Pictures of Hope: Treating Clubfoot in Uganda

Pictures of Hope: Treating Clubfoot in Uganda
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Children’s stories illustrate the correction process.
Importance of the assessment
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Once it is assessed that a child suffers from clubfoot, he or she is immediately referred for treatment at a clubfoot clinic.
Step one - Casting
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The first step of the Ponseti Method, the non-surgical treatment used to correct clubfoot, is the orthopedic cast made from plaster, encasing the deformed limb to hold the bones in place.
Free to low-cost materials
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Plaster is provided for free when available. A roll costs approximately $1 USD. When casting materials are not available, parents have to buy them in pharmacies near the hospital.
Step two - Braces
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After 5 to 7 casts, children wear braces until they are four years old. The braces are made locally, using local materials, making them affordable and accessible.
Early treatment, best results
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Treatment is less effective if started after the child starts to walk. After walking age, treatment still helps, but it may be more difficult to achieve full correction.
Challenges
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Common challenges in obtaining treatment are: availability and cost of materials, remoteness from medical services and transportation costs. Some parents have to make the difficult decision to let their child live with a guardian.
Accessibility and local ownership
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Thousands of Ugandan primary health personnel were trained to recognize foot deformities in infants and to refer these children to clubfoot clinics. Training is now locally driven and reaching the children in great need.
Stories of healing
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The stories that follow were compiled during AUCC visit to the Mulago Hospital Clubfoot Clinic in Kampala, Uganda on March 15, 2012. They document each stage in the healing process.
First visit, first cast
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At nearly a month old, Dellick visits the clinic today for the first time. His casting process serves as a training session to 12 physiotherapists, midwives and orthopaedics residents.
Halfway through the treatment: final cast
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At 5 months old, Sara is visiting the clinic for the third time. After this last cast, she will be fitted for braces in the hope of having her deformity corrected.
Braces for healthy steps
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At four months old, Esther is proof that clubfoot can be corrected if detected early. She had a particularly challenging case and started the treatment shortly after birth. She has now been wearing braces for a month and will continue until around 4 years old.
Facing difficult decisions during treatment
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Erin’s deformity was only detected when she was five years old because of her village remoteness. At now 6 years old, she was entrusted by her parents to a guardian from Buloba village, 18 km from Kampala, to care for her and get her to the clinic as needed.
Overcoming challenges
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On this day, the hospital did not have casting material available and Erin’s guardian only had 4 plaster rolls instead the needed 8 for her new cast. Thanks to his commitment and some luck, he got the funds to buy the needed materials so she could get her new cast.
Smiling through the miles
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Aldrian was born in 2007 and started the treatment the same year at the Mubende District Hospital Clubfoot Clinic, over 150 km from Kampala.
Overcoming the relapse
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He is visiting the Mulago Hospital Clubfoot Clinic with his father because he needs to be casted. Shortage of braces at the District clinic has caused him to relapse.
The plight of parents and children
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At 1 and a half years old, Emmanuel lives in Nakasongola, 122 km from Kampala. He had to travel to the clinic every two weeks for treatment. He relapsed because his parents could not afford the transportation. He now has to undergo surgery to correct his deformity.
Making a difference by committing to the treatment
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Being detected at birth, Nicole started the treatment at 3 months old to correct her deformity. Now she is 1 year and 5 months old, and her deformity is almost corrected. She is at the clinic today to get new braces.
There is nothing like a mom’s love
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Nicole’s mother travelled to the regional clinic in Masaka, 130 km from Kampala, to purchase fitting braces at a time when Mulago Hospital did not have any. She is determined to see to it that the deformity is corrected by the time Nicole goes to school.
Picture of hope: Clubfoot is treatable
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Dan started the treatment when he was one month old. Now 3 years old, he is cured but has to come back every 6 months until he is four for a check-up.