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Wheelchair
History Made in Uganda
(The Second of an Occasional Series on Wheelchair History)
by Marc Krizack
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 cango 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.
The first article in this series appeared in DisabilityWorld under the
title "Smithsonian Exhibit on Disability Rights Leaves Gap in Technology."
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