In rural northern China, where the price of a wheelchair can be as much as a year's earnings, many disabled live without the gift of mobility or the benefit of physical therapy. Often homebound, they depend on family members to carry them from place to place.
UC San Francisco physical therapist John Fan is trying to change that, one wheelchair at a time.
For the past eight years, Fan has journeyed to China to help fit disabled children and adults into wheelchairs — most for the first time in their lives — and give them a chance at greater self-sufficiency.
"It is really something to see their faces when they move themselves for the first time," Fan said. "Sometimes, they don't even wait for us. They're so excited when we get them into the chairs that they just start going and we have to chase after them."
Fan, a UCSF graduate, is among the legions of dedicated volunteers with Wheels for the World, a nonprofit group that collects donated wheelchairs and distributes them globally to disabled people who could not otherwise afford the chairs.
Wheels for the World has delivered more than 63,000 wheelchairs to people affected by disabilities in 105 developing countries. The organization, part of the Joni and Friends International Disability Center, began in 1994.
It was Fan's wife who first suggested in 2005 that he volunteer with the group. The couple discussed whether the volunteer missions would be too taxing on their young family — the Fans were raising two boys and a girl at the time, the youngest still a toddler — but his wife assured him that she could handle things during his trips.
The family support has been crucial, Fan says, because the annual trips are by no means short excursions. They typically are 14-day trips, during which Fan and other volunteers spend up to 10 hours a day at a local center evaluating patients and fitting them in wheelchairs. Sometimes, the team travels hours on uneven, rocky roads to distant villages to deliver chairs to recipients.
While many Americans with a disability have access to physical therapy and a wheelchair, including motorized chairs one can move with a chin, joystick or even by voice command, it can be starkly different in developing countries. In northern China, it is not uncommon to see disabled people who have been paralyzed for decades and who have never had therapy.
"In America, we have a lot more resources. You might have to fight your insurance to get it, but you can get it," Fan said. "In developing countries, a lot of resources do not exist. You might see someone with cerebral palsy who never had a wheelchair before, who must be carried around the house by a family member."
The wheelchair recipients, and the extent of their mobility, vary: Children with developmental disabilities. Young adults with spinal injuries from a car crash or diving accident. Seniors recovering from a stroke.
For some, a chair fitting involves simply adjusting leg rests. But often, such as when someone has lost the ability to move their arms and neck or wiggle their fingers, Fan said the team huddles to brainstorm a more complex solution. They may take a wheelchair apart, resize it, adjust it and reassemble it to fit a patient's specific disability — an exercise that can take three people up to three hours to complete.
Once the fitting is complete, Fan, who is fluent in Cantonese and Mandarin and has a working medical fluency in Korean, teaches the patients how to maneuver the chairs. In some cases, he trains family members on how to position a patient in a wheelchair to avoid the onset of pressure sores that can accompany poor blood circulation.
Fan's efforts have won him admiration among his colleagues and the 2013 UCSF Chancellor's Award for Public Service.
"By providing wheelchairs for the underserved in China through Wheels for the World, John has provided life-altering possibilities for people with disabilities and their caregivers. Many recipients have never seen the world above floor or bed level," said Kathy Bonacini, a physical therapist at UCSF who nominated Fan for the award. "His devotion to travel annually to China to help those in need is an inspiration to all."
In recent years, Fan's eldest son has accompanied him on his Wheels for the World missions. He started out fashioning seat cushions for the chairs, then received training on how to retrofit the wheelchairs. The 24 year old is now in school to become a physical therapist and plans to join his father on future trips.
"We cannot do enough there," Fan said. "What I'm doing is really so little, but it can make a big difference in someone's life. One woman said that with the wheelchair, she can now go to school. She wants to be a journalist, to write about issues important to the disabled."