- By Naomi Grimley
- Global health correspondent, Dakar
Serigne in integral plaster
As Africa holds its first-ever 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.
At the start of the year, 14-year-old Serigne was reluctant to leave home.
He might walk very slowly, but, born with both feet turned inward, he was just too ashamed. Some made fun of the way he walked… But today, less than six months later, his feet are transformed and his dream of playing football for Senegal seems at least possible.
Serigne has clubfoot, also known as talipes. It is in the process of initiating a new stage in the correction of this anomaly.
Each year, 200,000 babies are born with clubfoot. According to charity MiracleFeet, of the approximately 10 million people born with clubfoot, 8 million have never received treatment.
Senegal was a relatively late adopter of the Ponseti method – a pioneering method of clubfoot correction, named following the Spanish doctor who invented it – compared to other African countries.
Malawi and Uganda, for example, have moved ahead of many Western countries in recognizing its potential.
Serigne’s feet before and following the treatment
But it does mean Senegalese doctors have perfected the original concept and are now using it to treat teenagers and even adults who thought they were past the age for any surgery.
Serigne’s mother is beaming with joy at her son’s progress. She knows better than anyone the cruel nature of this handicap.
“Once he even refused to leave the house for three days. It hurt me so much. But now we are happy,” she rejoices.
Serigne now needs some physio to strengthen his straight legs.
With the Ponseti method, a new cast is applied weekly to gradually bring the foot into a better position. As his case is very serious, Serigne had 20 casts in as many weeks, the average being between five and eight.
As in most cases, towards the end of the treatment, a minor operation is necessary to release the Achilles tendon, but this treatment is not invasive – in other words, it cannot alter his organism.
Best of all, it’s inexpensive, doesn’t require highly skilled surgeons, and is extremely effective – 90% of children under the age of two receiving help with routine treatment retain good foot function, whereas surgery can lead to complications.
The change is truly amazing when looking at the video footage of Serigne being dragged before treatment began.
Fatou has her cast changed.
Fatou explains that, as she lives in a remote part of the country, she did not expect her foot to be treated. She is therefore happy to have been treated.
School was tough – watching other children run and jump – for Fatou, who had to rely on crutches.
“I mightn’t do everything I wanted to. But once I’m cured, I can do whatever I want,” she promises herself.
This includes working towards her new dream of becoming a doctor, so successful has her experience been.
But not everyone is so lucky. Take the example of Oumou Barry, 32 years old. When we visit her at Lac Rose, a suburb of the Senegalese capital, she shows us her left foot, which is large and misshapen. She hobbles on the side of her foot and shooting pains prevent her from walking far. Her life has been marked by the scars of clubfoot, and she wipes away tears as she recalls her childhood.
“I used to ask my mother why I was like that? She answered me: ‘It is the will of God’ and ‘You were born like that'”. Oumou has experienced exactly the kind of fatalism that prevents many families in Senegal 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 bear the bullying any longer.
Even away from his mocking classmates, life is hard. She had to give up a sewing class because operating the sewing machine pedal was too painful for her.
Oumou has a husband and two children, so her life isn’t 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 cling to anything concrete,” she cries.
Unfortunately, due to her age and a botched operation, Oumou cannot receive Ponseti treatment. Some adults may respond well to Ponseti treatment, but it’s complicated because their feet are less flexible.
In most cases, the exact causes of congenital clubfoot are still not fully understood, although 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 is walking confidently in a market in the town of Thiès, 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 unnoticed.
Aisha says her own feet were “completely upside down” until, in the 1990s, when she was in her teens, she was sent to the United States for complex surgery. Today, she is a volunteer ambassador for the charity MiracleFeet, which campaigns for early detection of newborns.
Aisha (right) uses a picture book to explain how the Ponseti method works.
“If people recognize the disease and bring their children out of hiding, we can take them to the hospital to treat them,” says Aisha Mballo.
Rosalind Owen of the Global Clubfoot Initiative, who has studied the perception of clubfoot in Africa, says that in traditional communities there are “huge issues of stigma”.
“People think you were cursed, or that you were the victim of witchcraft, or maybe your parents did something wrong. This can include, she says, the belief that the mother committed adultery and that clubfoot is the punishment.”
Yet less than 20% of clubfoot cases are treated at birth in Senegal, leaving plenty of room for improvement.
Before leaving Thiès, we went to another clinic to see a two-week-old girl get a new cast.
Doctors and nurses wrap bandages around her tiny legs, then apply wet plaster over them.
This is the perfect time to correct clubfoot.
In the waiting room, a two-year-old boy, possibly an aspiring footballer, kicks a pile of fruit juice. He’s a bit unsteady – with one foot still facing inwards – but at least he’s getting the treatment he needs.
Gabriella O’Donnell, Nick Loomis and Borso Tall contributed to the text and the photo report.