Not Ranked
David, you just continue to impress the hell out of me.
I have been on a number of medical missions to thrid world countries around the world. in '97 or so, I went to Ariquipa, Peru. Those missions (Peru in particular) have opened my eyes to a whole differant world.
Here's an idea for a wheel chaai. Normal propulsion is with the hands directly on the large rear wheel. On the flat and level, that's fine. As you already know, rough terrain or uphill can be impossible. Maybe you could design some kind auxillary gear drive for tough travel. A smaller gear that would drop down onto another gear on the back of the wheel. Operate the gear with a crank handle. It would double or triple the their arm strength when needed. Then move it up and out of the way when not needed.
Make the gear a ratchet, so it can't roll backwards while engaged.
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