Sunday, April 25, 2010


I got to go on a really great run to the top of a little mountain overlooking the city. Everyone was saying there was a very unusual haze for this time of year. Usually you can see forever out into the sea. (Double click to see detail)

One of Last year's biggest challenges was accurate measurement of the patient's body for the wheelchair. The chairs we provide are built to fit the user's hips, thigh length and lower leg height. An accurate fit might make all the difference in the wheelchair user's success or failure with the chair. We found that measurement continues to be a challenge for our clinicians.

Through a unique twist, we found that Motivation held a training at the Rehab Center the two weeks before our arrival. Nicky Seymour was a Motivation trainer who gave us excellent feedback on her training and the general situation there in Freetown. We were able to evaluate Emily and Cecil as they assessed a patient for a new wheelchair.

Here she is with her current chair

As a Physical Therapist, I can say that its always difficult to have another Clinician around to critique your work. There is an extra pressure that can make you overlook the obvious. Having two people observe and critique your work is twice as bad. That said, Emily and Cecil did very well with their patient evaluation. We had to review measurement again and hopefully practice will make perfect.

One of the issues that came out of Nicky's observation is that there had been some chairs in Freetown that were issued without proper fit. This dangerous situation came about when one of the government officials ordered the staff at the Rehab Center to build a bunch of chairs and hand them out without fitting. The politics of Sierra Leon are famously rough handed and I can't blame the staff for following orders. Fortunately, we are working with them to disallow this in the future.


One of the most exciting things about the LDS Humanitarian Service and LDS Charities is the intelligent ways in which they pursue their mission. The Wheelchair Initiative has been fortunate to partner with Motivation UK, gaining much from their long experience in providing very high quality, low cost wheelchairs AND training clinicians and technicians for prescription wheelchair service. The Worldmade philosophy and program is explained on their website and some background is in the blog I wrote last year. My respect for them continues to grow as I see the progressive way they pursue their goals. Fairly brilliant approach and execution.

One of the Hallmarks of the Motivation approach is to train Clinicians and Technicians in a prescription wheelchair service. This approach magnifies the clinical and technical skills of wheelchair providers in areas that need it most. Motivation has several levels of training and LDS Humanitarian services has worked to incorporate their training system. Obviously with an effort and need this broad, there are many diverse ways of approaching the problem.

Last year we were able to go to Liberia, where we taught teams from Liberia and Sierra Leon for the Worldmade Fit for Life program. The goal was to 'train the trainers'. The program has been largely successful in that the teams from both countries were able to extend the training by relaying their knowledge to other clinicians and technicians.

This year we wanted to follow up with the teams from Sierra Leon and evaluate their implementation. Isaac Ferguson had been to Freetown to implement a Neonatal Resuscitation Training in the fall and made a surprising discovery that the technicians from Bo had formed their own Wheelchair Production site. We were keen on visiting this site to evaluate the quality and efficacy of their program. We were also very interested in evaluating the performance of the clinicians in Freetown and Bo.

Ike Ferguson and I were sent to Sierra Leon for the first leg of our trip. We flew from SLC to JFK and then to Accra, Ghana and finally to Sierra Leon. Arriving in any 3rd world country is always a shock and this was no different. The airport is across a big bay and there are several ways to get across. On the way over, we took the 'speed boat', which was like a floating yellow sauna.

Its just amazing to leave Utah on a 60 degree spring day in March, travel across the Atlantic and end up in 95 degree heat with 100% humidity. Getting to the boat involved driving in a small bus down a half mile of dirt roads to the shore, where it was blissfully cool. Then we had to put on the lifejackets and get into the sauna.

Of course, there were more temperate alternatives:

Freetown is an amazing mountainside city by the sea that was founded by freed slaves from returning America and England. The English used it as a returning point for Africans liberated from slave ships in the 1800's and the Colonial influences are found throughout.

We found the Sierra Leonian Navy.

And the famous Cotton Tree, where freed slaves prayed under and Christened Freetown

The most exciting part of arriving in Freetown was the 15 minute drive to the Mission Offices. Aside from being in such a cool and very foreign feeling place, we saw over 11 Worldmade Wheelchairs!

This was an encouraging sign as we were hoping to be able to assess someone who previously received a chair and evaluate the appropriateness of their fit.