- By Naomi Grimley
- Global Health Correspondent, Dakar
As Africa holds its first conference on clubfoot – a condition that affects around one in 800 people worldwide – the BBC visits a clinic in Senegal to witness a life-changing treatment.
Earlier in the year, 14-year-old Serigne was reluctant to leave the house.
He could walk very slowly, but, born with both feet turned in, he was too ashamed. Some teased him about the way he walked… But today, less than six months later, his feet have transformed and his dream of playing football for Senegal seems at least possible.
Serigne has clubfoot, also known as clubfoot. It is about to start a new phase in correcting this anomaly.
Every year, 200,000 babies are born with clubfoot. According to the charity MiracleFeet, of the estimated 10 million people born with clubfoot, 8 million have never received treatment.
Senegal adopted the Ponseti method – a pioneering method of correcting clubfoot, named after the Spanish doctor who invented it – relatively late compared to other African countries.
Malawi and Uganda, for example, have preceded many Western countries in recognizing their potential.
But it does mean that Senegalese doctors have perfected the original concept and are now using it to treat teenagers and even adults who thought they were past age for any surgery.
Serigne’s mother beams with joy at her son’s progress. You know better than anyone the cruel nature of this handicap.
“Once he even refused to leave the house for three days. It hurt so much. But now we are happy,” she rejoices.
With the Ponseti method, a new cast is applied every week to gradually bring the foot into a better position. Since his case is very serious, Serigne underwent 20 casts in as many weeks, with an average of between five and eight.
As in most cases, towards the end of the treatment, a small operation is necessary to free the Achilles tendon, but this treatment is non-invasive, i.e. it cannot alter your body.
Best of all, it’s inexpensive, doesn’t require highly trained surgeons, and is highly effective: 90 percent of children under two who get help with routine treatment retain good foot function, while surgery can lead to complications.
The change is truly striking when you watch the footage of Serigne being dragged before the treatment begins.
Fatou explains that because she lives in a remote part of the country, she didn’t expect her foot to be treated. She is therefore happy that she was treated.
School was tough — watching other kids run and jump — for Fatou, who had to rely on crutches.
“I couldn’t do whatever I wanted. But once I’m healed, I can do whatever I want,” she promises herself.
That includes working towards her new dream of being a doctor, so successful has her experience been.
But not everyone is so lucky. Take the example of Oumou Barry, 32. When we go to see her in Lac Rose, a suburb of the Senegalese capital, she shows us her left foot, which is large and deformed. She limps on the side of her foot and her shooting pains keep her from walking far. Her life has been marked by clubfoot scars and she wipes away her tears as she recalls her childhood.
“I used to ask my mother why I was like this? She would answer me: ‘It’s God’s will’ and ‘You were born like this'”. Oumou has experienced exactly the kind of fatalism that prevents many Senegalese families from seeking treatment.
She says the hardest time was during her teenage years when her friends started wearing heels, but she had to stick to sandals. She ended up dropping out of school, unable to take the bullying anymore.
Even away from his mocking classmates, life is hard. She had to give up a sewing course because pedaling the sewing machine was too painful for her.
Oumou has a husband and two children, so her life is not as lonely as some people ostracized by clubfoot, but she still feels the limitations of a very visible disability, which has left her without use.
“I don’t hold on to anything concrete,” she cries.
Unfortunately, due to her age and a botched operation, Oumou is unable to receive the Ponseti treatment. Some adults may respond well to Ponseti treatment, but it’s tricky because their feet are less flexible.
In most cases, the exact causes of congenital clubfoot are still not fully understood, even though boys are twice as likely as girls to be born with the condition. The vast majority of cases worldwide are in low- and middle-income countries, due to high birth rates, and it is in the poorest countries that this anomaly is most likely to go uncorrected.
Aisha Mballo is a woman who has dedicated her life to ensuring that fewer people reach adulthood with clubfoot. When we meet her, she walks confidently in a market in the city of Thiès, with a large illustrated book under her arm. The book explains clubfoot and how the Ponseti method can correct it. You came here to look for clubfoot cases that might otherwise go unnoticed.
Aisha says her own feet were “completely inside out” until, in the 1990s, as a teenager, she was sent to the United States for complex surgery. Today she is a voluntary ambassador of the charity MiracleFeet, which fights for the early diagnosis of newborns.
“If people recognize the disease and take their children out of hiding, we can take them to hospital for treatment,” says Aisha Mballo.
Rosalind Owen of the Global Clubfoot Initiative, who has studied perceptions of clubfoot in Africa, says there are “huge stigma problems” in traditional communities.
“People think you’ve been cursed, or that you’ve been a victim of witchcraft, or maybe your parents did something wrong. This can include, he says, the belief that the mother committed adultery and that clubfoot is the punishment”.
However, less than 20% of clubfoot cases are treated at birth in Senegal, leaving room for improvement.
Before leaving Thiès, we went to another clinic to see a two-week-old baby get a new cast.
Doctors and nurses wrap bandages around her tiny legs, then apply a wet bandage to them.
This is the perfect time to correct clubfoot.
In the waiting room, a two-year-old boy, possibly an aspiring soccer player, kicks a pile of juice. He’s a little unsteady—with one foot still turned inward—but at least he’s getting the care he needs.
Gabriella O’Donnell, Nick Loomis and Borso Tall he contributed to the text and to the photographic reportage.