Transforming the lives of clubfoot disabled people in Senegalese

Serigne in full plaster

As Africa holds its first-ever conference on clubfoot – around one in 800 people around the world is born with it – the BBC visits a health clinic in Senegal to witness transformative, life-changing treatment.

Short representative gray line

Short representative gray line

Earlier this year, 14-year-old Serigne was reluctant to ever leave the house. He could walk very slowly, but – born with both feet in – he was just too ashamed. Some made fun of his gait, others were afraid and insulted him. But now, less than six months later, his feet have changed and his dream of playing football for Senegal seems at least possible.

Serigne has clubfoot, also known as clubfoot, and today is another step towards correcting it.

According to the charity MiracleFeet, of the nearly 10 million people born with clubfoot alive today, as many as eight million have never received treatment. Senegal was relatively late in adopting ponseti — a groundbreaking method of correcting clubfoot named after the Spanish doctor who invented it — compared to some other African countries. Malawi and Uganda, for example, were ahead of many Western countries in recognizing their potential. However, this means that Senegalese medical professionals have perfected the original concept and are now using it to treat teenagers or even adults who thought they were over the age for a procedure.

Serigne’s mother is beaming at her son’s progress. She knows better than anyone the cruel nature of this disability.

“Once he even refused to leave the house for three days. That hurt me so much inside. But now we are happy.”

Serigne before and after treatment

Serigne’s feet before and after treatment

Serigne after treatment

Serigne now just needs some physio to strengthen his stretched legs

As part of the Ponseti method, a new cast is applied each week to progressively manipulate the foot into a better position. Because his case is so severe, he’s had 20 casts in as many weeks, but the average is between five and eight. As in most cases, minor surgery was required towards the end of his treatment to loosen his Achilles tendon, but otherwise this treatment is non-invasive.

Better yet, it’s inexpensive, doesn’t need to be performed by highly skilled surgeons, and is extremely effective – 90% of children who receive help for routine cases under the age of two have good foot function, while surgery can lead to complications. The change is truly amazing when you watch the video footage of Serigne’s shuffle before the start of the treatment.

A few days ago, Serigne was put in his final cast. He’ll need some physical therapy after that to learn how to put weight on his legs and he’ll initially need to wear short leg braces to keep his feet in place, but his future is very bright.

Fatou, another child treated at this Dakar clinic, has traveled 400 miles (644 km) to receive the same treatment for her right foot. Today is her 13th birthday but the day begins with the removal of her fourth cast. The nurses saw through the cast and then pryed it off her leg in a cloud of dust. She flinches a little, but the clinic’s head nurse, Nicanor Manga, reassures her that some pain is normal and that it will be worth it in the end.

“We believe that her foot will be corrected and that she will be able to walk properly later,” he says. “Really, it’s a pleasure for us,” he smiles. “When we take the cast off and see the good progress, we’re really happy.”

Fatou has her cast changed

Fatou has her cast changed

Fatou explains that because she lives in such a remote part of the country, she never expected to have her foot corrected. So she’s glad to be patient.

School was tough – watching other kids run and jump around – while Fatou was forced to rely on crutches.

“I couldn’t do everything I longed for. But once I’m healed, I’ll be able to do whatever I want.”

This also includes working towards her new dream of becoming a doctor, her experiences here have been so positive.

But not everyone is so lucky. Take 32-year-old Oumou Barry, for example. When we visit her in Lac Rose, a suburb of the Senegalese capital, she shows us her left foot, which is chunky and misshapen. She hobbles sideways on her foot and shooting pains mean she cannot walk very far. Her life is marked by the stigma of clubfoot and she wipes away tears as she reminisces about her childhood.

“I used to ask my mom why I’m like this? She replied, ‘It is God’s will’ and ‘You were born that way.’” Oumou has experienced the kind of fatalism that keeps many families in Senegal from seeking treatment.

She says her toughest time was growing up when her friends started wearing heels but she had to stick to sandals. She ended up dropping out of school – unable to cope with the bullying.

Life was hard even away from hateful classmates. She had to drop out of a sewing course when she realized that operating the sewing machine pedal was just too painful.

Oumou has a husband and two children, so her life isn’t as isolated as some people ostracized for having clubfoot, but she still feels the limitations of a highly visible disability that has left her unemployed.

“I’m not holding on to anything specific,” she cries.

Unfortunately, due to her age and a botched surgery, Oumou is unable to receive Ponseti treatment. Some adults may respond well to ponseti, but it’s more complicated because their feet are less supple.

In most cases, the exact causes of congenital clubfoot are still not well understood, although boys are twice as likely to be born with it than girls. The vast majority of global cases occur in low- and middle-income countries due to high birth rates, and poorer countries are most likely to go uncorrected for the condition.

One woman who gave her life to help fewer people with clubfoot reach adulthood is Aisha Mballo. When we meet her, she is walking confidently through a market in the town of Thies, a large picture book under her arm. The book explains clubfoot and how the Ponseti method can correct it. She came here to look for cases of clubfoot that might otherwise go undetected.

Aisha says her own feet were “turned completely backwards” until she was sent to the United States for complex surgery in the 1990s, when she was in her mid-teens. Now she volunteers as an ambassador for the charity MiracleFeet and advocates for early detection of newborns.

Aisha Mballo (R) shows women a book explaining PonsetiAisha (R) shows women a book explaining Ponseti

Aisha (R) uses a picture book to explain how Ponseti works

“If people recognize the condition and get their children out of hiding, we can take them to the hospital for treatment.”

Rosalind Owen of the Global Clubfoot Initiative, who has researched perceptions of clubfoot in Africa, says there are “major issues with stigma” in traditional communities.

“People think you were cursed or had witchcraft against you or maybe your parents acted wrongly.” This, she says, may include believing that the mother committed adultery and that is the punishment.

However, less than 20% of cases of clubfoot at birth in Senegal are treated, so there is still a lot of room for improvement.

Before leaving Thies we visit another clinic to see a two week old girl getting a new cast.

The doctors and nurses wrap bandages around their tiny legs and then smooth the wet plaster over them.

This is the ideal time to correct clubfoot.

In the waiting room, a two-year-old boy, possibly an aspiring soccer player, is kicking around with a carton of juice. He’s a little unsteady – with one foot still turned in – but at least he’s getting the treatment he needs.

Photography and additional reporting by Gabriella O’Donnell and Nick Loomis

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