The Art of Adaptation: Crafting a Princess-Worthy Wheelchair in Indonesia

The Art of Adaptation: Crafting a Princess-Worthy Wheelchair in Indonesia

A number of years ago, I had the privilege of meeting Anya, a vibrant seven-year-old living with quadriplegic cerebral palsy. Her bright eyes and mischievous smile were a stark contrast to her ill-fitting borrowed wheelchair. As an occupational therapist, I was eager to contribute to the ongoing efforts to improve Anya's mobility and comfort.

The challenge was creating a custom seating system that addressed multiple needs: proper support, pressure distribution, and comfort – all while contending with the relentless Indonesian heat and limited resources. It quickly became clear that textbook solutions from Western clinics wouldn't cut it here.

One crucial aspect I had to consider was 24-hour positioning. However, Anya's family shared that she spent significant time on the floor, which meant the wheelchair wouldn't be her primary seating option. This insight was vital in shaping our approach. We needed to strike a balance between providing adequate support and creating a chair that could be easily folded and transported in the family's small car.

The local team's approach was heavily influenced by the book "When Helping Hurts" by Steve Corbett and Brian Fikkert. This philosophy aligns perfectly with the principles of Community-Based Rehabilitation (CBR). Both emphasize empowerment over handouts, and sustainable solutions over quick fixes.

In Anya's case, this meant:

1. Avoiding the temptation to import expensive, hard-to-maintain equipment

2. Focusing on solutions that could be replicated and repaired locally

3. Involving Anya's family in the design process to meet their specific needs

4. Building local capacity by working alongside Indonesian therapists and craftspeople

The team had already done incredible work in understanding Anya's world. They shared insights about her family's priorities, cultural context, and daily routines. School was important, mealtimes were crucial, but nothing topped playtime with her siblings.

The solution that emerged wasn't textbook-perfect, but it was brilliantly practical. We used breathable mesh fabric for the seat to allow crucial airflow in the sweltering climate. Foam padding was strategically placed for support without compromising comfort or the chair's ability to fold. We also explored alternative seating options for her floor time, ensuring a holistic approach to Anya's positioning needs.

This experience offered valuable lessons for Western therapists engaging in global health projects:

• Approach with humility and openness to learn

• Invest time in understanding local cultural contexts and family needs

• Focus on partnership rather than imposing solutions

• Embrace resourcefulness and creative problem-solving

By integrating the "When Helping Hurts" approach with CBR practices, we ensured that our efforts would have a lasting, positive impact. We weren't just solving an immediate problem; we were laying the groundwork for ongoing, community-driven support for children like Anya.

Anya's story highlights the persistent challenge of resource limitations in developing countries. It's a call for increased support for therapists in these settings, but also a testament to the power of ingenuity and adaptability.

In the end, the "best" solution isn't always the most technologically advanced. It's the one that empowers a child, respects family values, and integrates seamlessly into their unique world. Sometimes, that means thinking outside the box – or in this case, reimagining the wheelchair entirely.

As I reflected on my brief time with Anya and the dedicated local team, I was reminded that sustainable change comes through collaboration, cultural understanding, and a willingness to adapt. This experience underscores a crucial lesson: effective assistance, especially in healthcare, must be culturally sensitive, economically sustainable, and deeply rooted in community involvement. It's not just about the wheelchair – it's about fostering an environment where local innovation can thrive long after foreign helpers have gone home.

These lessons will undoubtedly shape my approach to future projects, both at home and abroad.

Carey Cheung

Occupational Therapist

International Disability Consultant