Ghana
THE GHANA CLUBFOOT PROGRAM
The Ponseti method of managing clubfeet is a specific protocol of manipulation, casting, bracing, and occasional relatively minor surgery. Since the late 90’s, Ponseti treatment has been the gold standard for management of this potentially disabling and socially isolating deformity. Success rates in the 90 to 100% range for initial correction and avoiding major surgery, and superior long-term outcomes have been widely reported.
Beginning in 2001, FOCOS sought to establish a clubfoot program in Ghana modeled after the Uganda Clubfoot Program. With extensive preparatory work, and with support from Rotary, Links, Wright & Filippis, and others, an elusive goal became reality.
In February, 2004, KATH and St. John of God Hospital established clubfoot clinics using the Ponseti method. Representing a major commitment by dedicated people of both institutions, optimal, and life-changing treatment of clubfoot deformity became available to the hundreds of infants in the region born each year with clubfeet which may otherwise have gone untreated.
Designed for further growth and sustainability, the clubfoot program represents a comprehensive approach including public awareness, provider education, and development of referral pathways. The program includes the training of additional practitioners, cooperation with and extension to other areas, facilities and organizations, and continued public education
The statistics from these two clubfoot programs as of April, 2007, are presented.
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KATH: |
2004 |
73 Infants |
St. John of God: |
~40 infants |
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2005 |
95 |
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~40 |
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2006 |
99 |
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92 |
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(1st quarter 2007) |
30 |
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27 |
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TOTAL |
297 |
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199 |
While success rates, compliance, and follow-up are rarely 100% in any setting, the vast majority of infants treated have been successfully managed. Initial success and correction rates, estimated in the 80 to 90 % range, have approached worldwide experience with this method. Obstacles to maintenance of correction, such as compliance with the requisite night time bracing program, are also similar to those encountered elsewhere as well. Again, as everywhere, resources to address common obstacles to continued care, to ensure follow-up, and to optimally track outcomes and maintain statistics are limited.
It is clear, however, from the first few years of our program, that the burden of clubfoot deformity is huge. The numbers above represent a fraction of children in need of care, and mostly reflect the lucky ones, referred in a timely fashion, from the immediately surrounding region. Based on generally accepted incidence and birth rates, an estimated 1500 infants are born with clubfeet in Ghana, alone, each year.
It is also clear that the impact of the program to date has been immense. The outlook for a child with untreated clubfoot deformity is bleak – generally, particularly in developing regions, each such child represents a lifetime of lost potential, poverty, social isolation, obvious disability, disfigurement, and physical and emotional pain. If measured only by lives changed thus far, the extensive efforts of all have been well-justified. All involved can reasonably be proud of the success, to date, of this program.
But, if measured by the number of children who could have been treated if found, and by possibly preventable failures of treatment, we must acknowledge that we have made a valuable beginning, but there is much work to be done.
Word has spread and infants have been brought from remote areas for care. A TV production about clubfoot care by Dr. Opuni and Mrs. Karikari, of KATH, is one of many awareness efforts. Parents of successfully treated infants have been some of the best ambassadors for the program. We need to continue this momentum and bring clubfoot care closer to home for those in need outside of the current reach of the clubfoot clinics.
We salute the members of the KATH and St. John of God clubfoot programs for their leadership and achievements thus far. At KATH, Dr. Steven Opuni, Chief of Orthopaedic Surgery, Mrs. Margaret Karikari, Head of Physical Therapy, and Dr. Nsiah-Asari, Chief Executive of KATH, Dr. Karikar, Medical Director of KATH, and others including Dr. Martin Adu-Ampofo and Dr. Ne Amon Kote have all had the vision and commitment to see the value of the clubfoot program on many levels. Similarly, at St. John of God, Dr. Prosper Moh, Orthopaedic Surgeon, and Mr. Charles Mensah, saw the value of the Ponseti method and of the clubfoot program. Representing FOCOS, Mr. Samual Opoku has played a major role in development and growth of the KATH program.
Current attention is being directed to coordinating efforts with organizations such as Cure International, and Christian Blind Mission (sponsor of the Uganda Clubfoot Project), and with outreach efforts of St. John of God, to improve the sponsorship, support, and provider base, and thus fulfill the fundamentals of a sustainable program:
Awareness through education of the public and of healthcare professionals
Development of the “trainers” and teaching materials and seminars for continued teaching of the Ponseti method
Establishment of accessible treatment centers with Ponseti – trained health-care professionals and access to physician and surgeon support
Orthotic support
Integration with Ministry of Health and other non-governmental organizations which are part of the health care programs in the targeted areas
Data collection and patient follow-up for continued adaptation of services to optimize outcomes.
The value of a treating a child with clubfoot is clear. The additional incidental benefits which a coordinated clubfoot program provides in terms of creating a network of providers which becomes a platform for care of other musculoskeletal disorders are huge.
We all remain committed to the continued development of this clubfoot program. As individuals, there is little more valuable that we could contribute. As a group, the multiplication of our efforts can have a great positive impact on the lives of so many.
Michael J. Mendelow, MD,
Pediatric Orthopaedic and Scoliosis Surgery
Board Member, Foundation For Orthopaedics and Complex Spine (FOCOS)
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