25 Milestones of History
25 Years Of Motivation When Simon Gue, Richard Frost and I started this journey as students twenty-five years ago, we had no idea it would lead to Motivation, as we know it today. We were unaware of the impact our student project, designing wheelchairs to improve people’s quality of life, could have in the developing world. When we founded Motivation, the provision of wheelchairs in places such as Cambodia, Bangladesh and Tanzania was either on an industrial scale with little consideration for the users’ needs or on an ‘artisan’ basis in small workshops with little consistent quality or design. What Motivation has done is introduce design into the international development sector. We have achieved this by developing wheelchairs that fit the users’ needs and providing training that can be delivered anywhere in the world. There has been an on-going challenge to secure funding while fighting to keep design for the beneficiary at the heart of our work. We have succeeded in not only maintaining our commitment to the task, but also building relationships within the international wheelchair sector to improve standards. Inside this book, you will find the twenty-five key milestones that Richard and I feel have either changed Motivation’s development or influenced the sector in which we work, together with some personal reflections. Twenty-five years on we believe we have gone some way to ‘raising the bar’ and professionalising the sector of wheelchair provision in developing countries. There is still a long way to go and we hope that you will continue to enjoy the journey with us as we work towards achieving our goals. Dedicated to our donors, supporters, partners, staff and beneficiaries.
David Constantine MBE 2016
1989 In 1989, while design students at the Royal College of Art (RCA), London, Simon and I presented our design of a ‘low-cost wheelchair for developing countries’ to the judges of the Frye Memorial Award. The design concept was a locally produced wheelchair for any country. The aim was to use readily available materials while at the same time maximising users’ independence and mobility. We felt it was important to think about everyday use. We won the award and were encouraged by the judges to pursue the idea. “Simon and I did the first sketches of the chair outside a café in Seville over the Easter break of 1989. During the presentation I nearly fell asleep while speaking, we’d been up all night finishing drawings and preparing the presentation. After winning the prize we were driven by the encouragement of the judges and our desire to travel to continue the project and our desire to travel.”
1990 With encouragement from Jocelyn Stevens, then Rector of the RCA, Simon and I teamed up with Richard Frost, a friend of mine from university, to travel to Bangladesh and India to research the relevance of our winning design. During the trip, we visited different workshops. In particular, the Centre for the Rehabilitation for the Paralysed (CRP) in Dhaka, Bangladesh, where we built a copy of our winning design chair in the Centre’s workshop. The founder of CRP, Valerie Taylor, invited us to return to Bangladesh to build wheelchairs ‘for a few months’. “When we asked Jocelyn Stevens for time off college, he asked how much money we needed, even though we weren’t asking him for this. We made up a figure on the spot, and he told me to see the Registrar, who would give me a cheque. Years later, I discovered that it had come from his own pocket. Going to India was like a rite of passage for me, both regarding my travel as a quadriplegic and for my photography. Whilst there I found my own style and creative approach. Since then I have also documented Motivation’s work, and have aimed to portray disabled people in a positive and dignified way.”
Tap the circles for interactive features
1991
We spent six months in Bangladesh building wheelchairs at CRP. It was during this time that Motivation was really born. Engineer Nigel Garvey and Pierre Willems, my personal assistant, joined us. We set about refurbishing CRP’s workshop, redesigning our original chair based on local knowledge, and starting batch production of twenty chairs a month. Working closely with the local technicians we trained a local team to produce the chairs; they are still made at CRP today.
“Going to Bangladesh for six months was very exciting and at times challenging in terms of living arrangements. We lived in a tin shed and I had to take everything I needed for my day-to-day living needs. Because of the high level of my spinal injury I have no body temperature control and the heat was oppressive. At 40ºC and 80% humidity, a table fan and a garden sprayer were often my only relief. Our shower was a tap against a tree in the open air. At one point we had no running water for three weeks.”
1992 On the strength of our work in Bangladesh, we were invited to work in Poland and subsequently Romania. Working in Eastern Europe shortly after the fall of the communist regime threw the Motivation team different but equally interesting challenges for the design and production of the low-cost wheelchair. The materials available were of better quality, but they were difficult to purchase in the relatively small quantities required by a small workshop. The workshop was based in the Orthopaedic Hospital in Poznan. In 1992 Motivation was registered as a UK charity.
1992 “We drove to Poland from London in two VW camper vans. Mine had a fuel pump problem on the way and kept stopping. Eventually, we used a plastic tube, feeding it into an open Jerry can of petrol, which was held by one of us inside the van. From that point on, smoking in the van was banned! I found Poland fascinating – the postcommunist period saw new consumer items for sale in the shops – the first Ikea and McDonald’s opened while we were there, creating long queues reminiscent of the previous regime. I spent every weekend away in my van photographing the beauty and horror of Poland – everything from village life in the Tatra mountains where farming methods had not changed for hundreds of years, to the concentration camps of Auschwitz/Birkenau.”
1993 With the overthrow of the Khmer Rouge in 1979, Motivation was invited to
address
wheelchair
needs
for
the thousands of disabled people, particularly amputees, in Cambodia. We set up a wheelchair workshop with the Jesuit Refugee Service. As there were no regular supplies of tubular steel due to the lack of infrastructure, the Motivation team designed the ‘Mekong’ wheelchair to be made of wood. Its three wheels enable use on rough terrain. For the first time Motivation deployed a seating therapist to provide clinical training in wheelchair seating to local staff. The ‘Mekong’ is still in production to this day.
1993 “Travelling and working in Cambodia, and being involved in helping the country and people, meant a great deal to me and our whole team. The people we met and worked with were all very special. What struck me was that anyone I met around my age or older had endured the Khmer Rouge regime since 1975. The Vietnam War was the first war where helicopters played both a vital and devastating role. They allowed troops to move quickly and attacks to take place almost anywhere. They also allowed for fast medical evacuation of the wounded. Spinal cord injuries were common due to shrapnel and gunshot wounds, and unlike WWII, soldiers could be airlifted to safety, and hospital, within an hour. I found it personally fascinating to go to a country where so much had happened, mainly in secret, and to witness what challenges disabled people in Cambodia faced. A stark contrast to those who survived and lived in the US.�
1994 Motivation’s first work in the field of seating for children with cerebral palsy took place in Eastern Europe in 1994–95. Many of the children were in orphanages and those that could not support themselves were left to lie on the floor or in bed. Motivation’s combined team of design engineers and therapists researched and worked on the most appropriate approach for low-cost seating that helps reduce spasms and ensure correct growth. Many of the elements of these designs still feature in Motivation’s seating products to this day. “I found Russia a stark, cold, yet fascinating place. Whether it was the space race or the arms race or the dominance in sport, during my lifetime Russia had always been portrayed as the dark stranger, the other side of the ‘Curtain’.We drove from London to Moscow in a VW van, a fascinating journey across Poland and Belarus.”
1994 Motivation featured in a TV documentary ‘Chariots of Wire’ and was granted a BBC Lifeline Appeal. 1,400 people wrote in to our office; the influx of letters and phone calls forming the database of core supporters we have today. As a result Motivation was invited by British Airways to be a charity partner; support that has enabled trainers to travel to different projects and share knowledge more readily. British Airways supports Motivation to this day. In the same year Motivation completed its project in Indonesia in collaboration with Leonard Cheshire Foundation.
1995 Motivation was invited to work in Nicaragua,
supporting
wheelchair
workshops. As in previous projects, the team consisted of designers, seating therapists and wheelchair trainers. At the end of the year, Motivation was asked by Sandy Gall’s Afghan Appeal to produce wheelchairs for amputees and other disabilities in Afghanistan. Both Central America and Afghanistan were incredible places to work in the mid-nineties. Working with very forward-thinking was
fascinating.
disability Active
groups women’s
movements in the disability field had risen up from the revolution in spite of a very patriarchal society.
1995 “In late 1995 on a research trip to Afghanistan we drove through the Khyber Pass in a four-wheel drive. A Pakistani guard was with us for protection in the tribal areas. He sat behind me holding a Lee Enfield 303 rifle, right next to my head, luckily it was pointing skywards. It was one of those drives you will never forget. I felt privileged to be able to make that trip in relative safety. Sadly, it would not be so today. On arrival in Jalalabad, we were treated to an incredible Afghan meal. At night the sky lit up with gunfire which we were assured was celebratory not hostile – a wedding, or a son being born. The next day, Richard went to Kabul where he spent a hair-raising night in the International Committee of the Red Cross (ICRC) shelter listening to the shelling of Kabul between the warlords in the civil war.”
1996 Motivation started as a college project. We worked out of my flat in London and then a run-down office in Holborn. In 1996, Rupert Ridge who had seen our work in Indonesia, invited us to use a building at his home near Bristol. Rupert and his wife Blanche offered Motivation rent-free premises for ten years in an 1808 schoolroom and stable. Twenty years on, Brockley remains our home thanks to the continued generosity of our hosts. Our amazing rural location is a home from home for many of us. It has allowed Motivation to grow and establish a solid base from which to work.
1997
Motivation was invited to Sri Lanka to produce wheelchairs at the Ragama Rehabilitation Hospital, Colombo. The project aimed to help the hospital build wheelchairs for people with spinal cord injuries. Many of the patients had been in bed for many months with pressure ulcers caused by lack of sensation and inappropriate methods of care. Motivation realised that before making wheelchairs, we needed to address the systems and procedures within the rehabilitation wards, ensuring patients with spinal cord injury had completed their rehabilitation in a fit state before receiving a wheelchair.
1997 “Sri Lanka is a wonderful mix of India and Bangladesh, with its own unique flavour. Sadly at this time, its beauty and history were set against the backdrop of a civil war raging between the Sinhalese Government and the Tamil North. As an NGO, we were not allowed to visit the North. However, we saw evidence of the war when the Army hospital next door to the Ragama Hospital started to request wheelchairs for their young disabled soldiers. Few of the Sinhalese Army casualties were reported in the press. In March I travelled to join our project team in Afghanistan. I nearly didn’t come back. On an 8-hour road trip from Jalalabad to Kabul on potholed dirt roads our driver and his son robbed us. In the ensuing argument they drove us straight into the hands of the armed Taliban laden with AK47s who proceeded to commandeer our vehicle. On the way to their police station through the unlit streets of Kabul, we were thankfully rescued with help from ICRC staff. I have never felt so far away from home as I did then.”
1998
After receiving numerous requests to work in Africa, Motivation responded by building a relationship with the Tanzanian Training Centre for Orthopaedic Technologists (TATCOT), a well-regarded training school for teaching prosthetics and orthotics. Together we developed the first ever Wheelchair Technologist Training Course (WTTC), offering the skills required to run a workshop, build wheelchairs, and carry out assessments and prescriptions. Motivation introduced a modified version of its steel-based three-wheel rough terrain wheelchair for production throughout Africa. In 2013, Motivation opened a regional office in Nairobi. Motivation has worked in seventeen African countries since 1997.
1999
Throughout 1999, Motivation’s Africa team began to train the trainers who would take over the course once we had left. In Sri Lanka the team completed its work on the Total Rehab project and in the same year Motivation entered a relationship with B&Q/Kingfisher. The marketing director of B&Q felt we had a great deal in common. He said: ‘you are helping people to help themselves and try to improve their quality of life; that essentially is what B&Q does. Come down and meet us’. There followed an incredible seven-year relationship putting flat-pack wheelchairs into production in China and training our staff in logistics. B&Q/Kingfisher generously funded a great deal of the project.
2001 In the ten years since 1991, Motivation had set up twenty-two wheelchair workshops
in
eighteen
throughout
Asia,
Africa,
countries Central
America and Eastern Europe. We had produced new designs and produced around 18,000 wheelchairs. However, an estimated 65 million people in developing
countries
still
needed
appropriate wheelchairs. We developed the ‘Worldmade’ concept to redesign and flat-pack a range of wheelchairs. These would be produced in a central location where quality and cost could be controlled, then shipped worldwide to partner organisations. We also developed a package to provide local training in seating assessment and
prescription.
B&Q/Kingfisher
supported the design and production side of the programme.
2001 “Starting and working on ‘Worldmade’ was a leap in the dark for the Motivation team. Its success has meant that today many organisations follow the same project model. The two images on this page show an early concept model of the Worldmade Rough Terrain wheelchair put together by our Motivation designer, Ian Harris. The other image shows me trialing an early production prototype in Brockley yard with Pierre Willems.“
2001 Motivation
started
developing
the
‘Fit for Life’ training package as part of
the
‘Worldmade’
programme,
providing basic training to local staff in developing countries. The package covered the assessment of the user, prescription of wheelchair, assembly and adjustment of any wheelchair and fitting of the chair to the user. In 2001 Motivation returned to Sri Lanka to run a supportive seating programme for children with cerebral palsy at the Ragama Rehabilitation Hospital.
2002 The
first
Wheelchair
five
graduates
Technologists
of
the
Training
Course graduated from TATCOT. They returned to their respective countries, Uganda, Tanzania and Zimbabwe, and to their workshops to start producing wheelchairs based on the designs they had learnt on the course. Meanwhile in Sri Lanka, Motivation’s seating team were completing the seating project that had started in 2001. At this time, Motivation developed a relationship with the US Agency for International
Development
(USAID)
who have become a significant funder of Motivation’s work over the past fifteen years.
20012004 In 2001, Motivation was invited by USAID to upgrade the production and provision of prosthetics and orthotics throughout Sri Lanka. This project combined the improvement and provision of wheelchairs nationwide. We also began working on vocational training programmes to teach disabled people income-generation skills. In 2004, Motivation was invited on to the Open Board of the International Society of Prosthetics and Orthotics (ISPO), a key organisation supporting prosthetic and orthotic work worldwide.
2005 The
Worldmade
‘Rough
Terrain’
three-wheeled wheelchair was put in production by Merits, a wheelchair factory engaged by Motivation in Shanghai, China. The first container of 340 wheelchairs arrived in Sri Lanka in 2005 and Motivation partner staff from Sri Lanka, India, and Nepal took part in the first ‘Fit for Life’ training programme in Sri Lanka. Motivation still produces the Rough Terrain
chair
at
Merits
in
China,
along with a number of four-wheeled chairs, supportive seating for children and hand
powered trikes. Our aim of
creating consistent-quality wheelchairs, adaptable
to the individual, fit for
purpose, at low cost, had become a reality. “Seeing the delivery of the training and assembly of the first flat-pack wheelchairs, after nearly five years of development, was an incredible experience.
Ten
years
of
field
experience was paying off and allowing deliverables in greater numbers while still servicing the individual.” .
2006
ISPO and the World Health Organization (WHO) held a conference that brought together key organisations to discuss and recommend an agreed approach on providing low-cost wheelchairs in developing countries. This conference, initiated by Motivation, was a turning point in wheelchair provision worldwide. The conference concluded with a set of recommendations and agreements. For Motivation, this was the beginning of some key collaborative relationships with other organisations that would change the sector dramatically over the next ten years.“The Consensus Conference was a key moment for Motivation and the sector. I felt proud that we were making changes to other organisations’ thinking and approach. However I nearly didn’t see any of the conference as I fell out of my chair on the day I was to make my presentation and thought I had broken my leg. As I have no feeling it was hard to know. I borrowed an empty room at the venue and got undressed so I could see if any bones were sticking out. They weren’t so I went on and gave my presentation.”
2007 The ‘Worldmade’ concept meant that Motivation could provide a greater number of wheelchairs to its own and other organisations’ programmes. The International Committee of the Red Cross (ICRC) bought their first container of wheelchairs from Motivation and requested training for their overseas staff. This resulted in the provision of better quality wheelchairs reaching more people in need of them. Two four-wheel designs were soon developed, tested, and launched to add to the range of user choice. The Helen Hamlyn Foundation and The Conran Foundation funded these designs.
Guidelines on the provision of
Manual Wheelchairs in less resourced settings
2008 As a result of the 2006 Consensus conference, WHO published in their ‘Guidelines on the Provision of Manual Wheelchairs in less resourced settings’. This was a turning point in the sector of wheelchair provision. Three Motivation wheelchair designs appear on the front cover of the WHO publication. By 2010, this was the most downloaded set of guidelines from the WHO website. These guidelines have been translated into all UN languages and remain the most important document in the international wheelchair sector. “The three images on the front cover are all Motivation wheel-chairs, this was a very proud moment for us.”
2009
At the request of the International Paralympic Committee (IPC), International Tennis Federation (ITF) and International Wheelchair Basketball Federation (IWBF), Motivation designed a low-cost, entry-level sports wheelchair. Organisations and users took up the chair worldwide. Motivation changed the name of the ‘Worldmade’ brand to Motivation Direct Limited (MDL) and set it up as a social enterprise. This has enabled Motivation to create income from wheelchair sales, all of which is put back into our humanitarian work. We opened an office in India and collaborated with the ‘Free Wheelchair Mission’ in the US on a wheelchair design, which met the WHO Guidelines.
2010 Motivation developed a new strategic plan addressing four key areas of work: Survival – rehabilitation training for spinal injury centres and parent training for children with cerebral palsy. Mobility – delivery and training of wheelchairs. Empowerment – peer training courses providing the skills and knowledge for wheelchair users to stay healthy, be active and build confidence and selfesteem. Inclusion – changing attitudes and building more inclusive communities, so that disabled people can go to school, get a job and contribute to society. This model delivers Motivation’s mission of enhancing the quality of life of people with mobility disabilities.
2012
In 2012, WHO launched the first wheelchair service training package, initially for Basic level, to be followed later by an Intermediate level. These training packages marked a decisive moment in the dissemination of skills and knowledge in the provision of wheelchairs. The basis of the packages is Motivation’s original ‘Fit for Life’ training module. The IPC asked Motivation to design and launch a low-cost racing wheelchair. This was launched at the London 2012 Paralympics.
2012
“2012 was a key year for Motivation’s sports designs. In May I went to see our basketball wheelchairs being used in the first ever Afghan National Wheelchair Basketball Tournament organised by the ICRC in Kabul. Bringing together disabled people from all over Afghanistan was incredible. Seeing our chairs being used by Afghan players was unforgettable. In September Richard and I were invited to the Opening Ceremony of the Paralympics in London. As we watched the national teams parade round the stadium we started to notice that some of the international competitors were using Motivation wheelchairs as their everyday chair and had travelled to Games in them. It was a very moving moment for us both.”
2013
In 2013, Motivation developed an Emergency Response Wheelchair and training for rapid deployment following humanitarian disasters such as an earthquake. At the request of partner organisations, Handicap International and The Johanniter, a wheelchair was developed that could be stored at a central location, assembled quickly with a shortened training package, for rapid delivery to the user in a disaster zone. Since then the chairs have been deployed in the cyclone in the Philippines and the 2015 earthquake in Nepal.
2014
The Government of India asked Motivation to help them organise wheelchair provision through their factory ALIMCO. Negotiations began to produce five of Motivation’s flat-pack wheelchairs under licence. ALIMCO also asked us to develop wheelchair-training services in a number of provinces throughout India. The relationship offers the potential to improve the quality of Government wheelchair provision and improve the quality of life of thousands of wheelchair users. In 2015 Motivation produced its 25,000th flat-pack wheelchair since the launch in 2005.
Motivation is a journey that has taken David from the rubbish dumps of Calcutta to Buckingham Palace. Through war zones, broken societies and some of the most desperate situations in the world. A journey full of people, places, crazy ideas, laughter and tears and significant social change. What started as a student project has impacted the lives of many thousands of wheelchair users. When I first met David, I was inspired by his can-do attitude and through the life of Motivation we’ve been out there getting things done. I’m very proud to be part of the story; I hope it inspires you too.
Richard Frost CEO/Co-founder Thank you to all our supporters for all the advice, encouragement, guidance and funding you have provided. It wouldn’t have been possible without you.