Lessons the West learned from Africa with clubfoot

A new non-surgical technique to treat clubfoot was adopted in Uganda and Malawi, before spreading around Africa and to Asia, and the UK.

What is the background? Describe what happened in the project
Clubfoot is a congenital condition that occurs in approximately one in every 5/600 births in sub-Saharan Africa. If not treated it deteriorates as the child starts to walk and results in a severe deformity as seen here in a teenager from Cambodia. In developed countries where surgery was available, most children had access to satisfactory treatment. In resource poor countries where there were few surgeons it was a different matter and many children ended up with severe deformity that stopped them from going to school or getting paid employment. Fortunately a new and very effective non surgical treatment involving intensive manipulation and minor tendon release surgery was developed in Iowa USA by professor Ignatio Ponseti, and published in the late 1990s. It was slow to take off in the USA and Europe as the establishment is always slow to change, and surgery was readily available. In Uganda and Malawi however the new technique was adopted eagerly, as there were so few surgeons and so many children needing treatment. Thanks to the Uganda Sustainable Clubfoot Project and the Malawi National Clubfoot Project these 2 countries became the first 2 countries in the world to have a national clubfoot programme where efforts were made to offer treatment to every child who needed it.

What was the impact and what can be learned?
We learned that by involving the Ministry of Health, and all the major stakeholders in physical impairment we could set up national clubfoot treatment programmes in Uganda and Malawl. We also learned and showed that the treatment given by locally trained paramedic clinical officers was as good as that given by postgraduate surgeons and physiotherapists. [1] From Malawi and Uganda teams were invited to other African countries in the region, and also to West Africa to help set up national programmes. A team from Malawi also went to Cambodia to help start their programme and share what they had learned. UK doctors went to Malawi to learn the technique of effective manipulation in the early 2000s as there was so much more experience there than could be had in the UK. One UK doctor Steve Mannion went to Malawi and learned the technique then brought it back to several hospitals in England, earning the plaudit of being one of Lord Robert Winston’s “BBC superdocs”. We also modified and improved Ponsetis technique in Malawi by showing that gaps between manipulation did not need to be the standard Western one week, but could be reduced to as little as two days without affecting the efficacy of the treatment. This finding from Malawi was published in one of the worlds leading peer reviewed children’s surgery journals and has the potential to dramatically reduce treatment times from 6 weeks to 2 weeks

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