3. ISPO works to reduce Club Feet in Tanzania
In 2007 the ISPO Board approved a proposal for ISPO to help in a sustainable club foot educational venture in Tanzania together with the Ponseti International Association (PIA) and CBM. For more information contact the author of this article and ISPO representative on this project, John R. Fisk MD, via email to: jfisk@siumed.edu or ispo@ispoint.org or sailingfisk@gmail.com
Education in Tanzania to treat Club Foot
Over the past two years, ISPO has contributed to an educational venture in Tanzania, working with the PIA and CBM. Major funding for the project was to come from a PIA/CBM grant partnering with ISPO.
Background for the project
The stimulus for this venture included experience in Uganda, Cambodia, Nepal and a number of other developing nations. Tanzania was selected because of the potential for research and development on the foot abduction orthosis, a key portion of Ponseti management, at the Tanzanian Training Center for Orthopaedic Technologists (TATCOT). The Consensus Conference on Lower Limb Orthotics, Hanoi 2006 concluded that the Ponseti Method was the single best approach for treating infants having club feet, which is the most common congenital cause of ambulatory disability world wide. It affects between two and three children per every thousand live births in all cultures and races.
Ponseti Method summary
The Ponseti Method consists of manipulation and casting for approximately five weeks followed by a minor surgical procedure and bracing. It is successful in 97% of treated children as reported in the scientific literature from all parts of the world. The technique can be taught to any allied health personnel with casting skills and so is especially suitable for regions lacking in orthopaedic surgeons. The heel cord tenotomy is performed as an out patient procedure by any physician. The foot abduction orthosis, a key component of the program, is very specific in what it must accomplish.
Plans created during 2007
Activities began with a fact-finding visit to in November 2007. It was felt that Tanzania was sufficiently large that more than one center should be selected for training. Ultimately three treatment centres have been established.
Courses conducted during 2008
The first course was held at the Muhimbili Institute in Dar es Salaam, May of 2008, the second in Moshi at Kilimanjaro Christian Medical Center (KCMC) in October 2008. On going activities are occurring in the Mwanza region in eastern Tanzania. Follow-up visits will take place at the regional hospitals of the majority of course participants to support their newly learned skills and to ensure sustainability. A course about the foot abduction orthosis was conducted in Moshi by Michael Steenbeek in order to establish a central fabrication facility at KCMC to serve the whole region. Nine shoe makers and orthopaedic technologists attended that course.
Follow-up visits identifed some problems
After initial follow-up visits some problems have been identified.
Casting material is not universally available. Future visits to the Minister of Health will be aimed at establishing a country-wide program which will ensure adequate material.
Follow-up visits after the casting period are difficult due to transportation problems. Tanzania does not have a well established Community-Based Rehabilitation program through which follow-up could be provided locally rather than centrally. As a consequence, it is difficult to be confident that the orthosis is consistently worn by all children.
Prediction that 300 children will be cured of deformity
In spite of these observations, it is estimated that 300 children will be cured of their club foot deformities in 2009, based on the number of babies already being seen by the course participants. Additional country programs will be the responsibility of regionally established coordinators.
Further information
This Tanzanian Ponseti Sustainable Club Foot Project is part of similar projects occurring in ten other developing countries under the sponsorship of PIA and CBM. Please contact John Fisk for more information, via the details above
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