelchair distribution and start-up costs are often expensive [1]. The availability of low-cost mass produced wheelchairs may once again put local shops out of business. Transportation costs remain an issue with this type of wheelchair acquisition.

Local Workshops

Developing nations have had established local workshops for many years that provide service to wheelchair users. Often these shops have been established with the assistance of Disabled Persons Organizations (DPOs) who have become frustrated with the lack of accessibility in their home coutries.

Advantages

These wheelchairs are provided by local producers which makes individually fitted and designed wheelchairs an option. These can also be custom built to suit a range of needs and training. The accessibility to local workshops makes follow-up service available. These shops are a source of employment to the local population and help the local economy. They can also provide insight of their services to establish a local national rehabilitation system.

Disadvantages

These services, because of relatively low production rates, are often challenged with maintaining the balance of keeping costs low and quality high. Some of these local producers may copy mass produced designs because of a lack of proper training and access to information. These local shops are vulnerable to competition with low-cost or mass produced wheelchairs. The availability of these wheelchairs to users is limited because the inability of small local shops to receive government subsidies or provide financing options to end-users.

Design Considerations

The manual wheelchairs that are used in developing nations must have some special design considerations in order to provide the end-user with optimal and efficient mobility.

Wheel Diameter

24” wheels are standard for wheelchairs in industrialized nations and these wheels would be used on donated wheelchairs. They are lightweight and easily maneuverable, however, replacements are less available and slightly more expensive than the larger wheels. These smaller wheels also stick in bumps or potholes which can lead to user dependence or injury. 26" or 28” wheels are used on bicycles or bicycle Rickshaws which make them more readily available in developing nations. These larger wheels are easier to push on rough terrain. They are also larger and are more challenging to get inside buildings and may give the appearance of a larger device.

Wheel Width

Wide wheels travel easier over soft terrain like mud and sand than narrow wheels; howevever, they are heavier. Narrow wheels are lighter and travel well over hard terrain. Wide wheels are more appropriate for those living in rural areas while narrow wheels are better for those living in a paved (even if it contains potholes) urban area.

Front Castor Types

Pneumatic castors provide the user with a softer ride but can be punctured easily. If this occurs, they are expensive to fix and spares may be difficult to obtain. Solid wheels are more durable and less expensive but give the user a rougher ride.

Pressure Relief Cushions

Reducing the liklihood of secondary complications is a huge consideration for any wheelchair provider. This is the case especially in developing nations where the likelihood is increased due to inadequate wheelchair size, education to the user or access to healthcare. Pressure relief cushions may be used to combat these issues. The use of pressure relief cushions may increase the seat height and the following must be then considered: can the user reach the push rims, overall height in relation to furniture and altered position of the user’s arms on the arm rests.

Patient Considerations

Psychological

Special psychological considerations should be addressed when providing wheelchairs to those in developing nations. In some cultures, physical disability is looked-down upon and these opinions may have a belief or religious component. Other negative connotations include that he individual may be a burden and cannot contribute to society. A wheelchair that is properly fitted, well-made, and meets the user’s needs can provide them with the confidence, ability, outward appearance and independence to be an integral and contributing member of society. This also increases the individual’s self-esteem and confidence which also generates a positive reaction by those around them.

Financial

The idea of distributing wheelchairs at no cost to the user has been controversial. Some believe that a comprehensive financing system should be established. The idea of receiving a free device may lead to inadequate care or maintenance of the chair due to a lack of ownership. Paying a portion of the wheelchair gives the owner a sense of ownership and responsibility (Hsu, Michael, Fisk, 2008).

Donations Cites

The following are a few of the organizations that donate wheelchairs or accept money to provide wheelchairs to those in need internationally.

External Links

Whirlwind Wheelchair International Free Wheelchair Mission

World Health Organization- Wheelchair guidelines

References

  1. Hsu JD, Michael JW, Fisk JR. AAOS Atlas of Orthoses and Assistive Devices. Mosby, Inc. 2008
  2. The Wheelchair Foundation Accessed on October 17, 2011.
  3. Mobility Advisor Accessed on October 17, 2011.
  4. Issues in Indigenous Production United Nations Publications. Last updated November 1997. Accessed on October 17, 2011.
  5. Whirlwind Wheelchair Publishers Name. Last updated 2010. Accessed on October 17, 2011.