Going the Distance: Providers Mobilize to Reach Children at the Last Mile During Pandemic
There is something about clubfoot—a condition as treatable as it can be devastating—that leads many Ponseti providers to incredible feats in their quest to reach more children with proper care. What one clinic team in the Philippines did to keep 60 of their clubfoot patients on track during Covid is both remarkable and representative of how motivated MiracleFeet’s medical partners are to see children with clubfoot complete treatment.
When Covid caused public transportation throughout the Philippines to close, patients of Dr. Jean Pierre Leung’s in the steep Cordillera mountains were mostly cut off from health care and community resources. Strict lockdowns meant that people were not allowed to leave their homes, not even for routine reasons.
“One of the biggest obstacles was access. Since that’s one of the things that we can control, it’s something we tried to do,” said Dr. Leung, a pediatric orthopedic surgeon at Benguet General Hospital.
Treating clubfoot is time-sensitive. Beginning the process soon after birth and then maintaining the correction with a series of well-fitting shoes and braces is key to long-term success. And babies grow fast, so getting the next sized brace in time is critical to prevent a relapse as the child grows.
The clinic team knew that if they didn’t find a way to reach their patients with the next size of brace and shoes, many children would be at risk.
“We decided to bring the braces to them by biking,” physiotherapist Hya Babag remembers. Cars and buses were not allowed through roads, but bicycles were. For well over a year, they organized regular weekend cycling trips through the rugged terrain to deliver new braces and check on children.
Today, most of their patients are on track, and although the clinic has reopened, Dr. Lueng’s team will continue these treks to support families facing the greatest barriers. Throughout the country, clubfoot clinics have also employed social media, like private Facebook groups, to virtually follow children’s progress and answer questions from parents.
Reaching families across thousands of islands is an enormous challenge even in normal times. In all, there are 229 orthopedic doctors, physical therapists, and nurses at 24 MiracleFeet partner clinics working to find and treat the estimated 3,000 babies born with clubfoot in the Philippines every year.
Master orthopedic trainers in this national network also led the global pilot of a virtual 8-week course on the Ponseti method to enhance hands-on learning and give newcomers critical orientation in basic clubfoot management. Covid has led to staff turnover in many places; the course familiarizes new staff with the basic steps so they can support more experienced providers with clinic workflows and parent communication to maintain continuity of services.
The pandemic spurred partners across the globe to find innovative and safe ways to treat clubfoot patients, despite Covid-imposed obstacles.
In Nepal and Guatemala, mobile clinics brought treatment to families who could not travel for care during quarantines. In Morocco, providers conducted telehealth consultations to ensure treatment progression was on track. And globally, leading orthopedic surgeons who pioneered the Ponseti method in developing countries advocated to classify clubfoot services as essential healthcare—not elective—to prevent backlogs and relapses.
Innovation is part of the global clubfoot story, pandemic or not.
The global uptake of the Ponseti method has always been driven by its medical champions in countries where the multigenerational burden of untreated clubfoot demanded a better solution than surgery.
From Somalia to Nepal, Uganda to Paraguay, the master practitioners and trainers MiracleFeet partners with today are advancing treatment for children in dozens of countries. Their outreach, research, and clinical innovations have proven the success of clubfoot treatment in every setting on earth, led to adaptions in reaching older children with untreated clubfoot, and increased government awareness and support for clubfoot services as an essential newborn health intervention to prevent lifelong disability.