Nola PaterniAssociate Director, Marketing & Communications (USA)
Carl Mhina is an MD, originally from Tanzania, who has worked extensively in HIV and is now pursuing his MS at Duke University’s Department Population Health Sciences as he plans to transition into their PhD program. Carl was born with clubfoot and treated with a tendon lengthening in Tanzania. Because of his personal connection to clubfoot, he has always been interested in creating awareness about the condition.
Q: Can you take me back to the beginning and tell me what you remember about being born with clubfoot?
A: I was born in Tanzania in 1989, the second child in a family of four. I was born in a tertiary health center, similar to a referral hospital. My grandma was among the first people who noticed my feet and asked a doctor to examine them. He determined that they were not ok and immediately applied POP (plaster of paris). Every two weeks for almost a year I came back to the hospital for new casts. I think that was the typical schedule, but maybe it was also because I was a chubby baby. After a year of casts, they removed the one on my right foot, which looked ok, but my left foot still had problems. I had tendon lengthening surgery on my left foot to make sure both feet were properly aligned. My family knew the doctor who operated on me, so it made access to care a little easier. My dad gave him a bottle of whisky after the operation as a gesture of appreciation considering his efforts to make sure I could walk properly.
My feet were improved, but fast forward to high school, I still had pain in my left leg – especially when it was cold. I was also asthmatic (which I outgrew) but my parents, especially my mother, really didn’t want me to play soccer or overexert myself in any way. But I loved soccer, I still do. I would head out to school with my soccer ball and gear in my bag and my mom would ask me about it and I would tell her it was just books. It was my mom after all who spent most of the time with me when I was in the hospital. She would see me when I came back from school all dirty from playing soccer. She knew.
I tried to overcome the pain in my left leg by using it as my shooting leg. I joked it was the Greek god Achilles, the greatest and strongest of all the Greek warriors, helping me.
Q: Looking back, how did that feeling of overcoming physical limitations impact your life?
A: There’s this perception of clubfoot disability that you just have to live with it. But I refused to accept that. There’s no reason to conform to limitations. Clubfoot is unique in that it can be treated, but there’s no need to institutionalize disabled people or make them conform to a life of disability if they want more. It’s important to do as much as you can with what you have. It doesn’t matter if you have a disability if you survived, or healed, you can do so many things. It could be something you have inside that you are not aware of – something intrinsic – like my desire to help the vulnerable that motivates you to overcome physical limitations.
Q: Have you had, or do you plan to have, any additional or follow-up treatments?
A: I’ve worn arch supports in my shoes, but I’ve never worn a brace. My left leg is shorter than the right which makes my walk a little uneven. Sometimes people ask me, “is that your swagger or just the way you walk?” People used to call me “Leggie” and make fun of my limp. It’s gotten better, but I still can’t wear heavy shoes and all my footwear has to have good cushioning and support.
Q: Can you tell me more about your academic and professional journey?
A: I lived in Tanzania for most of my life – that’s where I grew up and where I went to primary and secondary school, and where I went to medical school. I got my MD at Kilimanjaro Christian Medical University. Then, in 2016, I moved to Cape Town, South Africa where I got my Master of Public Health in Health Economics. In 2019 I moved to Durham after receiving a scholarship from the Duke Global Health Institute to pursue a PhD in population health sciences.
Q: Wow. So many degrees. Why did you decide to go to medical school initially?
A: For three reasons – one because of my clubfoot. Another was because of my grandfather. Since I’d seen a lot of doctors at a young age, he called me “doctor, doctor, doctor” and it became my nickname, but also, he said I should always help others. The third reason was an innate drive to help the less fortunate – especially children. Although it wasn’t until I was in medical school when that really became clear to me.
I was propelled by something beyond medical curiosity to help children. While in medical school, I was part of an initiative to visit orphanages with a group of college mates to do health education and screenings. We would identify birth defects including clubfoot cases, but also contagious illnesses. We would also collect clothes and organize other donations to help these vulnerable children who were socio-economically disadvantaged, but also often ill and/or disabled. Out of this initiative came the organization that I’m still involved with today called Shine A Light which helps disadvantaged children in Tanzania achieve their dreams.
Q: Are there other ways your clubfoot has affected you or your family?
A: My wife actually didn’t know about my condition until she saw the scar on my leg from the tendon lengthening surgery. I mean, she knew a little, but then asked me more about it. And it has impacted my extended family in the way we approach things. My maternal grandfather also had a problem with his feet. We’re not sure if it was clubfoot, but first thing when my sons were born, we checked their feet. Same with my siblings – they had to make sure their children’s feet were thoroughly examined by a pediatrician and a physiotherapist.
Q: What’s life like for you now?
A: My journey has been interesting. I started as an MD doing these health awareness activities which led me to working on and with charities. I got to know my wife doing charity work, and that is how we formed our relationship. We were working on a mentoring program together in Tanzania before we moved to the US. One of the things kids in the program would often say is that they want to be doctors when they grow up so they can help others. And that’s why mentorship is so important.
“We had this dream of creating a hub – a physical space where orphaned and vulnerable children can acquire knowledge, recognize their unique talents, and be creative and innovative.”
When the pandemic hit it was a chance for my wife and I to redefine our charity work and focus on the impact we wanted to have. We started with a mind map (in Swahili) with mentorship at the core since we felt it is a key component to breaking the cycle of poverty and orphandom. We wanted to integrate health and the environment as well. And that’s how we landed on Ustawi (which means wellness in Swahili). It’s a mentorship program that includes emotional, spiritual, intellectual, physical, financial, and social support.
We also had this dream of creating a hub – a physical space where orphaned and vulnerable children can acquire knowledge, recognize their unique talents, and be creative and innovative. We had the idea to use a shipping container as the base of the building and transform it into an e-library. It’s almost finished.
This project unifies me and my wife and gives us a purpose beyond our academic and professional lives. It’s also where our professional lives and personal values merge into one. Charity is also part of our spiritual pillar of “giving generously” and we are looking into involving other people who are willing to be part of this journey. The next step is to add desks, computers, and a physical library. Our parents are helping with that. They are very supportive and such a driving force – they will make sure it gets done.
Along with my colleagues at Duke, I’ve also started developing a coaching model specifically for orphaned and vulnerable children drawing from the PiCASO model for children with chronic diseases as well as the Duke Complex Care services program. I’m taking a scientific approach to intervention.
With charity work there’s always instant gratification. It’s what keeps me motivated to do the academic side where the process is a bit slower, and the pressure is often on publishing rather than implementing. My real task is to merge the two.
And it’s important to me that my kids (3 months and 3 years) know the importance of charity. We learn so much from our families.