Focal Person Ponseti International Pakistan (Prof. Anisuddin Bhatti) presents Pakistan Clubfoot Disability Prevention programme success story. started in 2006-2020 / continues

2. Pakistan Clubfoot Program
Clubfoot Disability Free Pakistan-2020
Prof. Anisuddin Bhatti
Dr. Ziauddin University Hospital, Clifton, Karachi
President(Rtd), Paediatric Orthopaedic Society Pakistan
Focal Person, Ponseti International Pakistan
Journey to
Success

3. Pakistan Demographics
• Population: 217+ millions
• Disabled Population (DP)- 5.03 millions…
Physical, Mental, Opthalmic etc
• 43.4% of DP are children.
• 40% of DP are with physical disability.
• Clubfoot Deformity was one the cause of DP

4. Two & half decade back
it was common for
clubfeet to get Rx by various conservative
method or early age Surgery (PMR)
that too in nearly 50% Children
This usually led to a poor outcome
& the children were
left to live with Club foot disability

5. Impact of clubfoot disability
Economically Non-Productive
Socially Deprived / lifelong stigma
Curse on the Community
Neglected
Club Feet
Deformity
To
Disability

6. Out come: Clubfoot Surgery
Short, Ugly, Stiff, Pain & Shoe wear 7 yr f u

7. 2 Brothers 1st operated at age of one month &
other at 3 months
Both had Three times Surgeries 5 & 7 yr F U

8. PMR, 12 Yr FU,
Painful, stiff, flat feet
1997, age 3 yr, now 15 years
Clubfoot Surgery - a maltreatment ?

9. Endorsement of Ponseti on PMR
With Surgery…. the
feet become rigid,
rigid,weak and
painfull.”
“…… I was convinced
that surgery was
the wrong
approach for
treatment of club
foot”.
Ignacio V Ponseti 1941,
UIOWA

10. Ponseti’s Club foot treatment
Gold Standard… 95% Excellent Results

11. Treatment must be started
soon after birth
Ponseti casting
2wks age &
FAB 3 yrs
FU 19 yrs

12. Ponseti Method: Four Yr Fu

13. Ponseti Rx: ZNB 5 yr fu
Before P4 cast

14. Ponseti Teq: Slmn 5 yr fu, Lt ft

15. Pakistan Club Foot
Disabilty prevention
Programme
2006 - 2020
Objectives
Clubfoot Disability Free Pakistan by 2020

16. Objectives: Pak CF Programme
Prevent Clubfoot Disability: 2020
Inadequate Rx
Maltreatment Rx
Neglect
Neglect
Maltreatment Rx

17. Basic awareness Ponseti workshops
2006-2012: #20, 2015-19:#29
World clubfoot days: #4
Ponseti Mentorship Programme 2013-2015:
Consultants 45_2wks + PGT60_6mon
2006-2020

18. 2006:
• 1st Ponseti Workshop
at LNH by Paeds
Ortho Forum. Lead
by Dr. Anis Bhatti &
Haroon ur Rasheed
2007:
• 2nd Ponseti Workshop
at JPMC, By Bhatti &
Chinoy.
Organizers of
1st Workshop 2006,
Bhatti & Haroon

19. • 3rd Ponseti Workshop at
DIPMR DUHS as a part of
2008 Orthocon.
• Deven Taneja & Yasir
Elbatrawi & National
instructor

20. • 2009 at JPMC
• 5th Ponseti Workshop at
LUMHS Jamshoro for 2010
Orthocon.
• Prof. Khalique Siddiqui, Prof G.
Mahboob were legend Speakers.
Organized by Ayub Laghari
• Directed by Bhatti & Chinoy.

21. POA: GLOBAL PARTNER:2012

23. Training for Trainers2012-2014
Master Trainer Advance workshops = 6
By Morcuende, Pirani and National Mentors
Grooming of Mentors; 2012- 2014
UIOWA, Jose A Morcuende = 6
Sau Palo, Brazil, Monica Nogourie= 2

24. Training for Trainers
Workshop
KHI,
Decmbr
1-2
2012
Lhr,
Decmber
3-4
2012
KHI Group with Dr. J. Morcuende & Dr. S. Pirani

25. LHR Group with Dr. J. Morcuende
on revisit 16th July 2013
Training for Trainers
Workshop
North
Trainee 10 Px
Decem
3-4
2012
Children
hospital
lahore

26. Grooming of Mentors
UIOWA = 6 & Brazil=2
2011
2013
2014
2015
2013
2014

27. Grooming of Mentors
UIOWA = 6 & Brazil=2
2014
2013

28. Basic & Live Workshops
N=29
• POA: Paediatric Orthopaedic Forum
• POA Forum - 2006-2012:: 7+5 [12]
•
• Ponseti International Pakistan & Paediatric
Orthopaedic Society Pakistan - 2012-2019 [17]

29. Establishment of Ponseti Clinics
@ National Level2013
February 26, 2013
The Secretary, Health Department, Government of
Sindh
• Ponseti International has established clubfoot
programs in many countries throughout the
world. Together, with the American Academy of
Orthopaedic Society (AAOS), we are happy to
collaborate with Pakistan on developing a high-
quality, sustainable clubfoot program. We
currently have providers of the Ponseti
Method in Pakistan and we are eager to get
started on expanding your program. In
December I had the opportunity to visit
Pakistan, along with Dr. Shafique Pirani, and
we were impressed by the dedication and
commitment of the doctors we met and
trained.
Jose A. Morcuende, MD, PhD

30. USAID: Ponseti Mentorship opportunities April
2wks for Consultants & 6 months or Trainees
• PIA Trn
CENTERS:
• JPMC
• INDUS
• LUMHS
• DIMC
• MENTORS:
• Anis
• Chinoy
• Mansoor
• Mehtab
• Nussrat
Mentees: 40 Consultants + 12 Foreigners + 50 PG trainees,
2014- 2017
Mentorship
Opportunities:
2014 -2017
By National
Mentors: 100

31. Ponseti Champions & Pioneers
Providing Mentorship Trainings to
Consultants-40. Registrars-50. Foreign mentees-12

32. Ponseti Champions & Pioneers Providing
Mentorship Trainings to
Consultants-40. Registrars-50. Foreign mentees-12
Afghan Mentee 10
• UAE Mentee 1

33. Programme Scale-up: Stake Holders
meeting & CFC opening: Feb 2014
Hyderabad
VC LUHMS, Inauguration CFC LUHS
Stake holders meeting Upper Sindh:
Districts: Jacobabad, Larkana, Nawabshah,
Khairpur, Sukkur, Thata, Hyderabad
Following this meeting: Four CF clinics were established

34. Programme Scale-up: Stake Holders
meeting & CFC opening: Feb 2014
Karachi
DIMC CFC inauguration
Karachi
Abbasi Shaheed Hospital CFC inaguration

35. Programme Scale-up: Stake Holders
meeting & CFC opening- Lahore: Feb 2014
Children Hospital Lahore
King Edward Medical University
VC

36. Programme Scale-up: Stake Holders
meeting & CFC opening-Islamabad: Feb 2014
Islamabad feb2014:
VC QAI University Armed Forces Lt.General Sohail Hafeez

37. Programme Scale-up: Stake Holders
meeting & CFC opening-Turbat: 12.4.2019

38. Chicago March 2013

39. Agenda:
• Review Work done,
Limitations
Future Planning
 Coordination

40. Contribution n “Clinical
Guidelines for Ponseti Rx of CF”
Composition of the
Work Group:
Olayinka
Adegbehingbe,
Hersey Barriga,
Anisuddin Bhatti,
M Amin Chinoy,
Thomas Cook,
Mansoor Khan,
Omolade
Lasebinkan,
Jose A.
Morcuende,
Monica Nogueira,
Edith Parker,
Shafique Pirani,

41. Contribution n “Clinical
Guidelines for Ponseti Rx of CF”
Composition of the Working Group:
Olayinka Adegbehingbe, Hersey Barriga, Anisuddin Bhatti, M Amin
Chinoy, Thomas Cook, Mansoor Khan, Omolade Lasebinkan, Jose A.
Morcuende, Monica Nogueira, Edith Parker, Shafique Pirani,

42. Contribution in Propagation of World
Clubfoot Disability Prevention program
MENA – Jordan 2016
Established Ponseti Clubfoot Disability Program at Middle East & North Africa
Ponseti Clubfoot Workshop & meeting with Health Minister Jordan 2016 -
Aman

43. Contribution in Chinese
Ponseti Clubfoot Program
WCORT 2017 Tai Yuanan

44. Target Achieved
To change the Mindsets of Orthpods
from Hiram Kite Methodology, KFOs &
Surgeries on 3 month old babies to
Ponseti Technique
Ponseti workshops 2006-2019 =29
Training for Trainer2012-2014 =6
IOWA & Brazil2012-2015 = 8
Mentorship Trainings2014-2017 : 102

45. Pakistan Clubfoot Programme
is Owned by
Ponseti International Association
to establish
PONSETI CLINICS /
ICR Integrated Research Centers
&
Federal & All Provincial Governments

46. Pak-Clubfoot Program
Clubfoot Disability Free Pakistan-2020
Targets-Objectives set in 2012
• Building Capacity: (PIA+USAID+POA+Govt)
• PIA/USAID Integrated Clubfoot Clinics Network
• Standard – Uniform Ponseti Management
• Identification, Early referrals
• Clubfoot load assessment
• PIA Pakistan/UIOWA Integrated Research
• Centers network : ICR
• Public & Parents awareness Programmes for early and
complete Club Foot management.
• Awareness & Involvement of all stakeholders in public
health care

47. Growth of Dedicated CF Clinics
ICR Integrated
CFC Growth:
• 2011=03,
• 2012=5,
• 2013=7,
• 2014=20
• 2015=23
• 2016=29
• 2018= 84
• 2019=105
• 2020=110
• With 150 Users

48. Dedicated Clubfoot Clinic
CFC: A dedicated Clinic on specific Day, Time & Space With
Ownership by Consultant. With Infra- structure, Auxiliary Staff
and Supply for treatment of Clubfoot Deformity ONLY.
48
Integrated & Monitored by PIP & PIA for Quality Assurance

49. Active ICR Integrated = 36
Clubfoot Foot Clinics:
Yearly Growth
• 2011 3
• 2012 6
• 2013 10
• 2014 20
• 2015 21
• 2016 21
• 2017 18
• 2018 15
• 2109 36

50. Total CFC Entries 2012-2019: 10145
Served by Gender & Laterality
• Male: 7376 [72%]
• Female: 2769 [28%] Bilateral: 5484 [54%]
• Left: 2119 [21%] Unilateral: 4661 [46%]
• Right 2543 [25%]

51. Total CFC Entries 2012-2019: 10145
Age at first Visit by years
• 0-3 Mon: 4812 [47%] 1-2 yrs.: 1056 [10%]
• 3-6 Mon: 1428 [14%] 2-5yrs: 907 [09%]
• 6-12 Mon: 1199 [12%] 5-10 yrs.: 212 [02%]

52. N=10145

53. (Slag 2016-2018 +/- Retirement Anis / Mehtab & less growth of CFC,
Then up-rise 2018-2019 due significant increase in # CFC )
N=10145

54. Clubfoot patients not yet
Entered in ICR
ICR Registered: 10,145
Yet to be entered
aprx Same number 10,000
Total CF Registered & treated patients
20,145

55. Clubfoot Disability Free Pakistan 2025

56. Pakistan Clubfoot Program: Public
awareness
Press release by Health
Ministry

57. Public Awareness
Clubfoot Posters & flyer

58. Medical Camps
TV- Radio Live Telecast
Documentary
Telecasted 18 11 13
On Sindh TV

59. World Clubfoot Day
3rd June ,2013-2016
Celebrate the Past, Create a Pathway for the Future

60. Do we have achieved Targets
Clubfoot Programme
Objectives Set During 2012 Working Group Meeting:
• No Neglected Clubfeet by 2020
• Capacity Building: Workshops & Mentorships: 150
• Clubfoot load registry: CFC=110 – Pt. N= +20,000
• Early referral & Treatment < 6months age 61%
• Standard Ponseti Management: Followers 90-95%
• Public & Parents awareness for early and complete Club
Foot management. Sessions >20
• UIOWA Integrated Research CFC network: 36/110
• Awareness & Involvement of all stakeholders in public
health care:: Federal & all Provincial Govts