A few weeks ago, the CURE hospital in Niger hosted a seminar on clubfoot at our hospital, as part of the CURE Clubfoot Worldwide program. We brought in a number of medical professionals from other hospitals here in Niger for training on the Ponseti method of healing clubfoot, as well as counselors and social workers that were trained on how to help the families throughout the process and with the follow-up.
I had the privilege of attending the sessions with the counselors, which were great, and we also had a few lectures on the technical, medical side, which was also very informative. I have to admit, much of it flew over my head, but I did get the essentials, and it was really is fascinating. So much of it seemed to apply to life in general, so at the risk of showing my ignorance (and/or of sounding too much like the medical = life, pseudo-philosophical voiceovers that open and close every cheesy-yet-addictive episode of Grey’s Anatomy), I thought I would draw out some of my observations.
First of all, however, it is important to understand the basics of the Ponseti method. The best way to do that is probably to read about it. Here is a good start. But since I know everyone is busy, I will try and briefly recap what I got out of the lectures. Since I am not a doctor, you should take it with a grain (or more) of salt.
The Ponseti method is a radical departure from the older methods used to treat clubfoot in that it is far less invasive, and tries to use the natural physiological makeup of the body to help with the cure, rather than relying only on surgical interventions. The principle behind it is that people, and especially children, are malleable, and that clubfeet can be stretched back into place.
The foot is pushed as far as it can go in the right direction, and then put in a cast. After a week the cast is removed, the foot is pushed even further and another cast is put on. This goes on for a few weeks, or longer, depending on the case, and in this way the foot can be almost completely brought into the correct position. At a certain point, depending on the case, a small surgery is needed, to cut the Achilles tendon. But this is a minor operation and heals quickly. After the process, a brace is worn for up to 4 years, but the success rate is very high among those who carefully do all of the follow-up. Something like 90%.
First of all, I think it is incredible that our bodies can be changed and shaped to such a large degree, especially using only time and pressure. We tend to think of our bodies as having some sort of permanence, some consistency, but they are actually very transient. This is true, however, the older we get the less capable of change we become. With the Ponseti method, the earlier the better, and we have babies come in who are just a few weeks old for consultation. In a very real sense, they are still being formed; they are still open to correction.
Unfortunately, this becomes less and less true with time. We still treat older children (above the age of 10-12) and even adults with clubfoot, but the Ponseti method is much less effective. Their feet have already become much more rigid and are unable to bend and change. They can alter the appearance of the feet with surgery, and this helps a great deal, but they cannot regain total use of their feet and ankles. The healing is not complete.
This is true of so much in life, and I am experiencing it first-hand. Being in a new place, trying to learn my way around a new city, trying to learn Hausa, and trying to remember the names and faces of so many new people, my brain feels pretty rigid. I am not that old, but I can already feel the difference; when I was younger I could absorb new information like a sponge. Now not so much. If I can associate it with something I already know, then I have about a 50/50 chance of remembering it. Otherwise, its like my brain is saying “No thank you. I already have enough information.”
Another really interesting thing about the Ponseti method is that the follow-up actually takes much longer than the actual treatment. It could be mistaken for an afterthought, but it is actually a vital part of the healing process. Even though there is a great success rate with the Ponseti method, if the follow-up is not strictly implemented, there is an 80% chance of regression! We learned that some of the parents get very far along in the process, see that the feet seem fine, and then stop using the brace. These cases are really sad because they were already so close. I can totally relate to this as well. Sometimes we work so hard to accomplish something, and we do accomplish it, but then we get cocky. We let up. We relax and relapse.
In 2010, 811,759 babies were born in Niger. 1,600 of them were born with clubfoot. This is a widespread problem here, and there is a cure! This is one of the many reasons I am so proud to be working at our hospital. And it is great that the Clubfoot Worldwide program is training other hospitals in Niger as well. Hopefully soon there will be a clinic that can effectively treat clubfoot in every region of Niger.