Did you know that about 1,650 new babies in Kenya every year are born with clubfoot? Clubfoot is a congenital deformity of the foot caused by the abnormal development of a baby’s bones, ligaments and muscles while in the womb. The affected foot is usually twisted inwards and downwards, could be shorter than a normal foot and the calf muscles are smaller. If not treated, a child with the deformity will never be able to walk normally, inhibiting its mobility and activity and is more likely to find it difficult to access education and employment. Such children also experience stigma and even exclusion from society.
Clubfoot may occur in either one foot (unilateral) or both feet (bilateral). Bilateral cases of clubfoot account for around 50% of cases. In spite of the deformity’s high prevalence in Kenya, awareness is very minimal, making treatment difficult. The problem is further compounded by disability-related stigma in most cultures, and poverty.
Cure International Hospital is a non-profit organization that operates charitable hospitals and programs in 16 African countries and 32 worldwide. According to the Cure Kenya Chief Executive Abed Milelu, the hospital’s key focus is on securing the future of societies by treating and correcting clubfoot especially among children.
“The hospital was founded on the need to offer treatment to the many young children who could not go to school because of clubfoot disability”, says Abed of the facility established in 1997. It is part of the global chain of hospitals, Cure International. According to its website, the hospital has since inception had over 2.9 million outpatient visits, provided over 218,000 life-changing surgeries, and trained over 8,100 medical professionals in Kenya.
Clubfoot, Abed says, is closely linked to poverty since a child living with the condition is highly dependent. “This requires the dedicated attention to assist them with basic physiological and physical needs. If the caregiver is also the family’s bread winner, they might not take up other productive work like employment. This compromises the quality of life in that family”, says the former finance director, now CEO.
The hospital operates on a mobile clinic model. This does not mean they have vans moving from place to place, but they have partnered with other healthcare institutions across the country that help them identify new cases of clubfoot and follow up on those they have treated. The Cure orthopedics and counselors move around the country to treat cases that do not require surgery and counsel the parents or guardians. Counseling is a crucial component of the clubfoot treatment because of the stigma and hopelessness associated with the condition.
“We have found that having a counselor actively in communication with the family significantly increases compliance, which in turn produces consistent outcomes of fully corrected feet”, notes Abed.
Abed says disability in general is associated with many myths in Africa. In some cultures, disabled children are seen as a curse and are killed at birth to save the family from being ridiculed or discriminated against by society. As a result, he says, most clubfoot cases remain unreported, making early treatment impossible.
“In more developed countries, clubfoot is treated soon after birth and most kids will have completed treatment by the time they are of school-going age. They grow up with normal feet and few, if any, memories of life with the condition”, says Abed, decrying the inadequate awareness on the condition and limited access to medical care.
AIC-Cure does not just treat clubfoot; it unites and heals families, says the professional accountant who easily passes as a medic due to his grasp of medical terminology and details. He recounts a case where a couple almost broke up because of their daughter, born with clubfoot. The girl’s father blamed his wife for the condition. Fortunately the wife found out about AIC-Cure where they sought treatment for their daughter. She was fully treated and walked normally, and was one of the flower girls during the couple’s wedding.
He says clubfoot can affect one foot (unilateral) but in most cases, it’s both feet (bilateral). There are two modes of treating the debilitating condition. Surgery can be done especially when the affected person is already an adult. This is more tedious and costly. The other mode is Posenti, a minimally invasive procedure that includes gentle manipulation of the feet followed by the application of plaster casts. It is extremely effective when implemented in the first three months of life and ideally will start before a child celebrates the first birthday, and lasts six to eight weeks.
The Posenti method is most effective when the family faithfully takes their child for weekly castings and follows up with consistent use of the foot abduction brace. Most orthopedic surgeons agree that the primary treatment for clubfoot in young children should be conservative. Compared to surgical and other conservative techniques, the Posenti method has been found to have the best long term outcomes and provides long term correction of the deformity resulting in a foot that is fully functional, pain-free and without calluses and the patient is able to wear normal shoes.
Unlike most other for-profit facilities, Abed says AIC-Cure recommends surgery on clubfoot patients only as a last resort- in the advanced cases which Posenti cannot correct.
The hospital, whose main facility is in Kijabe relies mostly on donor funding to offset the costs of treatment since most families cannot afford the cost. The hospital may only levy a small proportion of the total cost of treatment to encourage commitment and ownership of the corrective process.
The hospital performs between 30 and 35 surgeries a week, with the average cost of treatment ranging between Ksh.33,000 to Ksh. 100,000 per case depending on the severity. The non-surgical Posenti method on the other hand costs an average of Ksh. 50,000. They perform corrective surgery on an average of 100 cases every quarter.
In most cases, especially where families cannot afford, the costs are born by the hospital which has a bed capacity of 30 for children and 4 beds for adults. Abed’s plan is to more than double the bed and human resource capacity over the next five years to sufficiently serve the increasing demand for treatment of clubfoot and other conditions. He also hopes to make the institution fully sustain itself locally in the face of dwindling donor support occasioned by the upgrading of Kenya to a middle-income economy in 2014.
ABC Bank has been Cure Kenya’s financial partner for many years, offering financing and regular banking services.
“Previously we’ve had relationships with other banks but we wanted a bank that would listen. We have had a very good relationship with ABC Bank and whenever we request for certain considerations they are always magnanimous and yet very professional,” points Abed, saying that the bank has sufficiently supported the hospital with its financial needs.
Besides clubfoot, AIC-Cure also treats other conditions such as cleft lips and palates, spinal cord and other physical injuries occasioned by accidents injuries as well as physiotherapy to aid in full recovery of injured tissues and bones. It also has specialists in sports medicine who attend to professional sportsmen and women.
The hospital- which is on its way to ISO certification- is running a public awareness campaign on road safety in partnership with the APDK (Association of Persons with Disabilities-Kenya). Dubbed Linda Maisha, Zuia Ulemavu, the campaign is aimed at reducing the road accident-related injuries in Kenya.
Cure Kenya contacts: Web- https://cure.org/kenya/