WARNING:
This is a super long post! ... and I just realized that SOOOO MUCH has happened in just a year or so!
Hope you will still browse through this and get to know our CLUBFOOT story from April 2018 to June 2019!
Also have fun going through the photos, you might just be in one of them!!
Clubfoot is a common congenital birth defect with an
average prevalence of 1 per 1000 live births, but may vary among different
countries. (1) According to Miracle Feet data, about 3,523 children
with Clubfoot are born in the Philippines.(2)
Clubfoot disability when untreated leads to low self esteem on the patients and families and many pass through the phase of bullying. Others are deprived of the opportunities, some educational and also in work because of the disability.
Giving them the opportunity for a normal life is the best gift we can give to the Clubfoot kids!
The important aspect of this birth defect is
that Clubfoot is TREATABLE and thus, there is the consortium called the Global Clubfoot Initiative
(GCI) with the battlecry #runfree2030, which envisions a world where children with clubfoot can
walk and run free from disability by the year 2030, of which Miracle Feet is one of the participating partners.
It is, of course, advised to refer the children with Clubfoot for treatment as soon as it is diagnosed (DAYS OLD) for a shorter treatment period and with better compliance.
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| "Parents of infants born with clubfeet may be reassured that their baby, if otherwise normal, when treated by expert hands will have normal looking feet with normal function for all practical purposes. The well treated clubfoot is no handicap and is fully compatible with normal, active life." Ignacio Ponseti, M.D.(3) |
Isn't it amazing to see this happen?
Isn't this magic? Isn't this a miracle?
YES, it is a miracle and appears like magic BUT THIS IS REALITY!
After the intensive efforts for Case-finding, we now have several Clubfoot kids and young adults ages 4 to 22 years with the so-called neglected Clubfoot with ongoing Ponseti treatment and they are responding well, although, they still have to complete their treatment.
Our realization is that "THERE IS HOPE FOR CLUBFOOT, WHATEVER THE AGE" and we just have to refer the children to the Treatment providers to find out the options.
This is the reason, we, in the Zamboanga City Medical Center (ZCMC) Clubfoot Clinic together with, and as part of the Philippine National Clubfoot Program passionately want to SPREAD THE ADVOCACY that:
CLUBFOOT IS TREATABLE!
FREE TREATMENT IS AVAILABLE in the PHILIPPINES
Prior to 2018, there was and is no established national program under the Department of Health for the treatment of Clubfoot, thus, case-finding in the Philippines including Zamboanga Peninsula is very low.
Then, treatment could only be availed in some private clinics and few government hospitals located in 6 regions, National Capital Region, Bicol Region, Central Visayas, Northern Mindanao and Socsksargen.
Now in June 2019, Clubfoot treatment is available in 19 partner clinics (and counting) throughout the Philippines.
In Zamboanga City, the ZCMC Clubfoot Clinic started the Ponseti treatment for Clubfoot in 2014,
after the training of the Orthopedics Department head Dr. George Rojo on the
Ponseti method, which is a manipulative technique correcting clubfoot without
invasive surgery.
The Ponseti method utilizes weekly gentle manipulation with casting for an average of 6 to 8 weeks followed with possible Tenotomy then Foot Abduction Bracing for 23 hours for 3 months and during naps and sleep time up to 5 years old, or an average of an additional 10 to 30 months to prevent relapse. (4)
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| Casting of our 15 year old Clubfoot teener |
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| Casting during World Clubfoot Day 2019 as fellow advocates from Ciudad Medical Zamboanga Breast Wellness Center watch on |
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| Clubfoot kids on Cast |
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| Clubfoot kids on Foot Abduction Braces from Miracle Feet |
During his Orthopedic residency training in the 1990s, Dr. Rojo said that
Clubfoot kids after age 2 years were subjected to surgery. Thus, the new knowledge
on the Ponseti method is indeed a breakthrough for treatment since there is no
major surgery performed for the patients and the outcomes were successful.
One problem, though, is that the
treatment process takes several months with weekly casting and years of bracing, thus, needs
patience, commitment and strong family support for the treatment to be
completed.
Zamboanga City Medical Center (ZCMC) is an 800-bed government hospital and the main referral center in Western
Mindanao and neighboring islands in southwestern Philippines.
Our target patients are from Zamboanga City,
Philippines. However, the real catchment area extends to adjacent provinces in
the Zamboanga Peninsula, namely Zamboanga Del Norte, Zamboanga Del Sur,
Zamboanga Sibugay as well as the neighboring islands of Basilan, Sulu and the Tawi-Tawi where there are no Pediatric Orthopedic
practitioners
Among the main issues of the
ZCMC Clubfoot Clinic (and of the Philippine Clubfoot situation) prior to
early 2018 were:
1) financial or affordability issues since treatment materials
were not free at that time (and treatment lasts for about 8 weeks) and braces
were not available as well as budget on transportation to treatment center;
2)
availability of treatment providers and documentation of progress in treatment;
3) awareness of the availability of the treatment options and treatment center; and
4) lack of family support and commitment
resulting in poor adherence to treatment.
Financial issues have repeatedly been expressed by
many parents as the main challenge.
**I remember Dr. George visited a patient in La Paz, which is about 20 kilometers from the ZC City Hall and they said the fare to the hospital would be about P1000.00 so it is difficult to come weekly.
**Several mothers expressed that the weekly casting expenses of P2000.00 to 3000.00 is too expensive, thus, after 4 to 5 sessions, many of them drop out.
**One mother was told she had to prepare about P30,000.00 for treatment, thus, only came now that the kid is 4 years old.
**Another mother was told they had to spend P150,000.00 for surgery for her older Clubfoot child.
**Many of the children also come from Zamboanga Del Sur or Zamboanga Del Norte or from Basilan, Jolo and Tawi-Tawi, thus they really have to prepare their time, which may be about 30 minutes by boat or plane or even reaching four to five hours for their bus rides and of course, their weekly expenses including their stay in Zamboanga City.
Major breakthrough came last April 2018 when Miracle Feet, a US-based NGO through Ms. Maria Cristina Mosende, the new Miracle Feet Asia Program Manager visited
the ZCMC Clubfoot Clinic and partnered for complete support of treatment
materials and braces with better organizational structure and documentation,
which addresses the first two challenges.
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| Ma. Cristina Mosende of new Miracle Feet Asia Program Manager with Dr. George and Filipinas Rojo of the ZCMC Clubfoot Clinic, Pediatric Orthopedic Surgeon Dr. Rotti Flores and Ms. Linda Abris of the Philippine Band of Mercy. |
Thus, the ZCMC Clubfoot Clinic was reorganized with Dr. George C. Rojo as Head and Miss Natalya Sousa, ZCMC nurse as Site Coordinator with Department of Orthopedic Surgery residents as the treatment providers. Dr. Filipinas Rojo serves as volunteer to assist in Parent education and for the use of Social Media for spread of the advocacy.
This is the first group photo we had last April 14, 2018 for the ZCMC Clubfoot Clinic and our second Instagram post.
Media and social media were utilized in the advocacy to propagate the message that: “Clubfoot is Treatable!” and “Free Clubfoot Treatment is available at the Zamboanga City Medical Center Clubfoot Clinic”.
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| We had three patients during our first month with Miracle Feet, Edgar at 2 months old, Jerome at 1 year 6 months and Sonny Boy (not in photo) at 8 months old. |
Second group photo in August 2018, with a slight increase in Clubfoot kids for treatment .
Within 2018, Miracle Feet
also had a change of national implementation partner, now with the Philippine
NGO Council on Population Health and Welfare (PNGOC), thus, a new Memorandum of
Understanding was signed with the ZCMC Clubfoot Clinic last January 5, 2019.
PNGOC is also active in advocacy and thus, supports ZCMC Clubfoot Clinic on the
third challenge.
Use of more aggressive online methods and tri-media was only started January 2019, when the new national implementation partner, PNGOC was officially identified and renewal of Memorandum of Understanding were signed.
A group photo was taken during the MOU signing which was also during the 2019 New Year party last January 5, 2019 with further increase in size of our Clubfoot family.
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| PNGOC Executive Director Ms. Eden Divinagracia with Dr. Rey Salinel together with the ZCMC Clubfoot Clinic for the Memorandum of Understanding done January 5, 2019 during the 2019 New Year Party and Press Conference. |
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| Happy faces during the New Year 2019 party! |
Posts from our Media Partners after Press Conference with TV/Radio through E-Media.
Miracle Feet and PNGOC provided continuing education fora such as the Basic Ponseti training and CAST training and other process improvement initiatives which is beneficial for the partner Ponseti Clinics all over the Philippines.
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| February 10, 2019 Basic Clubfoot Treatment Provider Training |
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| April 2019 CAST Training |
On March
2019, about a year after we started, there were only 16 patients, 9 patients less than the target of 25 kids, thus,
a second wave of digital exposure and tri-media exposure were done to try to reach the target number of patients .
Thank you so much to our media partners who listened to our call and is helping us spread the advocacy further and definitely increased our patient numbers.
On our first year with Miracle Feet from April 2018 to June 2019, the ZCMC Clubfoot Clinic served a total of 44 clubfoot patients, with 32 new cases from July 2018 to June 2019, with 24 TA Tenotomies and with Foot Abduction Braces to 28 patients. (ZCMC Clubfoot Clinic files)
From 2 patients in April 2018, we now have 44 patients in June 2019.
Therefore, from July 2018 to March 2019 (months) with 16 patients, we added another 16 patients in three months after intensive traditional and digital media efforts reaching 32 patients which is 128% of our target. Yehey! Target Achieved!
TV and Radio guestings with Facebook live-streaming
Press Conferences
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| with Zamboanga City Press and the Philippine Information Agency |
Lectures with Zamboanga City Health Office Nurses and Midwives to the 98 barangays last May 31, 2019 and follow-up lecture at the Barangay Health Workers Summit on June 20, 2019
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| with Zamboanga City Health Officer, Dr. Dulce Dagalea-Miravite |
Clubfoot posters from Miracle Feet translated to the Chavacano and Visayan dialect!
Focused Group Discussions and Lecturettes.
Last June 3, 2019, we celebrated WORLD CLUBFOOT DAY in honor of Dr. Ignacio Ponseti and to share the love with our Clubfoot kids and families.
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| ZCMC Clubfoot Clinic Team |
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| World Clubfoot Day 2019 celebration graced by ZCMC Chief Nurse, Ms Ellen Macias, ASEC Department of Tourism and former Councilor, Hon. Myra Paz Abubakar and most supportive head of the Public Health Unit, Dr. Afdal Kunting |
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| lot of treats and gifts and a wonderful cake from Crumbsnbuns by Nora. |
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| Our Clubfoot family has now grown in number... more happy families served! |
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| Our first three Clubfoot kids, Sonny Boy, Jerome and Edgar, now playing happily with normal feet... still ongoing bracing though! |
The ZCMC Clubfoot Clinic and the Clubfoot in Zamboanga PH Program would like to invite you
to share with us in this advocacy through building awareness, improving
clubfoot identification and referral processes, providing free treatment
services as well as training for providers in strategic places in the Zamboanga
Peninsula and neighboring islands.
See where you can help!
We now have a BIG HAPPY FAMILY!
Again and again...
Clubfoot is treatable!
Clubfoot Treatment is
free at the
ZCMC Clubfoot Clinic
every Saturday, 8-11 am
at ZCMC Ward 2.
With the length of our story, an EPIC so it seems in just a year's time. But we value every moment we had with our Clubfoot family!
Would you like to share your thoughts on our Advocacy for Prevention of Clubfoot Disability?
References
1 Adnan
Ansar, et al. Systematic review and meta-analysis of global birth prevalence of
clubfoot: a study protocol, BMJ Open, 2018: 8(3); e019246
2 Miracle Feet website https://www.miraclefeet.org/
