MiracleFeet’s innovative work in clubfoot care that started with the development of the MiracleFeet brace expanded in April 2016 when MiracleFeet was awarded a $1M Impact Challenge Grant from Google.org. With this grant, we set out to solve a problem facing many global health nonprofits working in low-income countries: advances in healthcare technology are often unavailable or difficult to implement in low-resource settings.
With this in mind, our aim was to improve clubfoot care by developing a suite of technology tools that could be used globally by our partners. We ended up with four major initiatives seeking to address treatment quality and compliance.
The need: A unified, codified, cloud-based system for storing patient records.
One of the major challenges of using mobile technology in low-resource settings is that internet service is not always reliable. This can lead to difficulty synching data, putting patient records at risk of being inadvertently deleted. Paper records also consume a great deal of space, are more likely to contain errors, and can be easily destroyed in the event of natural disasters or extreme weather.
In order to build something that would work for our partners, we contracted with Dimagi, a social enterprise company that develops technology solutions for low-income countries. Using the platform CommCare, they built the mobile app CAST for use in our clinics. CommCare works offline and then providers synch data when they have internet access, eliminating the need for paper records and allowing for interruptions in internet service.
Progress to date: Following a year of piloting the app in India, Madagascar, and Congo-Brazzaville, the final version of the app was rolled out in March 2018 in Liberia. We’re now in the process of a worldwide rollout of CAST!
What’s next: MiracleFeet’s mHealth coordinator will continue to keep the app up-to-date and make sure clinicians are trained in its use. One exciting area of need that we’ll be working on: SMS reminders to parents. These messages will be part of the app, sending parents encouragement and reminders about appointments and bracing.
The need: Reaching MiracleFeet’s goal of eliminating clubfoot disability means training and empowering local healthcare providers to pass along their knowledge. A sustainable solution requires an interconnected network of clubfoot providers using the latest technology to access online training modules.
Progress to date: Content has been outlined and MiracleFeet has been working with OPENPediatrics to develop up to ten training modules containing videos and quizzes.
What’s next: Our team will continue to refine content and number of modules, incorporating information from the Africa Clubfoot Training (ACT). Tentative launch date is in 2019.
The need: With the development of the MiracleFeet Brace in 2013 came the need to answer the question: Does our brace stand up against other AFOs used in clubfoot treatment? In addition, bracing compliance is the biggest obstacle to successful treatment. Many children do not wear the brace as prescribed and thus are at risk of relapse.
MiracleFeet partnered with the Indian Institute of Technology – Bombay to conduct a brace sensor study that would provide data to help us improve treatment outcomes. Sensors were inserted into both MiracleFeet and Steenbeek braces. The sensors collect data such as how often the brace is worn and for how long.
Progress to date: The data collection for this study began in June 2017 and will run through June 2018. Patients at Wadia Hospital in Mumbai participate.
What’s next: At the end of June 2018, the data will be organized and analyzed. This process will take about six months, after which we’ll decide whether to integrate the data with CAST.
The need: In addition to using eLearning to improve the training process, a number of initiatives for in-person training play an important role in our innovation goals. Treating clubfoot involves a great deal of tactile training – from taking a Pirani score, to manipulating the foot, to applying casts correctly.
Progress to date: The Africa Clubfoot Training (ACT), a project of University of Oxford and the Global Clubfoot Initiative (GCI) has trained providers from 18 countries throughout Africa. This unique training method involves a series of three training “teams” who receive training and then go on to train new providers. This ensures that knowledge is constantly being shared. MiracleFeet is one of several sponsors from GCI who support this training.
In addition, MIT student Jason Troutner is working on a silicone foot model with 3D-printed bones to help improve training for providers.
What’s next: The ACT curriculum is being translated into French and Spanish for use in Francophone and Spanish-speaking countries. The feedback process will continue on the foot model and our volunteer team from MIT will make changes as requested.