Fourteen thousand kilometres separate the UBC Faculty of Medicine from Uganda. Dr. Shafique Pirani is trying to bridge that gap.
A clinical professor in the Department of Orthopedics, Pirani first returned to the country of his youth a decade ago and has made 20 subsequent trips, trying to rid the east African nation of clubfoot, a birth defect in which one or both feet are turned inward and downward.
He has been working not as a practitioner, but as a proselytizer of the Ponseti method, a non-surgical way of curing clubfoot. Originated by U.S. orthopedic specialist, the late Dr. Ignacio Ponseti, the method is the “gold standard” for clubfoot treatment. It involves gently manipulating a baby’s foot, placing a cast on it, and then repeating the process over several weeks, the flexible cartilage is molded into the proper position and stays put as it becomes bone.
Pirani, an orthopedic surgeon at Royal Columbian Hospital in New Westminster, has helped make the Ponseti method the mainstream treatment for clubfoot in North America. But he has been even more determined to see it taken up in Uganda, where the limitations and pain imposed by clubfoot are critical (the main means of transportation is walking, while farming and manual labour are the main occupations.) Moreover, because the treatment doesn’t have to be performed by physicians, it’s the best hope for eradicating the condition in a country with so few orthopedic surgeons.
Funded in part by the Canadian International Development Agency (CIDA), Pirani, Professor Richard Mathias, of UBC’s School of Population and Public Health, and Edward Naddumba, Head of the Department of Orthopedic Surgery at Uganda’s Makerere University, have worked to create a network of 30 clinics throughout the country staffed by “orthopedic officers.” He is aiming to add 10 more before the CIDA grant expires next year.
Pirani estimates that about 40 per cent of Ugandan babies born with clubfoot are now being treated in one of those clinics. Many of the other 60 per cent, Pirani suspects, are babies not born in hospitals so the Ugandan Ministry of Health has undertaken a public awareness campaign using posters, brochures and radio spots in various languages. (To listen to the spots in English and Luganda, go to www.med.ubc.ca/media/med_mag/clubfoot.htm.)
“Because of the Ponseti treatment, children born in Uganda with clubfeet now have a good chance to grow up with normally functioning feet, freeing them from a lifetime of pain and suffering,” Pirani says.
Pirani has received a $100,000 gift from an anonymous donor to expand training within Uganda, and to replicate the project in other countries. Governments in Bangladesh, Mali, Nepal and the Indian state of Karnataka, have expressed interest, and he has already taken his message to Brazil and Malawi.
The Ponseti International Association estimates that clubfoot occurs in 150,000-200,000 babies each year worldwide.
