A Vancouver doctor brings a cure for clubfoot to children in Uganda

In 1998 Dr. Shafique Pirani returned to Uganda to visit his birthplace and childhood school. A member of the Ismaili diaspora, Dr. Pirani had been among those expelled from Uganda by Idi Amin’s government in 1972. In making preparations to visit the country of his birth, he had not intended to tackle problems of Ugandan public health, but while on that visit he bore witness to a problem that he was uniquely qualified to diagnose and address.

Years before his fateful trip to Uganda, Dr. Priani had taken a research interest in a congenital musculoskeletal disorder known commonly as clubfoot. This disorder occurs in roughly 1 in 1000 children and, if untreated, leads to deformation of the feet. This can leave the sufferer walking on the sensitive dorsum (top) of the foot, resulting in chronic pain, immobility, ulcerations, infection and, often, stigmatization. At the time of Dr. Pirani’s visit, the most commonly practiced treatment for clubfoot around the world was corrective surgery.

Surgical treatment for clubfoot in Uganda was not an option. In a country of 28 million with a birth rate of 3.5% annually, approximately 1500 Ugandan children are born with clubfoot every year. As late as 2008 the country had 20 practicing orthopedic surgeons, most of whom were concentrated in Kampala and focused on trauma. Dr. Pirani recognized a dire need for alternative treatments for clubfoot in Uganda that could be economically and socially feasible.

A Ugnandan baby born with the potenitally crippling congeatal disorder know as "clubfoot." Photo: USCCP

In the late 1940s, a doctor at the University of Iowa named Ignacio Ponseti was investigating the long-term results of clubfoot surgeries. The results he observed were not encouraging and he soon began work on a nonsurgical method to correct the disorder. The resulting “Ponseti Method” proved far superior to surgical treatment, but failed to catch on with the medical community for another 50 years. In 1997 Dr. Pirani had begun using the Ponseti method in his Vancouver practice, with promising results. In Uganda, Dr. Pirani saw the life altering implications of the Ponseti Method for thousands of children. 

Soon after his 1998 visit, Dr. Pirani began working on how the Ponseti Method could be brought to Uganda, bearing in mind the limited number of surgeons. The solution was to train paramedical health care professionals  in the method, so that they would treat the children. Dr. Pirani developed training materials, and set about organizing Ponseti Method workshops and seminars for paramedicals in Uganda, sponsored by the Rotary Clubs of Burnaby and New Westminster Royal City. Dr. Pirani’s pilot studies showed that children born with clubfeet could have the clubfeet corrected by paramedicals trained in the Ponseti Method.

Dr. Pirani was then successful in securing $1 million in funding from the Canadian International Development Agency for the Uganda Sustainable Clubfoot Care Project. Through partnerships with several organizations including Uganda’s Makerere University and the Uganda Ministry of Health, the project has built capacity within the Ugandan healthcare system to screen for, diagnose and treat clubfoot using the Ponseti Method. Dr. Pirani and his partners have worked to adapt the Ponseti Method to make the treatment socially and economically feasible for Uganda. The estimated cost for treatment is less than $150 per child, with benefits potentially lasting an entire lifetime. The ultimate objectives are to develop treatment and training capacity in Uganda such that project’s like the USCCP are no longer required.

Paramedicals in Uganda trained by the USCCP apply a locally-appropriate adaptation of the "Ponseti Method" to treat clubfoot. Photo: USCCP

Throughout its years of operation, the Ugandan Sustainable Clubfoot Care Project has encountered some challenges. For example, as with many development projects spanning international boundaries, the project initially struggled to develop a truly inclusive and participatory approach.  On the whole, however, the project has been tremendously successful. The model pioneered by the Dr. Pirani and the USCCP has already been expanded to Malawi, Rwanda, Kenya, Tanzania, Zimbabwe, and Bangladesh. Health care practitioners and officials in Brazil, Honduras, India and Nepal are also drawing lessons from the UCSSP in Uganda. The project stands as a shining example of how members of the diaspora can build international connections that foster significant and sustainable improvements in health.

Dr. Pirani will share his experiences and insights at the Engaging Diasporas in Development project’s “Improving Global Health” dialogue on March 16, 2011. Those interested in joining in the discussion can register for the dialogue here. For more information on the Engaging Diasporas in Development project, please visit the project website here.

Bibliography:

Naddumba, E.K. (2009) “Preventing Neglected Club Feet in Uganda: A Challenge to the Health Workers with Limited Resources”. In: East African Orthopedic Journal Vol. 3, No. 1.

Pirani S, Naddumba E, Mathias R, Konde-Lule J, Penny JN, Beyeza T, Mbonye B, Amone J, Franceschi F. “Towards effective Ponseti clubfoot care: the Uganda Sustainable Clubfoot Care Project.” Clinical Orthopaedics and Related Research. 2009 May;467(5):1154-63.

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