- By Naomi Grimley
- Global Health Correspondent, Dakar
As Africa hosts its first conference on clubfoot – which affects one in 800 people worldwide – the BBC visited a clinic in Senegal to witness the life-changing treatment.
At the beginning of the year, 14-year-old Serigne was reluctant to leave home.
He could walk very slowly, but, with both legs turned inward, he was very shy. Some made fun of the way he walked… but today, less than six months later, his legs have been replaced and his dream of playing football for Senegal is at least possible.
Serigne is clubfooted, also known as talipes. It is in the process of starting a new phase in correcting this anomaly.
Every year, 200,000 babies are born with clubfoot. According to the charity MiracleFeet, of the approximately 10 million people born with clubfoot, 8 million go untreated.
Senegal was a relatively late adopter of the Ponsetti method – a pioneering method of clubfoot correction, named after the Spanish doctor who invented it – compared to other African countries.
Malawi and Uganda, for example, are ahead of many Western countries in recognizing its potential.
But doctors in Senegal have perfected the original concept and are now using it to treat teenagers and adults who feel too old for any surgery.
Serigne’s mother is overjoyed to see her son’s progress. She knows better than anyone the brutal nature of this disability.
“Once he refused to leave the house for three days, which hurt me a lot. But now we are happy,” she gloats.
In the Ponsetti method, a new cast is applied weekly to gradually bring the foot back into shape. Because his case was so serious, Serigne had 20 cast members over several weeks, averaging five to eight.
In most cases, at the end of the treatment, a small operation is necessary to release the Achilles tendon, but this treatment is not invasive – in other words, it cannot change his organism.
After all, it is cheap, does not require highly skilled surgeons, and is very effective – 90% of children under the age of two with conventional treatment retain leg function, whereas surgery can lead to complications.
The transformation is truly amazing when you watch the video footage of Serigne being dragged before the treatment started.
Fatou explains that living in a remote part of the country, he did not expect his foot to be treated. So she is happy to have the treatment.
School was difficult for Fattu, who relied on crutches — watching other children run and jump.
“I can’t do everything I want. But once I get better, I can do what I want,” she assures herself.
This includes working towards his new dream of becoming a doctor, an experience he has been very successful at.
But not everyone is so lucky. Take the example of 32-year-old Omo Bari. When we meet her in Lac Rose, a suburb of the Senegalese capital, she shows us her left foot, which is large and misshapen. She bounces on the side of her foot and the pain prevents her from walking very far. Her life is marked by scars from clubfoot, and she wipes away tears as she recalls her childhood.
“I asked my mother why I am the way I am? She answered me: ‘It’s God’s will’ and ‘You were born that way’. Oumou has experienced the kind of death that prevents many families in Senegal from seeking treatment.
She says that in her teenage years, when her friends started wearing heels, she had to stick to sandals. Unable to bear any more bullying, she dropped out of school.
Even away from teasing classmates, life is tough. She had to drop out of sewing class because it was so painful for her to operate the sewing machine pedal.
Oumou has a husband and two children, so her life is not as lonely as some people with clubfoot have been, but she still feels the limitations of a conspicuous disability that has left her unused.
“I’m not clinging to anything concrete,” she cries.
Unfortunately, due to her age and surgery, Oumou cannot receive Ponsetti treatment. Some adults may respond well to Ponsetti therapy, but this is complicated by the fact that their legs are less flexible.
In most cases, the exact causes of congenital clubfoot are still not fully understood, although boys are twice as likely to be born with the condition as girls. Most cases around the world are in low- and middle-income countries, due to high birth rates, and in poorer countries this anomaly is likely to remain uncorrected.
Ayesha Mballo is a woman who has dedicated her life to making it into adulthood through Clubfoot. When we meet her, she’s walking confidently through a market in Thiès, a large picture book under her arm. The book explains how to fix clubfoot and the Ponsetti method. She’s here to look for cases of clubfoot that might otherwise go unnoticed.
Ayesha says her own legs were “completely upside down” in the 1990s, when she was a teenager when she was sent to the US for complex surgery. Today, she is a volunteer ambassador for MiracleFeet, a charity campaigning for early detection of newborns.
“If people recognize the disease and bring their children out of hiding, they can take them to the hospital for treatment,” says Ayesha Mballo.
Rosalind Owen of the Global Clubfood Initiative, who has studied the concept of clubfood in Africa, says there are “huge issues of stigma” in traditional societies.
“People think you’re cursed, or you’re a victim of witchcraft, or maybe your parents did something wrong. This includes the belief that mom committed adultery, and the clubfoot punishment,” she says.
Nevertheless, less than 20% of clubfoot cases are treated at birth in Senegal, leaving much room for improvement.
Before leaving Thies, we went to another clinic to see a new cast for the two-week-old girl.
Doctors and nurses would tie bandages around her little feet and apply wet plasters over them.
Now is the perfect time to fix clubfoot.
In the waiting room, a two-year-old boy, perhaps an aspiring soccer player, kicks a pile of juice. He’s a bit unstable – one leg still pointing inwards – but at least he’s getting the treatment he needs.
Gabriella O’Donnell, Nick Loomis and Borzo Dahl Contributed text and photo reporting.
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