clay: 2009

Why did I go to Africa?

The Church of Jesus Christ of Latter-Day Saints has an ongoing Wheelchair Initiative, providing wheelchairs of various complexity and function. Recently, a need was identified for wheelchairs that could be both custom fit to the user and have more specific functions – such as handling rough terrain or folding for transport in a car. So an partnership was formed with Worldmade, a wheelchair services NGO that provides not only wheelchairs but training for wheelchair services provision.

The World Health Organization recently issued a guide to Wheelchair Provision in developing countries, which is a long but fascinating read. There are several reasons that simply giving wheelchairs to users without prescripton can do great harm to a community: 1) The chair may harm the user 2) The user may not actually need a chair and often there is no filter for determining need (a rehab chair can make a great cart for hauling items) 3) The existing wheelchair service provider in the country will be put out of business when their market is suddenly flooded with free wheelchairs from abroad 4) The chairs may wear out very quickly leaving the end user in a worse position than when they started.

The worldmade model stresses training for wheelchair providers, assembly technicians and end users to ensure the best chair ends up with the appropriate user. This ensures the appropriate chair ends up with the appropriate user, the existing wheelchair services provider is strengthened through increased training and the providers have more options for wheelchairs to give.

Therefore, the LDS Church is working to provide a spectrum of wheelchair services worldwide. Sharon Eubanks has spearheaded this effort you can hear her audio clips on this project in the above link.

One day last summer I received a random email about volunteering for the wheelchair initiative. We don’t really know exactly how I ended up on their list but I’m very grateful have been found.

In October, Worldmade came to Salt Lake City and trained the Short Terms Specialists on their method of training. In January, we were informed we’d be going to Monrovia, Liberia for the training. Our team consisted of Emily Cawley and Cathy Mills on the technician training side, Dan Mills and myself on the prescription side and Issaac Ferguson as our coordinator and program facilitator. Ike is a veteran of LDS Humanitarian Services and has spend many years in Africa working to improve the living conditions for the people there. Actually, Ike is like the Forrest Gump of Humanitarian Services in that he’s been in just about every country you can imagine over many decades, working on projects like clean water, iodine provision and most recently developed the Neonatal Resuscitation Training program. More on Ike later.

At the end of March, 2009, we flew from SLC to Accra, Ghana. This was my first trip to Africa and I was amazed at the sights and sounds. Ghana is a beautiful country just above the equator in West-Central southern coast of Africa. We were there for a day and a half, waiting for the bi-weekly flight to Liberia and stayed in downtown Accra.

It was fun milling out a bit with the people there. Caution! This video clip may make you have a seizure! But it was the only way I felt I could have a camera out without offending.

They even have fruit bats in the trees…

We flew to Roberts Field, the major airport for Liberia on Kenya Airways, which was a really nice airline if you ever get the chance to fly with them. Who knew they would serve greens? I was already feeling at home.

Roberts Field is an old world war II airstrip the US built for staging their war and was an important cold war air base. It sits directly next to a million acre Firestone rubber plantation and about an hour from Monrovia, the capital.

The difference between Accra and Monrovia was amazing. There have been several cival wars and much unrest in the country for many years. There is a telling documentary called “Liberia, an Uncivil War" that explains the details of Liberian politics in far greater detail than I can. Its fairly graphic but worth watching. All of the city shots from the film are in Monrovia close to the location of JFK hospital. The UN has its largest peacekeeping mission in Liberia with 15,000 troops from many nations (but not ours). So there are hundreds of really cool Landcruisers and Nissan Patrols with just about every acronym you can imagine. NGO's from many, many countries are working to help stabilize and develop the country.

Ex-Patriots generally stay in compounds like this, with plenty of bars, high walls and razor wire. We didn't go out at night, but during the day things seemed safe enough.

Downtown Monrovia

A trip to the hardware store. Most of the businesses are owned by the Lebanese, who are good at economic development anywhere. There are also plenty of Indians and Chinese. Dan and Ike think its hot in Liberia.

The Chinese have a different emphasis on economic development than we do. They build roads and universities and infrastructure like crazy. The US is focusing on building institutions and programs to educate the people. Thing is, the roads are easier to see and often the politicians end up pocketing the money the US sends. Our reputation is getting kicked around by the differences and basically, the Chinese are taking over Africa through economic development.

This is a classic tricycle wheelchair in the third world. More on this guy later...

We had a hard time getting the shipping container with the wheelchairs out of Customs. Actually, Ike, Aaron of Handicap Internationa l and Josephine of the Monrovia Rehab Center of JFK Hospital were on the case and worked hard to get things moving. We weren't sure the container would arrive and decided to proceed with the opening ceremonies so we could at least start the training. But sure enough just as we were ending the ceremonies, this ancient chinese smoke bomb truck rolled in and we got our chairs!

It was hilarious watching the guys open the container with a pipe but apparently it can be done.

We were excited to meet the therapists and technicians who came from both Liberia and Sierra Leon for the training. Most of the Liberians were trained by Handicap International about 5 or 6 years ago and they had an amazing breadth of experience. The team from Sierra Leyon was likewise dynamic and engaging. It was apparent from the start that we had a great crew to work with.

Sometimes I feel kinda tall... Like I somehow stick out a little.

First we learned what they knew about wheelchairs and then worked on wheelchair service provision with adjustable chairs.

When you don't have chairs that are adjustable, why would you ever need to measure a wheelchair user?

Measuring has its challenges...

But in the end, we all got on the same page

Afterwards, we got the Tripple P. Pita, Peanut Butter and Plantains. Between that and the Jallah rice and chicken we ate every day... I wouldn't live long in a place like this without adding many more P's (as in pounds) to the equation.

Most NGO's and definitely the UN use some of the coolest Landcruisers I've ever seen. Everywhere you looked there were Nissan Patrols and funky trucks to be found.

But not us, we wanted to blend in a lot better. So we got ourselves a Nissan. We weren't sure which model it was, so Emily dubbed it the 'Nissan Awesome" and it stuck. 5 large Americans in that thing gave us all new definitions for 'stuck'.

Note the bulging tire - it was one of the several we had to change

Ike prepping for a 'Driveway Moment' in which he told almost always told us about an amazing experience in the far corners of the Public Health Universe. It also gave us prime opportunity to tease Ike about his excellent backing up skills.

For me, Ike's stories brought home the spirit and principles of services and Public Health. Serving others through training and systematic programs allows them to embrace principles that will help them grow into self-sustaining life. Having a systematic program allows us to evaluate if its actually working and find better ways to help them grow. This wheelchair program is a prime example and is why the WHO issued their guidelines for wheelchair provision in third world countries. We hope that we are providing chairs through the existing services delivery program to support and grow their capabilites in their countries.

Back to the course. One of the reasons I love Physical Therapy is that you get to turn book knowledge into practical use. The MRC brought some wheelchair candidates in for measuring,

Here are a few of them. During the wars, there was great difficulty in administering Polio vaccine causing s a significant outbreak in Liberia. Many of the patients we saw in clinic were either victims of these outbreaks or of rocket attacks. They were normal people who wanted to work and make their way in the world. These 3 guys were typical in that they all were either in school and/or working in the community. They needed wheelchairs to get into their schools or work.

It is fairly amazing to see the way these guys got around. But they did get around and made things happen.

Once the measurement and assessment was complete the technicians built the chair to the specific prescription. When that was completed, the patients returned for the final assessment and adjustments of the chair to fit their bodies.

At times, novel adjustments had to be made to protect the users. The staff at the MRC were especially good at this component.

It was fun to see the knowledge brought together with many happy smiles. Here are a few of the cases...

Liberia is an amazing country. It was my first time in the third world but I don't think its all that different from Chicago or Houston or Atlanta. Just hotter, with no traffic lights, nicer people, and a lot more difficult living conditions. Oh, and its a lot more jiggly.