Improving healthcare for children born with clubfoot

Clubfoot training course in Madagascar, supported by MiracleFeet – photo courtesy of Dr Kighoma

More than 30,000 children in Africa are born with clubfoot each year. Many thousands of these children get no treatment, as it is simply not available where they live. They end up with severe deformities that make it hard and very painful to walk.

University of Oxford leads the Africa Clubfoot Training project, which has developed a new set of clubfoot teaching materials to train healthcare workers across Africa. Over 50 expert clubfoot practitioners in Africa gave their input and expertise during the consultation and pilot phases. Since the materials were published in June 2017, the Africa Clubfoot Training materials have been used (in English and French) in Guinea Bissau, Kenya, Malawi, Rwanda, Burundi, Ghana, Ethiopia,  Zambia, Zimbabwe, Tanzania, Togo, Niger, Senegal, Cameroon, DRC, Congo-Brazzaville, Burkina Faso and Madagascar.

Prof Chris Lavy, consultant orthopaedic surgeon, who leads the ACT project, explains:

“The ACT project has helped to promote life-changing treatment for clubfoot. We have worked together with many dedicated colleagues and supporters to help train more health professionals which means that more children will be able to access effective treatment, so that they can walk and lead a normal life.”

Although the materials were originally designed for use in clubfoot programmes in Africa, they have also been incorporated into training UK healthcare workers in clubfoot treatment, and have been used in Cambodia and Myanmar in the past year. They are now being translated into Spanish for use in Central and South America.

Dr Simplice Kighoma Vuhaka is an Orthopaedic and Trauma Surgeon at HEAL Africa Hospital in Goma, DRCongo, who attended the ACT instructor training course, and has since gone on to train new clubfoot treatment providers, in both English and French. He says:

“The ACT Provider Course Faculty Manual and Participant Manual, plus the rubber and skeletal models of clubfoot, really have facilitated my delivery of clubfoot training in DRC/Madagascar/Congo Brazzaville and Burundi. ACT is a straight forward training, coupling a clear, concise and comprehensive theory to practical sessions, first on models then to patients. The materials have helped me to lead an interactive and participative learning and teaching. I have developed my skills to train others by first learning from seniors as a participant in basic and advanced courses but also exercising mentorship and several supervisions to Ponseti clinics in the DRCongo.”

Dr Paul Mang’oli, Orthopaedic and trauma surgeon, AIC-CURE International Hospital, Kijabe, Kenya:

I have adopted the ACT training in my regular trainings where potential trainers have observed the interactive style of training, that involve frequent small group discussions. The participants get a chance of one on one with the trainer, and hence get closer attention from the trainer/mentor. This way, they are able to retain more of what they have been taught, and put it into practice.

The ACT Project is a partnership between the NDORMS University of Oxford, CURE Ethiopia Children’s Hospital, CURE Clubfoot, Global Clubfoot Initiative (GCI), CURE International UK and local ministries of health, supported by the UK Clubfoot Consensus Group. The initial funding was from the UK Department for International Development through the Health Partnership Scheme, with subsequent support from the OxReach Africa Clubfoot Training campaign. www.ndorms.ox.ac.uk/act.php