A report from Chesca Colloredo-Mansfeld, MiracleFeet Executive Director

Last month, MiracleFeet Program Manager Jen Everhart and I accompanied Nicholas Kristof, a Pulitzer Prize-winning New York Times journalist, to visit clinics and families we support in Liberia. Nick’s accomplishments are extensive and impressive; he is said to have inspired Bill and Melinda Gates to focus their philanthropy on global health through an article he wrote in 1997. As fate would have it, his mother was born with clubfoot.

After working to get an audience with him for several years, the visit came after a brief meeting we were able to secure last November. Nicholas recently published a beautiful piece about his visit to Liberia which can be read here.

The trip with Nicholas Kristof was, by design, a time for us to listen and observe. And while the visit to Grand Bassa County, Liberia was just one day spent in a village to hear the stories of people affected by clubfoot, it was a powerful validation of MiracleFeet’s vision, approach, and philosophy. Specifically, I have left with concrete proof of these truths:

• Clubfoot is a root cause of extreme poverty and suffering in the developing world
• Providing quality care means calculated risk-taking and trust in our partners
• MiracleFeet’s support is needed
• Our model works

As you read more about these truths and the people we met with, I hope you are equally inspired and encouraged.

Clubfoot is a root cause of extreme poverty and suffering in the developing world

We visited a family in which the grandmother and the mother, Hannah, live with untreated clubfoot. In contrast the baby, Miracles (and no, we did not make that up), also born with clubfoot, has been treated by Dr. Augustine Chiewolo and our wonderful Liberian team.

Hannah and her mother struggle deeply every day. They live in a hut with a leaking ceiling. They depend on the charity of their neighbors for handouts. Neither attended school so they lack the basic skills that might help them improve their lives. They are subjects of pity, reduced to a life of poverty and misery, impregnated by men who later abandoned them, isolated and living day-to-day with little hope of any improvement. Why should they have suffered so much? They did nothing to deserve this. They just “lost the birth lottery” – born in the wrong place with the wrong problem.

Miracles still faces many challenges given that she was abandoned by her father and lives with two women who are probably among the poorest and most ill-educated in the village. However, the Liberia Clubfoot Program has given her a chance to break that cycle of poverty. She now has access to treatment, which was safe, inexpensive and simple to deliver, putting her life on a different trajectory. I am confident that the team will keep their eye on her and will help make sure she gets additional healthcare, food, and goes to school. The visit validated the fact that treating clubfoot really is a way to reduce lifelong suffering and poverty, which is exactly why we started MiracleFeet and why our local partners everywhere are so passionate about the issue.

As we were saying our goodbyes, another victim of untreated clubfoot emerged. Henroy, a shy 9-year old boy, had been brought down from another village to meet us when people heard we were interested in clubfoot (or “turtle foot” as it is called in the local vernacular). Head hanging, he struggled to walk on his twisted feet while other kids gathered around snickering. He, like Miracles, should have been treated at birth but there was no program available when he was born.

He will recover – the Liberia Clubfoot Program team is working with his family to bring him to Monrovia for treatment. But he has already suffered more than we can imagine.

Providing quality care means calculated risk-taking and trust in our partners.

Liberia is a country fraught with hardship. After a decade of civil war the health infrastructure in Liberia had been largely destroyed. Augustine Chiewolo, our partner in Liberia, took it upon himself to solve a problem in his decimated country. Thanks to his determination, and (to a lesser degree) because MiracleFeet was willing to take a risk to back his nascent effort to build a clubfoot clinic, children like Miracles are getting really good treatment. And the conversation between us and Augustine is now around when, not if, we will reach all the children born in Liberia. That is an amazing accomplishment in 5 years!

I was told by several people not to work in Liberia that working in that country would be too hard, people in Liberia couldn’t be trusted, and we would lose our shirts as everyone is so desperate for money. But we made the decision to trust Augustine. It seemed irrational not to jump on an opportunity to help one of the poorest countries of the world where our support would make so much of a difference. Many people questioned that decision and it has not always been an easy partnership. We have been through a lot of ups and downs. Ebola hit. There were political divisions between doctors. The Ministry of Health has not always been helpful. The medical, administrative and organizational capacity of the team we work with in Liberia was probably lower than any other place we have ever tried to work.

But despite all of this, thanks to determination and incredible hard work by Augustine’s team and MiracleFeet’s program team, he has done it. Miracles got treated – and treated really well. That is proof that all the effort was worth it. Sometimes you just have to go with your gut instinct because a large part of our success depends on building trusting relationships with people on the other side of the world. What the team has done with our support is incredibly humbling – and I am so proud that we have played small role to help make it possible.

MiracleFeet’s support is needed

The arrival of Henroy, a 9 year old with untreated clubfoot, proved that the kids are out there. They are hidden away. Living lives of shame and exclusion. An embarrassment to their parents. But with the right systems in place, we can reach those children and set their feet and their lives straight.

Henroy’s face said it all. He was sad, ashamed, embarrassed. It was agony to see him, face down, dejected – among all the other kids with whom he probably never gets the chance to play. He was validation that our support is needed. This is a very real problem – we are not making it up or exaggerating the need for intervention.

Our model works

Miraclefeet has provided expertise and financial support to help build the capacity to treat clubfoot effectively within Liberia. Some would argue that our intervention is not needed; that foreign aid has largely failed in its efforts to improve lives in low income countries. They argue that the government should and will eventually take care of the problem. Perhaps this is true, but in a country like Liberia that seems like a distant dream. In the meantime, more children will suffer.

I don’t accept that it is okay to wait for the government to live up to its responsibility as there are too many examples where governments have failed, because of lack of will, skill or financial capacity – or some combination. I would rather act than wait in hope that they eventually decide to do the right thing. Regardless, we accelerate this and change lives of real children in the process. I do agree that it is really important we intervene in ways that makes long-term sustainability as likely as possible. We try to create health systems change. We try not to change incentive structures. We leverage the existing hospitals and medical teams. We rely on local trainers and local clubfoot champions to build the program up and to tell us where they need help and where they don’t. We work with the Ministry of Health and try to influence them to make clubfoot more of a priority. We think a lot about how to mitigate risk and about what will be left behind if we are no longer able to provide resources. So while I wrestle with the arguments that foreign aid creates dependence and furthers the colonial legacy, I have come to the conclusion that, at least in the case of building clubfoot capacity, outside help is needed to be a catalyst for change and to allow the local clubfoot champions and advocates to do what they want to do.

While the hard work has been done by Augustine’s team, I do believe they would have struggled without our help – financial, technical and just the moral support. However, we have to be very, very careful. We have to constantly question whether we are needed and we have to allow our local partners to direct and own the programs.

My visit to Liberia validated my belief that organizations like MiracleFeet are needed and our involvement makes a difference in children’s lives today – and will make a difference long after we have left.