A New Paradigm for Cape Verde
Wheelchair recipient and daughter with Physical Therapist who provided a new type of Wheelchair Service
If water is life, wheelchairs are freedom. From the beginning of LDS Humanitarian Services wheelchairs have been a key offering. We arrived in Cape Verde virtually with our first container of wheelchairs. Working with the Red Cross to distribute those wheelchairs to needy handicapped has been both gratifying and a little troubling. In past postings we have shared a number of experiences meeting those selected to receive wheelchairs. While it has been a privilege to participate in these deliveries, we sometimes wondered if this was always a good thing.
The Old Way
The guiding concept for these early projects was that almost any wheelchair offered lifestyle improvements and greater freedom than no wheelchair if you were poor and couldn’t get around. Wheelchairs came in different widths and some effort was made to match the width to the person, but it was clearly hit and miss.
As for wheelchair adjustment and maintenance, we offered them a tire patch kit, a basic wrench set, and said good luck.
After seeing more than a few situations that left us feeling, under the surface, a little unsure how much good we were doing, we were ready for something better.
December 2011 – A New Paradigm proposed
In December of 2011 we made contact with John and Marcia, short term wheelchair specialists, as we made plans to create our next wheelchair project. When they floated the idea of a new paradigm for furnishing wheelchairs, we were ready to bite. The new concept, based on World Health Organization guidelines and LDS Charities experience, was this: the wheelchair should be fit to the needs of the recipient, not the reverse. If the wheelchair was not appropriate for the person, don’t give it to them. It is possible to do more harm than good. What a concept.
Our wheelchair specialists come to Cape Verde
How would we accomplish this change? The first requirement was to partner with organizations that had medical personnel on staff able to learn principles of patient evaluation and wheelchair fitting. We also needed an organization that could store and control the release of the wheelchairs to only those certified to prescribe them and had connections to potential recipients in the community.
Here we are with our team of physical therapists, doctors, and pharmacists from the Ministry of Health planning the training
Second, we needed to train physical therapists and other medical professionals how to assess and fit wheelchairs. These would be the key people to make sure we offered something that would improve their situation, not hurt. We also wanted to train some more mechanical types in how to properly assemble the wheelchairs and maintain and repair them as needed. These people needed to be available to the recipients. We would set up a 3 day course using specialists from the US to prepare clinicians and technicians to perform their critical role in the new paradigm.
Our short term specialists offered to spend a week with us meeting with potential partners and selecting one or more that would fit the bill. They came to Cape Verde in February of 2012 and together we successfully identified the Ministry of Health as our primary partner. From among others we met with, we selected two to help identify potential recipients. We met with the ministry leaders all the way to the top, and learned that handling wheelchairs in any form would be a whole new ball game for them. Fortunately they had the right puzzle pieces to create the right picture once they learned to put it together. We were very pleased with the potential and excited to be part of a new dispensation for wheelchairs in Cape Verde.
A year in the development
Murphy’s law: Anything that can go wrong, will go wrong. Or is it just Cape Verde? We planned six months to get wheelchairs ready to distribute and it took a year.
Educating the parts, especially the head of the pharmacy organization, just took time. Remember this was all new to them. We faced a few disappointments of timing, but the players in time played their parts well. Here is a photo in June when we finally got our contract signed and could place the order for the wheelchairs, walkers, cuff crutches and canes, three months behind schedule.
The container full of new wheelchairs was shipped from China in September and arrived here in late November. Our partner had forecast one week to get the wheelchairs through customs and into their warehouse. In actuality it took almost two months. The space they planned to use to store these wheelchairs was full of medical materials waiting (and waiting, and waiting) to be disposed of, so they chose to leave the wheelchairs in customs and pay storage fees there.
During the months the wheelchairs were in manufacture or on the water we were working with a group at the hospital to get ready for the three day training. They would help select the place, the people to be trained, and find potential recipients to also be part of the training. Working around everyone’s year-end schedule, including the arrival of a baby, we set the end of January for our training. It seemed way far off, but with the delay in customs it could not have been any sooner.
A new wheelchair
Our previous project provided wheelchairs largely suited for indoor use. For this new project we looked at a couple of designs of more rugged outdoor style wheelchairs and decided on the RoughRider. Above is a photo of this chair nearly assembled. It has low profile wheels on the front that handle cobblestone streets, dirt roads with rocks, and generally rough terrain. The rear wheels are bicycle wheels with a standard tire size for replacement.
It also comes in 5 widths and most come in two depths. The seat cushion can also be sized to provide proper leg clearance in front. All of these options will be used to “fit” the chair to the recipient.
Countdown to the change
As our training dates approached we had a list of things to take care of so all would be ready for a smooth course. We thought the list might be of interest:
- Find the right place for two concurrent training sessions: Answer – our local LDS Chapel
- Identify the 12 clinicians and 12 technicians: While a Ministry responsibility, we made sure they covered the island, 10 evaluation centers
- Build assessment benches to be used by the clinicians in the 10 evaluation centers. Also a Ministry responsibility, but when they felt a little overwhelmed we stepped in, found the carpenter, got a quote, got him started in mid-December and they were ready before the end of January. Below is what the finished product looked like:
- Arrange for a caterer to provide snack breaks and lunch all three days: Answer – a woman with a good reputation near the Chapel
- Arrange for translators: Answer – two returned missionaries willing to work on a conditional basis (one is the guy in center in photo below) since all four of our trainers had served missions in Brazil
- Arrange for 50 wheelchairs of various sizes be delivered by the Ministry to the Chapel: Challenge - getting the working parts of this delivery service working (see 4th photo above)
- Work with the hospital staff to select and invite 30 potential beneficiaries for the training
- Order customized t-shirts for the training staff and trainees
- Purchase and put together simple tool kits for the clinicians to use in fitting
- Purchase clipboards, pens, and make copies of training materials for trainees
- Purchase paper to print participant certificates
- Make sure we had keys to the building and that the restrooms and other facilities would be clean and ready to use
- Work with Church Public Affairs to plan a closing ceremony, provide them with lists of invitees, a program to follow and suggested speakers to invite, with special plaques to recognize the contributing partners
- Make hotel reservations for the trainers and specialists
- Make last minute contact with the caterer to verify that all was ready to go
- Schedule members to help set up the training and lunch rooms
- Set up registration/check-in for the participants with all the materials they would receive as part of their trainee package
The change begins
We scheduled the training to begin on Tuesday. Our training staff flew into Praia on Saturday. We met them that night at their hotel and had dinner together to start getting acquainted. Sunday we all attended Church together in the morning then gathered at our place for a spaghetti lunch and a briefing session. That worked wonderfully to preserve a Sabbath atmosphere thanks to Janet.
The trainers in the midst of setup plan their attack
Monday we started early to set up the chapel for the training and then to begin prepping wheelchairs for the next day. We wanted 12 ready for the clinicians (see below).
Tuesday morning we introduced our translators and had a prayer meeting before starting. We started the training with a group session to welcome everyone and explain a few things about the course and the facility. We are ready to begin.
Training with a purpose
The actual training program was the key to this new paradigm. It was pretty clear that no one in Cape Verde has made it a point to evaluate recipients beforehand and consistently adjust the wheelchairs for the best possible fit.
The training was very much a hands-on experience for all the trainees. The clinicians were asked to spend the whole first day of training in a wheelchair. They had various types of experiences, all insightful. Brian and Brett, the trainers, did pretty well with Portuguese. They had posters up and lots of other visuals. They taught principles then went immediately into the practical stuff.
The technicians were either in a huddle around a demonstration or working in pairs to assemble and adjust the wheelchairs. Getting the brakes right was a key point. One of the technicians was partially deaf and another was partially handicapped, but that didn’t hold either back. This is the first time we are aware of an effort to put people out in the field where the wheelchair users are, available to adjust, repair, and do basic maintenance on demand.
Here are some additional photos of the fun during the first day of training.
The real benefits
The final part of the training was where the real benefits were manifest. As the selected potential beneficiaries began to file in, there was no question of their need. Some came in walking on their hands and what was left of their feet. Others were carried in. Still others came in old broken down wheelchairs (see above). They waited patiently until their number was called.
In the first round with real handicapped, the trainees took their time with close surveillance by their instructors to walk through the steps of the evaluation, asking the right questions, gauging the appropriateness of a wheelchair, understanding their life situation and needs, looking for evidence of existing pressure sores or open wounds, then beginning to measure the width, foot support height, seat depth, and so forth.
Not everyone in the group of 30 qualified for a wheelchair, and that was a hard conclusion to reach, but a very important one. The instructors were very pleased to see them make honest and difficult assessments and send some away with alternative recommendations but no wheelchair.
By the end of the third day the now certified clinicians were much more confident and quicker in their assessments. They were read to graduate.
Celebrating
The final step of the course was a closing ceremony with dignitaries, certificates, refreshments, and time to mix.
Sister Broderick offering a certificate and beijinhos (cheek kisses) to one of the clinicians
One of our partners is himself handicapped. Here he recognizes one of the newly trained physical therapists.
Our Church Public Affairs director sent out the invitations and MC’d the event. We thought the Minster of Health was going to attend and say a few words, but on the day of the event we heard that she had changed her mind. Instead the director of the Pharmacy Department represented the Ministry of Health and was our final speaker. Our specialists pointed out they have never seen the top person attend one of these events.
Our clinicians and instructors standing to be recognized as a group
For the program we invited some of the last beneficiaries in the training and their family members to attend and share some of their feelings. The Church was well represented with the Praia Stake President and several local members attending. The hospital and an association of handicapped were represented.
A priesthood leader sharing a Liahona with one of the participants during the refreshment break at the end
Check out this video that one of the trainers made to share with his family.
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