Helping children with clubfoot in Tanzania

As I entered at the Orthopaedic Department of the Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) room number 21, Athuman Said, a two-month-old baby was on the hospital bed surrounded by three physiotherapists.

Athuman looked calm as the application procedure of Plaster of Paris (POP) was taking place on both of his legs. The process is part of the treatment of the clubfoot condition.

Clubfoot condition is a deformity where the foot is curved inwards and downwards. The deformity can create mobility challenges that can prevent a child from attending school or earning income later in life.

Available information from CCBRT shows approximately 2,200 children are born per year with clubfoot in Tanzania. Almost 50 per cent of them have both feet affected. The ratio is roughly 5:2 male to female respectively.

According to the interviews conducted by Sound Living with the medical experts and parents raising children with clubfoot, early treatment could help these children feet get back to normal.

Athuman’s mother who wa sreluctant to give her real name says she realised strange deformity on Athuman’s foot soon after he was born two months ago in Mtwara. It was not easy for her to notice the condition as her first born did not have such condition.

“This is my second child. I noticed the difference soon after he was born. And the doctors back in Mtwara referred me for further treatment in CCBRT. Upon my arrival here, I was told that my son would be going through different therapies so that his feet get back to shape.

She says he was on his third POP. He stays with POP for a week before it is changed by the physiotherapist. She is hoping for the best as doctors have assured her that it would turn out well since they started at a very early stage.

Dr Luijisyo Mwakalukwa is the Orthopaedic Surgeon at the CCBRT Hospital. He says, medical reasons on the root causes of the condition are still unknown however it is believed that improper position of the infant during pregnancy can result to clubfoot. It also believed that, some foot muscles get paralysed before the child is born and result to clubfoot.

He says, the orthopaedic and reconstructive department was established back in 2000. The department has daily clubfoot treatment. Early treatment on clubfoot condition and commitment towards medical procedures lead to positive results and give the children the opportunity to get back on their feet.

“If a child is put on early treatment and parents of the child are committed to following the right treatment for the first 4 to 5 years after the birth of a child, it can be completely corrected and his or her foot gets back to normal,” says Dr Mwakalukwa.

Adding that if it is not corrected at a tender age, the person could live in severe pain his entire life since the deformed foot will not afford to support the body weight.

Revina Gregory,36, a mother of four children living in Kigoma region says two of her children have the condition. Currently, Revina is at the CCBRT Hospital where her three-year-old son Frank Fredrick is undergoing treatment.

She says, her six-year-old daughter has same condition that resulted to disability of her right feet. Revina tried so many hospitals back in Kigoma but they all failed to treat her daughter Bestida. Until now she is living with disability.

“I never knew about the condition and doctors back in Kalenge village never told me it could be corrected. After trying different hospitals ,I gave up and decided to continue with life. Soon after giving birth to Frank at Maweni Hospital in Kigoma the doctors told me that he had clubfoot condition but never told me if my son could be treated,” she says.

Adding to that she says, soon after Frank was born doctors recognised the clubfoot condition and were advised to buy special shoes to support his son with clubfoot condition.

She spent more than Sh200,000 on treatment and buying special therapeutic shoes which never helped. After several visits in different hospital with no positive results, she again gave up on treatment.

“For the past two years my family has been depending on me since my husband is currently suffering from mental illness. I am the one responsible for educating my children, providing food and treatment for the entire family, I am also responsible for caring for them,” she says.

This year in June, she visited her relatives in Morogoro and was informed that CCBRT is treating such conditions. Upon her arrival at CCBRT, her son was put on treatment immediately.

“It was never easy to manage my emotions when the physiotherapist started the exercise process on my son’s legs. He was in severe pain as he started his treatment at a late stage,” says Revina adding that she couldn’t help but cry.

She says, Frank cried on the first day of his treatment. It also left her in tears knowing that the son was going through a lot of pain. But on the other hand Revina was happy that finally he will finally lead a normal life after the corrections unlike his sister Bestida.

Commenting on late treatment, Dr Mwakalukwa says, there is more work to be done if a child starts treatment after three years. Children who are between eight to fifteen years must undergo surgery for their feet to be corrected.

He says that, it takes up to Sh1,000,000 to cover the entire treatment which is way beyond the economic capacity of some Tanzanians. Some of this is sponsored by CCBRT but parents have to foot some of the bill to support the treatment.

He says that, after the weeks of the POP treatment, children have to start wearing special shoes with steenbeek brace every moment expect when the child is taking a shower. After three months of the first treatment the child will be wearing the special shoes for 12 hours during night.

This will go on until the child turns 5 years where his or her foot will be completely corrected. Not following the right treatment leads to reconstruction of the foot. Parents are advised to remain committed to the entire time until the child completes the treatment.

“There is a need for raising awareness on the clubfoot condition to make sure community knows that the condition can be corrected. Majority doesn’t know and they stay at home with their children without seeking treatment,” he says.

Agnela Komba,27, came from Ruvuma region for her son’s treatment. Her son Bioniphasia Mbugu, 4, has gone through treatment and two minor surgeries at CCBRT. This is her second visit at CCBRT and there is a very big improvement on the foot according to her assessment.

“It is not easy to come for regular checkups as I don’t have money to enable me travel every now and then. Travelling from Ruvuma is expensive. This makes me stay here for more than a month whenever I visit,” she says.

She says, her son’s condition was identified early and was referred to CCBRT. However, it took her more than five months to raise money to support her son’s treatment.

CCBRT has its future of clubfoot treatment priorities in order to continue increasing access to high quality, affordable and effective clubfoot treatment in Tanzania.

The priorities are to train healthcare workers on the ponseti method in Tanzania. This method is used to treat the club foot without surgery. They also plan to establish a network of clubfoot clinics across Tanzania with the same standard of quality and effective treatment.

Ensuring constant supply of foot abduction braces in order to prevent recurrence of clubfoot is also on their agenda. They also want to provide health education to parents and caretakers of children with clubfoot on the importance of treatment compliance plus enable municipal and district hospitals throughout the country to manage the treatment and follow up of clubfoot patients.

Email: [email protected]