Re: Update on the Uganda Clubfoot Project (year 3)

[Guest guest]

I forgot to mention that we have a file of the initial Uganda

Clubfoot Project proposal from March 1999 and prior years reports

(1999 and 2000) on their annual trips to Africa in the files section

of the nosurgery4clubfoot site at

http://groups.yahoo.com/group/nosurgery4clubfoot/files/The%20Uganda%

20Clubfoot%20Project/

and

> I just got an e-mail from Shenilla Abdula who is traveling again

this

> year with Dr. Pirani and Dr. Penny as a part of the the Uganda

> Clubfoot Project in Uganda, Malawi, Zambia, Tanzania and other East

> African Countries. The 4 year project was begun in November 1999

and

> involves an annual 3 to 6 week trip from Canada to Uganda to train

> local " orthopedic officers " in the use of the Ponseti method and to

> update surgical techniques training for the few doctors availalbe

to

> treat older untreated children and those for whom the Ponseti

method

> was not successful.

>

> The Clubfoot Project's goal is to ensure that by the end of its

four

> year term, children in Uganda with clubfoot deformities will be

> identified at birth and have access to corrective treatment in

those

> parts of Uganda where such treatment is currently unavailable.

>

> The Clubfoot Project was conceived by Drs. Pirani and Penny and has

> been partnered by The Uganda Society for Disabled Children,

Kampala,

> Uganda; The Uganda Society for Disabled Children, United Kingdom;

The

> Uganda Ministry of Health; Children's Orthopaedic Rehabilitation

> Project, Kampala, Uganda; Christian Blind Mission, Germany; the

> Rotary Club of Burnaby, Canada and Mossadiq Umedaly.

>

> I had posted some other introductory information previously about

the

> Uganda Clubfoot project that can be seen at this link

> http://groups.yahoo.com/group/nosurgery4clubfoot/message/8153

>

> The Uganda Clubfoot project has a stuffed teddy bear mascot

> named " Paddington Bear " who travels with the group of doctors and

is

> the pen name of the person who sends e-mail reports back to the

> sponsors as well as to other interested parties. The first year the

> project was only 3 weeks, but because of interest from health

groups

> in neighboring countries, they had to go for 6 weeks this year.

They

> left for Africa in mid November and will be back home around

> Christmas. The following is the e-mail report I recieved today.

>

> [sTART OF E-MAIL] PADDINGTON'S AFRICAN SAFARI 2001-1

>

> Hello again. This is Paddington Bear, your intrepid reporter,

writing

> to you from the shores of Lake Jacana, in Uganda, East Africa on

> Sunday, November 25th, 2001. I have once again been assigned the

task

> of accompanying Dr. Shafique Pirani, Dr Norgrove Penny and Shenilla

> Abdula on the Rotary sponsored " Uganda Clubfoot Project " (UCP) in

> the heart of deepest Africa. You may recall from my journalistic

> efforts last year that I am a mascot for the project, lent to the

> project by my mum Pam Gardner, President of the Burnaby Rotary

Club,

> in British Columbia, Canada. Also supporting this project are the

> Rotary Clubs of Royal City, New Westminster, Kampala North,

> Rotary International and the Rotary Foundation, CRCID (Rotary's

CIDA

> Arm), The Childrens Orthopaedic Rehabiltation Project, and many

> generous individual donors to whom I say a BIG thankyou and send

bear

> hugs. I had a wonderful time accompanying the good doctor last year

> and so jumped at the opportunity to come to this blessed country

> again.

>

> So here I am, sipping my " masala chai " (a good STIFF cup of mixed

> spicy Indian tea.....sorry Starbucks, you just don't match up with

> your version of chai) and wondering how to begin to describe to you

> the feeling of being here once again in this incredibly beautiful

and

> lush country where seeds dropped out of a car window would probably

> sprout immediately. As I sip my chai, I hear the sounds of the

> Chimpanzees and Colubus monkeys (with their unbelievably long furry

> tails) across the river playfully swinging from tree to tree. A

> beautiful blue breasted kingfisher stops by to offer me greetings

> (smart bird realizes I too am from the animal kingdom. He asks what

> black thing sits on my lap and why it makes tapping sounds when I

hit

> it but doesn't make music like other instruments he sees the local

> people tapping. He is fascinated by the project's lap top). My

short

> fat little legs are perched on the coffee table and I am certainly

> not missing the cold and damp weather at home.

>

> We arrived in Uganda on the night of November the 13th (via London)

> and got to work on the 14th with organizational meetings with Dr.

> Norgrove Penny (founding partner of the project), and Marieke and

> Michiel Steenbeek (our Kampala project coordinator and her husband,

a

> physiotherapist and project trainer) and unpacking all the many

> training and surgical supplies that we bring from Canada.

>

> On Thursday the 15th we were at the Mulago Clubfoot clinic for our

> weekly visits. Once again the crowded hallways were filled with

> gorgeous looking young mothers (many wearing such colorful and

exotic

> ethnic clothing) and their adorable babies, mostly under the age of

> one year and all born with clubfeet. Many mothers had traveled from

> far to have their children's feet attended to. (I know that may not

> be correct grammatically, but don't be too hard on me, after all I

am

> only a teddy bear!!). You may recall from last year that we had

> followed a newborn child (Nakanja Kasifa) through the complete

> process of manipulation and casting of her teeny tiny clubfeet.

Some

> of you may also recall seeing her in the UCP phase 2 video produced

a

> few months ago. She had been invited back to the clinic for the

> doctors and training faculty of the project to see the effects of

the

> Ponseti method of manipulation and casting one year later. We were

> all delighted to see how well her feet had corrected and I heaved a

> sigh of relief that she did not need the extensive and expensive

> surgery that Joy Katono (the 10 year old girl with neglected

clubfeet

> that many of you have seen in both of the UCP videos) had

undergone.

> Once again the Ponseti method had proved to us all that this

> corrective technique was perfect for Uganda as it is effective,

> economical, easy and efficient and can be successfully completed

> usually with a series of 5 weekly casts, a very quick minor

surgical

> technique that can be performed under local anaesthetic and without

> the need for orthopaedic surgeons. Corrective boots are necessary

> full time for 3 months and then part time for 2 -4 years. Nakanja's

> mum was so happy too that her child would grow up with normal feet

> and avoid all the social, economical and psychological

disadvantages

> that a child with a deformity may confront all their lives. She

> told us that when Nakanja was born she had cried, tears of grief,

for

> the future struggle her baby might have had to be challenged by and

> today she was crying too, but her tears were of joy and hope for a

> bright future for her child. What a beautiful moment it was to be

in

> that room sharing that immense hope, joy and gratitude. It was in

> that moment that I once again said a sincere heartfelt thankyou to

> all of you that have made the work of this project possible. I hope

> this moment that I have shared with you helps you to understand the

> impact that your contribution is making to the lives of individual

> little girls and boys each of whom will walk, run, jump and dance

> as little people should (Arthur, I hope you don't mind my using

your

> beautifully descriptive language.)

>

> Friday the 16th found the doctors performing very challenging and

> extensive surgery on three young children with various debilitating

> deformities. In attendance too was Dr. Deo Bitariho, a paediatric

> orthopaedic fellow at the Mulago teaching hospital and this was an

> opportunity for him to observe and participate in very specialized

> surgical techniques that he can take with him into the future as

one

> of Africa's few specialty children's orthopaedic surgeons.

>

> The weekend brought about the opportunity to R & R, catch up on jet

> lag and fill my little fat tummy at a lovely picnic lunch at the

> Bujagali falls close to Jinja, with breathtaking views of the

source

> of the River Nile. What a treat to be in this beautiful country.

>

> Monday the 19th. We met with Dr. Alice Nganwa and Sam Enginyu of

the

> Ministry of Health, Disability Desk and had a very fruitful meeting

> for the preparation of the launch of the exciting awareness raising

> campaign to be started on the 26th November. Lots to talk about and

> get sorted out. Extensive discussions took place about how to

> ensure " Quality Control " is in place for all those who have been

> trained by the project in the Ponseti method of manipulation and

> casting. Everyone involved in the project is wanting to ensure that

> sustainability is possible for the work of the project so thousands

> of children and perhaps even hundreds of thousands of children

> will continue to have their clubfeet fixed correctly well into the

> future. To that end the project is financing both an awareness

> raising program and a " Quality Assurance " program that will be

> implemented in Uganda by the Ministry of Health. The " Quality

> Assurance " will be undertaken by the (UCP) training faculty who

will

> accompany Dr. Nganwa and others traveling throughout the country

and

> ensuring a visit to each district annually. Dr. Nganwa and her team

> will be conducting " Clubfoot sensitization training " throughout the

> districts with the goal that every child born with clubfeet

> will have the deformity recognized at birth by a nurse or

traditional

> birthing attendant and then referred to a trained paramedical

> professional to manipulate and cast the feet and perform the

tenotomy

> required. Many, many hours have gone into strategizing the

> sustainability component of the project's work and it is wonderful

to

> be at that point where implementation is about to begin.

>

> Tuesday the 20th found us at the Katalemwa Cheshire Rehabilitation

> center where children scheduled for surgery on Wednesday and Friday

> were seen by the three doctors (Penny, Pirani and Bitariho) and

> Michiel Steenbeek. In the afternoon Drs. Pirani and Penny had a

> teaching session with the orthopaedic and general surgery residents

> (15 of them were present) on the Ponseti method.

>

> On Wednesday the 21st, the doctors performed surgery on 10 children

> with clubfeet ranging in age from 2 months to 3 years in age. Most

of

> them were tenotomies. Senior level orthopaedic residents were

invited

> to participate in the surgeries to learn the technique involved in

> the tenotomy and other soft tissue releases.

>

> Thursday the 22nd. Back at the Mulago Clubfoot Clinic and an

> opportunity to see over 30 young children with clubfeet. In the

> afternoon Drs. Pirani and Penny had discussions with the UCP

training

> faculty about " Quality Assurance " , complications that can happen,

> mistakes to avoid, research issues and what to do to motivate the

> parents to bring their children back for the duration of the

> manipulation and casting process.

>

> Friday the 23rd. Dr. Pirani met with Dr. Nganwa and her " Clubfoot

> Sensitization " team to provide a training session for them to know

> what are the key issues to talk about when they are in the

districts

> for the awareness raising campaign. And then R & R. Ahhh, I am so

run

> off my tiny little feet trying to keep pace with all the tall

doctors

> going at a frenetic pace that when the weekend rolls by I am

> breathless and need to collapse and sleep to gather energy and

muscle

> power for my thighs for Monday morning. But what fun it is to try

and

> keep pace with these amazing, energetic, dedicated, skilled and

> compassionate medics.

>

> As I sit and do some teddy bear style evaluating on the impact of

the

> project's work and how the project's work is making a difference in

> Uganda the following thoughts come to mind: - I have observed a

> marvelous change in the treatment of clubfeet at the Mulago

Clubfoot

> Clinic. On our first trip to Mulago Hospital almost 3 years

> ago I found the doctors examining infants whose feet were treated

> under the " Kite " method and whose dear dedicated mothers had to

keep

> making repeated weekly trips to the clinic only to find that their

> children's feet were still not quite normal even after 6 months of

> weekly visits to the clinic. The Ponseti Method has changed all of

> that. The children are now being treated in under two months, with

> the feet correcting very well in almost all cases.

>

> The Clinic is run by the training faculty of the UCP and all the

> staff have a sound working knowledge of the Ponseti technique; -

The

> orthopaedic officers, some of whom make up the UCP training

faculty,

> are beginning to show increasing confidence in practicing the

Ponseti

> technique and are interested in following up the children as they

see

> that the method is working. This has also resulted in greater job

> satisfaction for the committed individuals. They have developed an

> appreciation for continuing education and also see the value of

> teaching others what they have learned; - The orthopaedic residents

> are also showing an increased confidence in their surgical skills.

> They are also far more aware of the benefits of pre operative

> surgical organization; - Many more children are showing up for the

> surgical camps who need less extensive surgery than before. This is

a

> direct result of the Ponseti technique and reflects that the

> technique is being carried out well and carried out extensively.

How

> wonderful to see the young babes showing up for surgery involving

> only a minor procedure to completely correct the feet rather than a

> complete reconstruction of the foot that takes time, money,

> special skills, months in rehab and cannot be made available to the

> majority of children in Uganda. The Ponseti technique will, we

pray,

> change this. Every child can be treated and with minimal disruption

> to the family's socioeconomic needs. The awareness raising campaign

> starting Monday the 26th of November should revolutionize the way

> Uganda deals with the issue of clubfeet for ever and every child

born

> with clubfeet should have an equal opportunity for treatment in an

> economically viable way.

>

> The project's partners are all excited that what was once only a

> vision is turning into nationwide action in Uganda. Today Uganda,

> tomorrow the rest of the developing world.......a vision waiting to

> be turned into reality too. And our experience in Uganda shows it

is

> possible.

>

> I have to go and pack now and get ready to jump into the bus for

our

> 7 hour road journey back to Kampala so .....gotta go. I'll keep you

> posted next weekend about how the coming week unfolds. Exciting

> things are happening and thank you all again for your blessings and

> support. Tata for now, all my love Paddington

>

> Well hello again. The week flew by and I had no time to email you

my

> last report so I'm doubling up and reporting for two weeks. Today

is

> Tuesday December 4th, 2001 and we have arrived and started work in

> Lusaka, Zambia. We arrived on Sunday the 2nd, with a 3.30 a.m.

start

> from Entebbe, Uganda. Eaaahhhhh...(Yawn, yawn). Before I start on

the

> work in Lusaka, let me fill you in on the last week in Kampala.

>

> As I had mentioned to you earlier, we had a very important meeting

at

> the Ministry of Health on Monday the 26th Nov, 2001, with, amongst

> others, the Health Commissioner for Clinical Services (Dr.Amandwa)

> present. This was the " official handover " meeting where the Uganda

> Clubfoot project was handing over the newly designed awareness

> raising poster to the Ministry for them to commence the countrywide

> Awareness Raising Campaign and the Quality Assurance Campaign. Many

> officials from the Ministry were present in addition to Members of

> the Rotary Club of Kampala North and the Uganda Society for

> Disabled Children. In his speech, the Commissioner endorsed the

work

> of the project and " committed to multiplying this method for early

> detection and treatment of clubfoot not only within Uganda but also

> within our neighboring countries " , which is very exciting for us

and

> the children of Uganda. Also on Nov 26th, the " New Vision " ,

Uganda's

> daily newspaper, ran a wonderful article on the work of the UCP and

> highlighted the treatment of the little girl Nakanja Kasifa that I

> spoke about earlier. The New Vision will also be publishing an

> article about the " official handover " meeting commencing the

> countrywide awareness raising campaign.

>

> The rest of the week continued with more follow up meetings,

surgery

> and the clubfoot clinic and packing to leave for Lusaka. Dr. Pirani

> was invited to meet the Deputy Director of Mulago Hospital, (Dr.

> Gideon Kikampikaho) to discuss ensuring the provision of plaster of

> paris to the clubfoot clinic. Unfortunately there is often even a

> shortage of basic medical supplies available for use, but now that

> the work of the project is gaining credibility all our partners are

> working to ensure sustainability of the project's work.

>

> Well back to Zambia. What a beautiful and lush country this is as

> well and what gentle people the Zambians are. Shenilla, Drs. Penny,

> Pirani and Bitariho were invited to run a Ponseti Method workshop

at

> the University Teaching Hospital, Lusaka, Zambia in conjunction

with

> the Fifty-second annual general meeting of the Association of

> Surgeons of East Africa, (ASEA), the premier association of

Surgeons

> in this part of the world. The Doctors all made presentations, not

> only about The Ponseti method, but also about the work of the

Uganda

> Clubfoot Project and the scientific research undertaken as a result

> thereof. I was in awe that in attendance at those presentations

were

> among the most experienced and skilled clubfoot doctors living

today

> and the discussions that took place between them flew way over my

> head but sounded amazing. Some of the research presented was very

> exiting....the doctors at the Queen Hospital in Blantyre,

> Malawi, the Mulago Hospital Clubfoot Clinic, and the major hospital

> in Lilongwe, Malawi all said in their research that the method was

> over 90% successful in correcting the deformity in children who

> completed treatment. In fact in Blantyre, they had experienced a

90%

> reduction in the need to give general anaesthetics to children with

> clubfeet to get them corrected. Being present there gave me a

> sense that the work of the UCP was in fact really well respected

> and " Big League " stuff....wow. To add to that, some of you may

recall

> that we were in Malawi last year for the UCP work. Since then,

Malawi

> has invited the UCP to help it launch a national campaign (Malawi

> Clubfoot Project) of the magnitude undertaken in Uganda. And guess

> what...today the UCP was asked to launch a national campaign in

> Zambia, (Zambia Clubfoot Project) once again with Rotary supporting

> the work. The momentum is picking up speed, we may have to clone

> Dr. Pirani and Dr. Penny, and Marieke Steenbeek and of course

> Paddington Bear to keep up. This is such exciting news. Imagine all

> the little children born with clubfeet who no longer have to live

> with that disability for life.

>

> I'm sending this email to you way past my bedtime and I'm yawning

as

> I'm typing which is a sure (Winnie the Pooh type) sign that I must

be

> tired. So I'll sign off for now and email from Tanzania when we get

> there next week for further training. So tata for now, stay safe

and

> well, all my love, Paddington. [END OF E-MAIL]

>

> I thought that some might be interested in this update to the Ugand

> Clubfoot Project.

>

> and (3-17-99)

[Guest guest]

, thank you so much for posting the Uganda update. I enjoyed reading

it and am so happy that the Ponseti method is catching on so well. I can

just picture the joy and hope that those doctors are bringing...

-.

Update on the Uganda Clubfoot Project

(year 3)

I just got an e-mail from Shenilla Abdula who is traveling again this

year with Dr. Pirani and Dr. Penny as a part of the the Uganda

Clubfoot Project in Uganda, Malawi, Zambia, Tanzania and other East

African Countries. The 4 year project was begun in November 1999 and

involves an annual 3 to 6 week trip from Canada to Uganda to train

local " orthopedic officers " in the use of the Ponseti method and to

update surgical techniques training for the few doctors availalbe to

treat older untreated children and those for whom the Ponseti method

was not successful.

The Clubfoot Project's goal is to ensure that by the end of its four

year term, children in Uganda with clubfoot deformities will be

identified at birth and have access to corrective treatment in those

parts of Uganda where such treatment is currently unavailable.

The Clubfoot Project was conceived by Drs. Pirani and Penny and has

been partnered by The Uganda Society for Disabled Children, Kampala,

Uganda; The Uganda Society for Disabled Children, United Kingdom; The

Uganda Ministry of Health; Children's Orthopaedic Rehabilitation

Project, Kampala, Uganda; Christian Blind Mission, Germany; the

Rotary Club of Burnaby, Canada and Mossadiq Umedaly.

I had posted some other introductory information previously about the

Uganda Clubfoot project that can be seen at this link

http://groups.yahoo.com/group/nosurgery4clubfoot/message/8153

The Uganda Clubfoot project has a stuffed teddy bear mascot

named " Paddington Bear " who travels with the group of doctors and is

the pen name of the person who sends e-mail reports back to the

sponsors as well as to other interested parties. The first year the

project was only 3 weeks, but because of interest from health groups

in neighboring countries, they had to go for 6 weeks this year. They

left for Africa in mid November and will be back home around

Christmas. The following is the e-mail report I recieved today.

[sTART OF E-MAIL] PADDINGTON'S AFRICAN SAFARI 2001-1

Hello again. This is Paddington Bear, your intrepid reporter, writing

to you from the shores of Lake Jacana, in Uganda, East Africa on

Sunday, November 25th, 2001. I have once again been assigned the task

of accompanying Dr. Shafique Pirani, Dr Norgrove Penny and Shenilla

Abdula on the Rotary sponsored " Uganda Clubfoot Project " (UCP) in

the heart of deepest Africa. You may recall from my journalistic

efforts last year that I am a mascot for the project, lent to the

project by my mum Pam Gardner, President of the Burnaby Rotary Club,

in British Columbia, Canada. Also supporting this project are the

Rotary Clubs of Royal City, New Westminster, Kampala North,

Rotary International and the Rotary Foundation, CRCID (Rotary's CIDA

Arm), The Childrens Orthopaedic Rehabiltation Project, and many

generous individual donors to whom I say a BIG thankyou and send bear

hugs. I had a wonderful time accompanying the good doctor last year

and so jumped at the opportunity to come to this blessed country

again.

So here I am, sipping my " masala chai " (a good STIFF cup of mixed

spicy Indian tea.....sorry Starbucks, you just don't match up with

your version of chai) and wondering how to begin to describe to you

the feeling of being here once again in this incredibly beautiful and

lush country where seeds dropped out of a car window would probably

sprout immediately. As I sip my chai, I hear the sounds of the

Chimpanzees and Colubus monkeys (with their unbelievably long furry

tails) across the river playfully swinging from tree to tree. A

beautiful blue breasted kingfisher stops by to offer me greetings

(smart bird realizes I too am from the animal kingdom. He asks what

black thing sits on my lap and why it makes tapping sounds when I hit

it but doesn't make music like other instruments he sees the local

people tapping. He is fascinated by the project's lap top). My short

fat little legs are perched on the coffee table and I am certainly

not missing the cold and damp weather at home.

We arrived in Uganda on the night of November the 13th (via London)

and got to work on the 14th with organizational meetings with Dr.

Norgrove Penny (founding partner of the project), and Marieke and

Michiel Steenbeek (our Kampala project coordinator and her husband, a

physiotherapist and project trainer) and unpacking all the many

training and surgical supplies that we bring from Canada.

On Thursday the 15th we were at the Mulago Clubfoot clinic for our

weekly visits. Once again the crowded hallways were filled with

gorgeous looking young mothers (many wearing such colorful and exotic

ethnic clothing) and their adorable babies, mostly under the age of

one year and all born with clubfeet. Many mothers had traveled from

far to have their children's feet attended to. (I know that may not

be correct grammatically, but don't be too hard on me, after all I am

only a teddy bear!!). You may recall from last year that we had

followed a newborn child (Nakanja Kasifa) through the complete

process of manipulation and casting of her teeny tiny clubfeet. Some

of you may also recall seeing her in the UCP phase 2 video produced a

few months ago. She had been invited back to the clinic for the

doctors and training faculty of the project to see the effects of the

Ponseti method of manipulation and casting one year later. We were

all delighted to see how well her feet had corrected and I heaved a

sigh of relief that she did not need the extensive and expensive

surgery that Joy Katono (the 10 year old girl with neglected clubfeet

that many of you have seen in both of the UCP videos) had undergone.

Once again the Ponseti method had proved to us all that this

corrective technique was perfect for Uganda as it is effective,

economical, easy and efficient and can be successfully completed

usually with a series of 5 weekly casts, a very quick minor surgical

technique that can be performed under local anaesthetic and without

the need for orthopaedic surgeons. Corrective boots are necessary

full time for 3 months and then part time for 2 -4 years. Nakanja's

mum was so happy too that her child would grow up with normal feet

and avoid all the social, economical and psychological disadvantages

that a child with a deformity may confront all their lives. She

told us that when Nakanja was born she had cried, tears of grief, for

the future struggle her baby might have had to be challenged by and

today she was crying too, but her tears were of joy and hope for a

bright future for her child. What a beautiful moment it was to be in

that room sharing that immense hope, joy and gratitude. It was in

that moment that I once again said a sincere heartfelt thankyou to

all of you that have made the work of this project possible. I hope

this moment that I have shared with you helps you to understand the

impact that your contribution is making to the lives of individual

little girls and boys each of whom will walk, run, jump and dance

as little people should (Arthur, I hope you don't mind my using your

beautifully descriptive language.)

Friday the 16th found the doctors performing very challenging and

extensive surgery on three young children with various debilitating

deformities. In attendance too was Dr. Deo Bitariho, a paediatric

orthopaedic fellow at the Mulago teaching hospital and this was an

opportunity for him to observe and participate in very specialized

surgical techniques that he can take with him into the future as one

of Africa's few specialty children's orthopaedic surgeons.

The weekend brought about the opportunity to R & R, catch up on jet

lag and fill my little fat tummy at a lovely picnic lunch at the

Bujagali falls close to Jinja, with breathtaking views of the source

of the River Nile. What a treat to be in this beautiful country.

Monday the 19th. We met with Dr. Alice Nganwa and Sam Enginyu of the

Ministry of Health, Disability Desk and had a very fruitful meeting

for the preparation of the launch of the exciting awareness raising

campaign to be started on the 26th November. Lots to talk about and

get sorted out. Extensive discussions took place about how to

ensure " Quality Control " is in place for all those who have been

trained by the project in the Ponseti method of manipulation and

casting. Everyone involved in the project is wanting to ensure that

sustainability is possible for the work of the project so thousands

of children and perhaps even hundreds of thousands of children

will continue to have their clubfeet fixed correctly well into the

future. To that end the project is financing both an awareness

raising program and a " Quality Assurance " program that will be

implemented in Uganda by the Ministry of Health. The " Quality

Assurance " will be undertaken by the (UCP) training faculty who will

accompany Dr. Nganwa and others traveling throughout the country and

ensuring a visit to each district annually. Dr. Nganwa and her team

will be conducting " Clubfoot sensitization training " throughout the

districts with the goal that every child born with clubfeet

will have the deformity recognized at birth by a nurse or traditional

birthing attendant and then referred to a trained paramedical

professional to manipulate and cast the feet and perform the tenotomy

required. Many, many hours have gone into strategizing the

sustainability component of the project's work and it is wonderful to

be at that point where implementation is about to begin.

Tuesday the 20th found us at the Katalemwa Cheshire Rehabilitation

center where children scheduled for surgery on Wednesday and Friday

were seen by the three doctors (Penny, Pirani and Bitariho) and

Michiel Steenbeek. In the afternoon Drs. Pirani and Penny had a

teaching session with the orthopaedic and general surgery residents

(15 of them were present) on the Ponseti method.

On Wednesday the 21st, the doctors performed surgery on 10 children

with clubfeet ranging in age from 2 months to 3 years in age. Most of

them were tenotomies. Senior level orthopaedic residents were invited

to participate in the surgeries to learn the technique involved in

the tenotomy and other soft tissue releases.

Thursday the 22nd. Back at the Mulago Clubfoot Clinic and an

opportunity to see over 30 young children with clubfeet. In the

afternoon Drs. Pirani and Penny had discussions with the UCP training

faculty about " Quality Assurance " , complications that can happen,

mistakes to avoid, research issues and what to do to motivate the

parents to bring their children back for the duration of the

manipulation and casting process.

Friday the 23rd. Dr. Pirani met with Dr. Nganwa and her " Clubfoot

Sensitization " team to provide a training session for them to know

what are the key issues to talk about when they are in the districts

for the awareness raising campaign. And then R & R. Ahhh, I am so run

off my tiny little feet trying to keep pace with all the tall doctors

going at a frenetic pace that when the weekend rolls by I am

breathless and need to collapse and sleep to gather energy and muscle

power for my thighs for Monday morning. But what fun it is to try and

keep pace with these amazing, energetic, dedicated, skilled and

compassionate medics.

As I sit and do some teddy bear style evaluating on the impact of the

project's work and how the project's work is making a difference in

Uganda the following thoughts come to mind: - I have observed a

marvelous change in the treatment of clubfeet at the Mulago Clubfoot

Clinic. On our first trip to Mulago Hospital almost 3 years

ago I found the doctors examining infants whose feet were treated

under the " Kite " method and whose dear dedicated mothers had to keep

making repeated weekly trips to the clinic only to find that their

children's feet were still not quite normal even after 6 months of

weekly visits to the clinic. The Ponseti Method has changed all of

that. The children are now being treated in under two months, with

the feet correcting very well in almost all cases.

The Clinic is run by the training faculty of the UCP and all the

staff have a sound working knowledge of the Ponseti technique; - The

orthopaedic officers, some of whom make up the UCP training faculty,

are beginning to show increasing confidence in practicing the Ponseti

technique and are interested in following up the children as they see

that the method is working. This has also resulted in greater job

satisfaction for the committed individuals. They have developed an

appreciation for continuing education and also see the value of

teaching others what they have learned; - The orthopaedic residents

are also showing an increased confidence in their surgical skills.

They are also far more aware of the benefits of pre operative

surgical organization; - Many more children are showing up for the

surgical camps who need less extensive surgery than before. This is a

direct result of the Ponseti technique and reflects that the

technique is being carried out well and carried out extensively. How

wonderful to see the young babes showing up for surgery involving

only a minor procedure to completely correct the feet rather than a

complete reconstruction of the foot that takes time, money,

special skills, months in rehab and cannot be made available to the

majority of children in Uganda. The Ponseti technique will, we pray,

change this. Every child can be treated and with minimal disruption

to the family's socioeconomic needs. The awareness raising campaign

starting Monday the 26th of November should revolutionize the way

Uganda deals with the issue of clubfeet for ever and every child born

with clubfeet should have an equal opportunity for treatment in an

economically viable way.

The project's partners are all excited that what was once only a

vision is turning into nationwide action in Uganda. Today Uganda,

tomorrow the rest of the developing world.......a vision waiting to

be turned into reality too. And our experience in Uganda shows it is

possible.

I have to go and pack now and get ready to jump into the bus for our

7 hour road journey back to Kampala so .....gotta go. I'll keep you

posted next weekend about how the coming week unfolds. Exciting

things are happening and thank you all again for your blessings and

support. Tata for now, all my love Paddington

Well hello again. The week flew by and I had no time to email you my

last report so I'm doubling up and reporting for two weeks. Today is

Tuesday December 4th, 2001 and we have arrived and started work in

Lusaka, Zambia. We arrived on Sunday the 2nd, with a 3.30 a.m. start

from Entebbe, Uganda. Eaaahhhhh...(Yawn, yawn). Before I start on the

work in Lusaka, let me fill you in on the last week in Kampala.

As I had mentioned to you earlier, we had a very important meeting at

the Ministry of Health on Monday the 26th Nov, 2001, with, amongst

others, the Health Commissioner for Clinical Services (Dr.Amandwa)

present. This was the " official handover " meeting where the Uganda

Clubfoot project was handing over the newly designed awareness

raising poster to the Ministry for them to commence the countrywide

Awareness Raising Campaign and the Quality Assurance Campaign. Many

officials from the Ministry were present in addition to Members of

the Rotary Club of Kampala North and the Uganda Society for

Disabled Children. In his speech, the Commissioner endorsed the work

of the project and " committed to multiplying this method for early

detection and treatment of clubfoot not only within Uganda but also

within our neighboring countries " , which is very exciting for us and

the children of Uganda. Also on Nov 26th, the " New Vision " , Uganda's

daily newspaper, ran a wonderful article on the work of the UCP and

highlighted the treatment of the little girl Nakanja Kasifa that I

spoke about earlier. The New Vision will also be publishing an

article about the " official handover " meeting commencing the

countrywide awareness raising campaign.

The rest of the week continued with more follow up meetings, surgery

and the clubfoot clinic and packing to leave for Lusaka. Dr. Pirani

was invited to meet the Deputy Director of Mulago Hospital, (Dr.

Gideon Kikampikaho) to discuss ensuring the provision of plaster of

paris to the clubfoot clinic. Unfortunately there is often even a

shortage of basic medical supplies available for use, but now that

the work of the project is gaining credibility all our partners are

working to ensure sustainability of the project's work.

Well back to Zambia. What a beautiful and lush country this is as

well and what gentle people the Zambians are. Shenilla, Drs. Penny,

Pirani and Bitariho were invited to run a Ponseti Method workshop at

the University Teaching Hospital, Lusaka, Zambia in conjunction with

the Fifty-second annual general meeting of the Association of

Surgeons of East Africa, (ASEA), the premier association of Surgeons

in this part of the world. The Doctors all made presentations, not

only about The Ponseti method, but also about the work of the Uganda

Clubfoot Project and the scientific research undertaken as a result

thereof. I was in awe that in attendance at those presentations were

among the most experienced and skilled clubfoot doctors living today

and the discussions that took place between them flew way over my

head but sounded amazing. Some of the research presented was very

exiting....the doctors at the Queen Hospital in Blantyre,

Malawi, the Mulago Hospital Clubfoot Clinic, and the major hospital

in Lilongwe, Malawi all said in their research that the method was

over 90% successful in correcting the deformity in children who

completed treatment. In fact in Blantyre, they had experienced a 90%

reduction in the need to give general anaesthetics to children with

clubfeet to get them corrected. Being present there gave me a

sense that the work of the UCP was in fact really well respected

and " Big League " stuff....wow. To add to that, some of you may recall

that we were in Malawi last year for the UCP work. Since then, Malawi

has invited the UCP to help it launch a national campaign (Malawi

Clubfoot Project) of the magnitude undertaken in Uganda. And guess

what...today the UCP was asked to launch a national campaign in

Zambia, (Zambia Clubfoot Project) once again with Rotary supporting

the work. The momentum is picking up speed, we may have to clone

Dr. Pirani and Dr. Penny, and Marieke Steenbeek and of course

Paddington Bear to keep up. This is such exciting news. Imagine all

the little children born with clubfeet who no longer have to live

with that disability for life.

I'm sending this email to you way past my bedtime and I'm yawning as

I'm typing which is a sure (Winnie the Pooh type) sign that I must be

tired. So I'll sign off for now and email from Tanzania when we get

there next week for further training. So tata for now, stay safe and

well, all my love, Paddington. [END OF E-MAIL]

I thought that some might be interested in this update to the Ugand

Clubfoot Project.

and (3-17-99)