Inside HRDC: World-Class Talent, Clubfoot Breakthroughs
Earlier this year, author Tom Hayes joined the AHF team on a trip to Nepal to meet with our partners and visit projects. During his visit, Tom immersed himself in the history of our programs and began writing about the deep-rooted relationship between AHF and our partners. In this four-part series, he shares his reflections on how these initiatives have grown into the successes they are today.
You know if you’ve been with AHF for a while or read Richard’s book that AHF partners excel in attracting and integrating world-class talents into their missions. That’s one of AHF’s core strengths: spotting “rock stars” with vision, flexibility and egos checked at the door.
The teaming of AHF, Dr. Ashok Banskota of Nepal’s Hospital and Rehabilitation Center for Disabled Children and orthopedic specialist David Spiegel shows how potent AHF’s role in these connections can be. A small clinic with origins in a humble apartment building became a world leader in advancing low-cost, long-lasting approaches to correcting clubfoot.
Here, in this first of two posts, is the story.
HRDC surgeons were completing hundreds of clubfoot surgeries a year on patients ranging from infants to adolescents by the early 2000s. Some 80 percent were already walking when they first came to the hospital, such as the cheerful child in the top photo.
David, a volunteer surgeon from Children’s Hospital of Philadelphia and adviser to the World Health Organization, had visited HRDC annually since its modern new hospital opened in 1997. (That hospital was built largely with AHF donor funds.) He had an idea—a new clubfoot treatment called the Ponseti method eliminated the need for surgery except in the most severe cases.
The method—a sequence of massaging and casting over several weeks as the foot regained a natural alignment—was less painful for infants and toddlers, more effective, and less costly. Would Dr. Banskota and his team be interested?
Fewer than 10 percent of specialists in the United States were using the Ponseti method at the time but it was slowly winning advocates. David was one of them, honing his massaging and casting skills after learning directly from the creator, Dr. Ignacio Ponseti.
Ashok and his team were curious “and wanted to explore the method,” David told me. For the next six months, he trained them. “By the time I left, they could correct clubfeet as well as anyone in the United States.” This was in 2004.
In this new treatment, gentle massaging during five weekly sessions (occasionally more), with plaster casts applied after each, gradually brings displaced bones back into correct alignment. At the time, only infants had been treated this way.
The Banskota team and David all wondered, without the old-style surgery realigning muscles, bones, joints, and pins, would the massaged tissue and realigned bones in older kids revert to original deformity? If so, in how many years?
“In essence HRDC was innovating, applying the Ponseti method to these kids who were already walking,” David says.
As we’ll see in the next post, it required many years but Ashok, Bibek, four of their colleagues and David delivered the uplifting answers. Their article in the world’s most prestigious orthopedics journal reported a near-perfect result in patients contacted after 10 years.
P.S. – If you want to be part of this life-changing work, you can give now and have twice the impact thanks to a matching gift. And don't miss out on the second part of this story, coming next week!
Photo credits: AHF, Chime Tashi Lama, David Spiegel
