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With any freewheeling internal-gear hub, you can have hybrid gearing using double or triple chainwheels. You must then also use a spring-loaded chain tensioner, which could be a rear derailer without a shifter and cable. In this way, you get to enjoy the quick shifting of the internal-gear hub in a hilly city such as San Francisco, and also have "bail-out" gears. Many hubs have splines wide enough that you could install two sprockets and shift them with a rear derailer. 13 and 15 teeth or 18 and 21 teeth split the wide steps of a three-speed nicely in half. Use derailer chain, and sprockets made for it. Use a modified Shimano cassette sprocket (see instructions) for the inner of the two. For the outer, use a dished sprocket also made for derailer chain. Such sprockets are usually stamped, like the one below, to fit in the space for a 1/8" sprocket. You may need to grind down the projections on the outward-dished side of the sprocket so you can fit all the necessary parts onto the hub's splines. With only two sprockets and/or two chainwheels, shifting is indexed even if the shifters are not!

Some internal-gear hubs are not rated for the stresses from extremely steep climbs and a heavy load, a potential problem with do-it-yourself hybrid gearing. Usually, manufacturers rate hubs in terms of the acceptable chainwheel/sprocket ratio, but this rating really amounts only to "we will make it so hard to pedal that you will get off and walk." Pushing a lower gear up the same hill actually stresses the hub less. A small rear wheel and smooth pedaling reduce stress on the hub.