SMP - Leonard Banza


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SMP - Leonard Banza

  1. 1. Scotland Malawi Partnership 2009 The Malawi National Clubfoot Program
  2. 2. The Malawi National Clubfoot Program INTRODUCTION <ul><li>What is Clubfoot? </li></ul><ul><li>Why is it a problem? </li></ul><ul><li>What is the Ponseti Method? </li></ul><ul><li>What is the MNCP? </li></ul><ul><li>What has it achieved? </li></ul><ul><li>How can we help/ purpose of SMP? </li></ul>
  3. 3. What is Clubfoot? <ul><li>Commonest significant congenital lower limb deformity </li></ul><ul><li>Incidence Of Clubfoot twice that in US / Europe (2 / 1,000 live births) </li></ul><ul><li>200,000 children / year worldwide </li></ul><ul><ul><li>less than 3% treated </li></ul></ul><ul><ul><li>In Malawi – approx 1200 new cases per year </li></ul></ul><ul><li>Do badly if left untreated </li></ul>
  4. 4. Why is clubfoot important <ul><li>Common & Completely treatable with simple cost effective non-operative technique </li></ul><ul><li>When badly or un-treated </li></ul><ul><li>Painful walking </li></ul><ul><li>Obvious stigma </li></ul><ul><li>Can’t wear shoes </li></ul><ul><li>Considered “useless” or cursed” </li></ul><ul><li>Do not gain education </li></ul><ul><li>Poor employment / marriage prospects </li></ul>
  5. 5. Untreated Clubfoot
  6. 6. Clubfoot treatment in Malawi <ul><li>Prior to 2000: </li></ul><ul><li>Manipulation & casting </li></ul><ul><ul><li>Haphazard </li></ul></ul><ul><ul><li>Poor technique </li></ul></ul><ul><ul><li>High Failure rate </li></ul></ul><ul><li>Surgery </li></ul><ul><ul><li>Not universally available </li></ul></ul><ul><ul><li>Expensive </li></ul></ul><ul><ul><li>Left foot stiff </li></ul></ul><ul><ul><li>Poor long-term results </li></ul></ul>
  7. 7. <ul><ul><li>Specific method of manipulation </li></ul></ul><ul><ul><li>Specific method of serial casting </li></ul></ul><ul><ul><li>Local Anaesthetic Tenotomy of the Achilles Tendon </li></ul></ul><ul><ul><li>A specific method of bracing </li></ul></ul><ul><ul><li>Long term follow up for recurrence </li></ul></ul>Current Treatment in Malawi: The Ponseti Method Dr Ignacio Ponseti
  8. 8. Clubfoot – The Ponseti method <ul><li>Must start as early as possible </li></ul>
  9. 9. Clubfoot – The Ponseti method <ul><li>Must start as early as possible </li></ul><ul><li>Weekly manipulations and casting for ~5w </li></ul><ul><li>Tenotomy and final cast for 3w </li></ul><ul><li>Braces full time for 3m and night time until 4y </li></ul>
  10. 10. The Ponseti Treatment Summary Ponseti Casting Tenotomy Bracing
  11. 11. Malawi National Clubfoot Program <ul><li>Aims to eradicate poorly treated and untreated clubfoot in Malawi </li></ul><ul><li>Program of educating all clinical staff treating clubfoot in country in PONSETI TECHNIQUE </li></ul><ul><li>Set up treatment centres in all DGHs </li></ul><ul><li>Ensure supply of treatment materials </li></ul><ul><li>Provide support and Counselling </li></ul><ul><li>Educate communities </li></ul><ul><li>Become self-sustaining in 5 y </li></ul>
  12. 12. Malawi National Clubfoot Program <ul><li>Set up in November 2002 </li></ul><ul><li>Has trained over 100 Clinical Officers, Rehabilitation Assistants and Technicians </li></ul><ul><li>Has 28 treatment centres each with at least 2 councillors </li></ul>
  13. 13. Malawi National Clubfoot Program <ul><li>Treated over 1000 patients </li></ul><ul><li>Full time coordinator </li></ul><ul><li>Distributes free braces and emergency casting material </li></ul><ul><li>Started training community midwives </li></ul>
  14. 14. Malawi National Clubfoot Program <ul><li>Costs 70,000 USD / yr – forecast to increase to over 100,000 USD / y to treat up to 1000 patients / y </li></ul><ul><li>Huge saving to economy - 10 times cheaper and better than surgery </li></ul><ul><ul><li>CURE operates on 100-200 “missed” children / y </li></ul></ul><ul><ul><li>Cost off $1200 / patient </li></ul></ul><ul><ul><li>Surgery = almost 1/4million USD/y for 200 children </li></ul></ul>
  15. 15. <ul><li>Malawi Government </li></ul><ul><li>Cure Clubfoot Worldwide </li></ul><ul><li>Malawi Against Physical Disabilities (MAP) </li></ul><ul><li>Malawi Council for the Handicapped (MACOHA) / CBM </li></ul>MALAWI NATIONAL CLUBFOOT PROJECT STAKEHOLDERS Ministry of Health
  16. 16. MNCP and Scotland-Malawi Partnership <ul><li>Needs Partnership in Support </li></ul><ul><ul><li>Assistance with Training </li></ul></ul><ul><ul><ul><li>Professional Expertise (Scottish Accredited Trainers) </li></ul></ul></ul><ul><ul><ul><li>Financial Assistance </li></ul></ul></ul><ul><ul><li>Assistance with Fundraising </li></ul></ul><ul><ul><ul><li>Expert advice </li></ul></ul></ul><ul><ul><ul><li>Scottish Parliament Funding Application </li></ul></ul></ul>
  17. 17. MNCP and Scotland-Malawi Partnership <ul><li>Conclusions </li></ul><ul><li>Clubfoot is common in Malawi and treatable </li></ul><ul><li>Untreated gives terrible unnecessary suffering, deprivation, stigmatisation and expensive surgery </li></ul><ul><li>SMP in position to assist with training and sourcing funding and possibly more? </li></ul>
  18. 18. Thank You