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Addis Ababa , MARCH 27TH-29TH2006
The first Ethiopian Ponseti clubfoot course was held in Addis Ababa over a 3 day period at the end of March. This was organised by interested surgeons allied to World Orthopaedic Concern UK, and funded jointly by CURE International, (an American Children's charity), World Orthopaedic Concern UK, the BMA Humanitarian Fund and steps (a British Children's charity).
The aim of the course was to bring surgeons in to Addis from around Ethiopia to teach and train them in the use of the Ponseti method for the treatment of clubfoot deformity. The ultimate intention was for them to then return home and set up their own clubfoot clinics. 20 delegates from outside Addis were invited to the course, with a doctor and an allied health care professional (such as a physiotherapist or a nurse) from each hospital.
The faculty consisted of doctors and 1 physio from Addis Ababa, the Sudan and the UK.
The first day consisted of lectures on the theory of clubfoot deformity and Ponseti management. The second day consisted of a practical session on how to manipulate and plaster using rubber models of clubfeet. There was also a talk on the use of the braces and the manufacture of the brace. Some of the faculty talked about clinics they had set up in other developing countries, such as Malawi, the Sudan and Cambodia.
The final day consisted of a morning in the clubfoot clinic at the Black Lion Hospital. Each group was able to examine, score and then plaster at least 4-5 baby clubfeet. Luckily there were 5 babies who needed tenotomies, and therefore all the delegates were able to see at least 2 or 3 tenotomies, and some of them got to do them themselves.
Each pair of delegates was then supplied with 15-10 braces of varying different sizes, to take home with them to enable them to start their clinics prior to setting up a brace making facility. steps had agreed to partially fund the provision of braces for delegates to take home with them at the end of the course to enable them to set up clubfoot clinics immediately. This was vital, for it will take some time for brace manufacturing systems to be implemented in their local hospitals, and unless the method is used as soon as possible after the course, confidence and practical skills will be lost and it is doubtful whether clubfoot clinics will ever be set up. These braces are made locally at the Prosthetics and Orthotics centre in Addis Ababa, costing approximately $10 each, much cheaper than the equivalent braces made for the European and North American market, but just as good if a little less complicated. Very positive feedback was received from all delegates and they all left intending to set up their own clinics. They were particularly grateful for the provision of the braces.
This pilot course is only the beginning. Follow-up of existing clinics is needed, and a nationwide program, similar to those already running in Malawi and Uganda, is planned.
Sally Tennant
Consultant Orthopaedic Surgeon, Stanmore
April 2006
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