Monthly Archives: November 2011

Jig for making push rim

When Gladys and Raoul got directions to Rumbos, the local grassroots wheelchair manufacturer, I wasn’t sure we’d be able to make it there. They said it was in a completely different section of this city of nearly 8 million people, which would entail not only driving onto the congested Pan American highway, but well off the beaten tracks, in a section of town where folks didn’t usually venture unless they lived there. But Gladys and Raoul decided to take the plunge, and we all headed across town into the less formal, more working class section of the town, where, as Todd Lefkowics told me, life was much more representative of the way folks lived in Peru.

After finding our way down innumerable side streets and asking directions toward the end, we found the modest storefront for “Rumbos Caminos una Esperanza” sandwiched between some other businesses in the Parque Industrial

Injection mold for making front casters

Villa El Salvador district. Inside the entrance, there was a very small room where a therapy table had been set up for children to receive occupational and physical therapy. A bit further down and to the right, the narrow hallway opened up into another work area, where me met Jose and his teenage son, who formed the heart of Rumbos. Also there to greet us was Manuel, the bilingual occupational therapist who Todd had introduced to me via email, as well as Manuel’s OT teacher and some other OT students and a family who came at Manuel’s invitation.

Jose proudly gave us a tour of his shop, where he and his son used their incredible metalworking skills to build wheelchairs from scratch out of steel tubing, which they bent using a homemade jig, then used another jig to hold the custom sized tubing in place to weld into side frames. I have seen no finer welding despite their having to make their own acetylene, combined with oxygen, and despite light to the shop being provided by opening up corrugated roofing to let the sunlight in and the fumes out. The simple jigs made of angle iron belied their accuracy, and Todd, the occupational therapist/engineer from

Joses, 14-year-old son and welder

Boeing who had worked with them over the years, had done an excellent job coming up with a simple but strong design, akin to the strength and simplicity of a good bike frame. The local paint shop did as fine a paint job as any wheelchair here in the US, and the handmade push rims were chromed locally and were flawless. Todd had worked with Jose to come up with a wide front caster that would negotiate the sandy, rocky surfaces that most folks would be using them on, and had made a mold for solid rubber injections, adding bearings to the built-in receivers.

But the tour was not complete without a wheelchair evaluation, where Manuel did a quick but comprehensive mat evaluation, followed by having the young girl sit in a mock up seating system jig that could adjust the seat depth, back height, foot plates, headrest and lateral pads to come up with the seating system designed to address anyone’s specific needs. The types of foam used to build the supportive seat, back, laterals and headrest were very simple—standard open cell foam and carpet foam for creating important supportive contours within the seating—but they were based on solid seating principles, and of course were finished in a most professional manner using an old upholstery sewing machine that Jose had.

Jig for making side frame

Manuel’s teacher, who couldn’t speak English, pointed to some pink 4 inch plastic water pipe, which I first didn’t understand, until I noticed that there was a sheet of pink low temperature plastic material next to it. We in occupational therapy create hand splints for a variety of purposes from such material, cutting pieces of the expensive material to shape into supportive splints that are custom designed to support a healing hand/wrist/elbow or to make a spastic hand more functional. Here once again was Peruvian ingenuity, where they were able to find a local substitute for something that would have otherwise been too expensive, extremely hard to get, or both. They had found that the water pipe plastic was malleable enough when heated up to unroll into sheets and then fashioned into splints that worked every bit as well as ones we in the US fashion out of our expensive low temperature plastic!

As our limited time was running out (Dale and I were to go back and make a presentation on seating principles), I made sure that everyone was invited to the presentation, and that they were welcome to participate in our wheelchair evaluation sesssions at CASP. In this case, misfortune worked in our favor, as Manuel had broken his foot and so could not work at his occupational therapy job, so he was able to join us for the rest of the week. Jose, his daughter, and many of the students were able to make the long trek to our presentation on seating and positioning principles and strategies. Julio, a CASP employee who depended on a power wheelchair, very capably had translated our presentation, and Liliana had lined up a very gracious and professional doctor to translate our English presentation that evening to around 100 doctors, therapists, families and folks with disabilities who showed up to hear us. Steve had taken out several sections of seats in the front so that those who sat in wheelchairs could attend.

The rest of the trip was like a whirlwind of assessments, modifications, repairs and fabrications for the rest of the week. After our talk, we added to our existing list of people, as Denisse took the names of people who attended the talk asked to be assessed or knew of others needing to be seen. We saw everyone from elderly adults with muscular dystrophy to very young children who were getting too big to be carried by their mothers much longer, and everyone in-between. We adjusted strollers, built inserts, pressure mapped folks in order to see if their seating provided enough pressure relief to prevent pressure sores, added obliquity pads and tried different types of supports to see what would enable folks to be more independent in their seating and mobility needs. I remember one child who had never been in a wheelchair at first too afraid of the wheels to even touch them, gradually relaxing enough to place his hands on the wheels, and discover that he could push the wheel to get across the room. We were able to go to a home in one case, and in some cases, talk to mothers just to reassure them that everything they were doing was the best possible thing to do, which was a big relief to some.

Chantal, who worked as a volunteer for CASP, was our bilingual interpreter, and kept up with our rapid chatter amazingly well, only once telling us exasperatedly, to slow down a bit. She also took pictures and organized our evaluations and paperwork for each person, which was invaluable since many of these folks were folks whom CASP had not seen before either. Manuel was able to provide valuable assistance to our assessments, being a therapist, helping position clients while I measured them, and also supplementing Chantal’s translating whenever needed. Cesar and other student occupational therapists were able to come at various times, learning by doing as well.

All the while Dale and I were doing our assessments and modifications, Steve and Mack were providing essential backup, using their considerable mechanical aptitude to make adjustments, swap our parts, build a wheelchair from parts, and pretty much whatever else we asked them to do. When there was a moment’s lapse between projects for them, they would disappear, off to do another project on the side somewhere on the CASP campus. At the end of the day midweek, we were told to wrap up our work on time, as Liliana wanted to invite us over to her place for supper. So we headed out to her home in La Punta, a very nice section of town, where she lived with her pharmacist father, Judith LeBlanc from KU, and several staff joined us for a sumptuous Peruvian feast that was gratefully appreciated.

I already miss the time we had with the wonderful folks we met and worked shoulder to shoulder with while we were in Lima. I cannot express enough gratitude to those who contributed funds to help make this trip possible and for us to leave some funds for the Rumbos folks to assist in building seating/wheelchairs for some of the folks we saw. For me, connecting up the Rumbos organization of wheelchair builders and therapists with CASP succeeded beyond my wildest dreams. Hopefully we provided a good enough foundation for their partnership to grow and grow to meet many more folks who have mobility needs, and what a better way to accomplish that than to help those folks to help themselves?