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Pehla Qadam project - presented to Ponseti International

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Pehla Qadam is a treatment project at Indus Hospital, Karachi Pakistan.

We presented the project and related research plan to the Ponseti International Association Board of Directors in October.

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Pehla Qadam project - presented to Ponseti International

  1. 1. The Indus Hospital “Quality care, free of cost” Clubfoot Program Overview for Ponseti International Board October 1, 2011
  2. 2. Indus Hospital • Started in 2007 – Initial donation of $10M – provides care free of cost • Located in low income locality of Karachi ‐ Completely paper free ‐ Data available for research • Service – 131 inpatient beds – plans to expand to 700 + – First 300 patients seen daily in walk-in screening clinics – 300-400 patients seen daily in specialist clinics – About 100 patients seen daily in TB clinic – Over 300 patients present daily to ER
  3. 3. Catchment Population Free health care Mapped study area 2.5M people within 10min bus ride. Serves Karachi pop = 18M Offers unique clean environment
  4. 4. Pehla Qadam: Clubfoot Care Program Indus Hospital Karachi
  5. 5. Mission Eliminate untreated club foot
  6. 6. Goals 1. Develop a local sustainable model for club foot care in resource constrained settings 2. Create public awareness about club foot and its optimal management 3. Establish clubfoot treatment free of cost in Indus Hospital
  7. 7. Pehla Qadam Team • Indus Hospital – Study, Implementation • Ponseti International – Technical guidance, tools, networking • Amer Haider and Munira Shamim – Pilot program and cost study sponsor – Support for Indus clinic and scale-up
  8. 8. Profile of Target Population • No primary health service structure • No health insurance • Low literacy rates • Superstitions • Traditional healers, malpractice
  9. 9. Pilot Program Approach • Community perceptions – Phase 1 – FGD and IDIs conducted – Aug-Sep 2011 – Preparation for enrollment – Sept 2011 • Clinic – Phase 2 – Recruitment + treatment – Oct 11’ to Mar 12’ – Treat 100 feet across ~ 70 infants – Implementation evaluation and iteration • Costing study • Scale up
  10. 10. Current status
  11. 11. Pilot Project – Phase 1 Community Perceptions Ethical approval sought and obtained 2 months durations (August-September 2011) Focus Group Discussions and In-depth Interviews – Lady health workers – Families of affected children – People living with clubfoot – General community
  12. 12. Results - Causes of clubfoot - Exposure to eclipses or lightening during pregnancy - Punishment from God/Will of God - Hygiene and Sanitation - Poor nutrition or other issues during pregnancy - Genetic, consanguinity
  13. 13. Results - Impact - Emotional name calling, low self-esteem, isolation - Physical (reduced mobility, pain) - Social (lack of marriage prospects, difficulty in obtaining education or employment)
  14. 14. Results - Treatment - Not everyone aware of treatment - Treatment thought to be costly (in terms of the treatment, transport, and time) - Alternative treatments often sought (religious, traditional healers, traditional treatments)
  15. 15. Pilot Project – Phase 1 Preparation for enrollment • Developing tools for awareness, recruitment and clinical follow up based on FGDs/IDIs • Code book developed for direct data entry in MIS (Indus is a paper-free hospital) • Phase 2 proposal and tools to be submitted on Oct 1 for ethical approval • Birthing centers, community leadership to be approached in Phase 2 identified • Weekly casting clinics scheduled
  16. 16. Pilot Project – Phase 2 Recruitment and Treatment • Start : October 15, 2011 (6 month duration) • Awareness campaign in birthing centers, LHWs and community leaders about club foot • Start of weekly casting clinics at Indus Hospital • Start of costing study • Concurrent data entry and outcome evaluation – Will input into International Registry • Analysis and preliminary report April 2012
  17. 17. Pilot Project Deliverables • Proposed Papers – Outcomes of the Pilot Program – Economic, Cost/Benefit of Treating Clubfoot – Community Perceptions • Tools – Brochure for awareness/recruitment – Pictorial Training manual – Socio-demographic , Economic Profile – Note: will use PIA clinical tools
  18. 18. Road Map • Establish Indus Hospital as Ponseti International Association (PIA) chapter in Pakistan • Expansion of the program – City, National – Create a Sustainable Model • Scalability, Capacity, Personnel, Financial, M&E, Reduce Costs – Work with PIA to help Regional/Global outreach
  19. 19. Proposal for PIA Board • Adopt costing study and expand to get representative global data – Show significant ROI for eliminating untreated club foot – Identify global partners for next costing study • Approach large foundations with ROI data – Show $20M+ investment in PIA is best bang for buck • Next Steps – Create joint plan for global costing study
  20. 20. Contact • USA – Amer Haider 408-234-0520, amerhhh@gmail.com • Pakistan – Lubna Samad lubna.samad@irdresearch.org http://www.facebook.com/pages/Pehla-Qadam/213440218712868
  21. 21. Additional Information
  22. 22. Dr. Amin Chinoy • Professor & Consultant Orthopedic Surgeon • Head of Dept of Trauma & Orthopedics • MBBS, FRCS – UK training • Key interest: Pediatrics & Arthroplasty • Principal Investigator – Pehla Qadam
  23. 23. Dr. Mansoor Ali Khan • Orthopedic Surgeon • MBBS,FCPS – AKU training – Clubfoot training at University of Iowa, home of Ponseti International • Interest in Pediatric Orthopedics • Clinical team lead on Pehla Qadam
  24. 24. Dr. Lubna Samad • Pediatric Surgeon • MD, MRCS, FCPS – UK training • Key interest: Global health delivery • Responsible for programmatic management of Pehla Qadam
  25. 25. Shama Mohammed • Director, Community Outreach • MPA/ID – Kennedy School, Harvard • Key interest: Community development • Leading the qualitative study to gauge the knowledge, perceptions, and stigma related to clubfoot
  26. 26. Dr. Hamidah Hussain • Physician/Public Health Specialist • MBBS, MSc – London School of Hygiene, Johns Hopkins • Key interest: Health Financing • Responsible for Cost of Illness studies and Cost Utility Analysis

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