Report on Ponseti training in the South Pacific on March 8th

[Guest guest]

This is a report on the Ponseti method for Clubfoot presentation at

the Pacific Islands Surgeons Association meeting in Suva, Fiji

during the week of March 6 to 10, 2006. The meetings are held every

2 years and this year was at the Fiji School of Medicine at the

Colonial War Memorial Hospital. The meetings were partially

sponsored by the Royal Australasian College of Surgeons. The Fiji

School of Medicine is the only medical school in the South Pacific

and most of it's students are natives to the different island

groups. The meetings included presentations on a number of

different surgical issues each day. The Ponseti method

presentations to the full group only occurred on Wednesday Afternoon.

There were surgeons at the meetings from nine major island groups in

the South Pacific including Fiji, Samoa, Tonga, Solomon Islands,

Cook Islands, Kiribati, Papua New Guinea, Federated States of

Micronesia and Vanuatu. Of the major island groups, only New

Caledonia and Tahiti were not represented, which I was told was

because of their closer medical relationships with France.

Attending the meetings were 7 surgeons from Fiji, 10 surgeons from

the other 8 islands, 7 doctors from Australia, 3 from New Zealand,

10 registrar (resident) doctors from the Fiji School of Medicine and

about 15 physiotherapists from Fiji. Government Ministers of Health

attended from Tonga and Fiji.

Dr. Shafique Pirani of Vancouver, B.C. and Dr. Haemish Crawford of

Auckland, New Zealand conducted the training program. Dr. Pirani is

one of the founders of the Uganda Clubfoot Project in 1999 and has

since been involved in Ponseti method related training in 5 other

African Countries as well as in the U.S., United Kingdom, Brazil,

India, Saudi Arabia and Bahrain. Dr. Crawford has treated many

Polynesian children at the Starship Children's Hospital in New

Zealand since returning from a one year Fellowship at the University

of Iowa in 2000.

On Monday, Dr. Pirani and I met with the Head of the School of

Medicine and his lead orthopedic doctor. The Head Doctor had been

in medical school in New Zealand many years earlier with Dr.

Crawford which is how the Ponseti method had been introduced as a

topic for the meetings. Dr. Pirani went over the basic concepts of

the Ponseti method and discussed the logistics for the Wednesday

Afternoon presentation. We then meet on Tuesday with the head

orthopedic surgeon, 3 lead physiotherapists in the School of

Medicine and the head orthotics person. We reviewed the Ponseti

method with them and discussed the issues about the need for the

brace and trying to address how to make them available or

manufacture them for the South Pacific. One of the physiotherapists

had been considering doing her masters thesis on the Ponseti method.

On Wednesday afternoon, the Ponseti method was presented to

approximately 75 including the above reference doctors and

physiotherapists and about 10 parents/grandparents with 5 children

with clubfoot and some others. The presentation included a brief

history of Clubfoot and treatment in the South Pacific, the Uganda

Clubfoot Project and it's expansion to other areas of the world, the

Parents Perspective, the treatment of Clubfoot in New Zealand and

what was so different about the Ponseti method. Then Dr. Pirani and

Dr. Crawford split into 2 different stations and there was an

opportunity for 2 children to have casts put on while doctors

gathered around to observe. The Parents perspective included 2

Television News segments by parents in the United States and the

introduction portion of the new United Kingdom STEPS's parents

video. There were a lot of questions and discussion with the

audience. At the end of the meeting, the Head of the School of

Medicine said that the Ponseti method is the way that they are going

to treat Clubfoot in the future. Dr. Pirani and Dr. Crawford

provided additional training materials to be left for the future.

Wednesday evening was a traditional Fijian dinner in a backyard of

one of the local doctor's home. Traditional food, song and dances

were presented in a wonderful evening program.

Thursday, Dr. Crawford had to return to New Zealand, but Dr. Pirani

and I went to a meeting with the 15 Physiotherapists. It included

the 3 lead physiotherapists, some from other cities and the student

physiotherapists at the School of Medicine. The 3 children who were

not casted at the prior days meetings were casted at that time. A

number of the physiotherapists did the casting as Dr. Pirani helped

them.

On Friday, there was a trip to the Pacific Harbour Fijian Cultural

center to see presentations of native dress, culture and

firewalking. Afterwards was a picnic on the beach a few yards from

the ocean as some of the doctors played rugby in the sand.

There are about 500 children born with Clubfoot each year in the

Pacific Islands with about another 500 born on Papua New Guniea. I

am hopeful that the Ponseti method training provided at this meeting

will be able to be utilized to help treat these children over the

coming years. I am hopeful that a way will be found to get or

locally manufacture braces that can be affordable for these areas of

the world.

For further information on the Ponseti method, please see Dr.

Ponseti's web site at the University of Iowa Hospitals and Clinics

at

http://www.uihealthcare.com/topics/medicaldepartments/orthopaedics/cl

ubfeet

Egbert and (born March 17, 1999)

martinegbert @ earthlink.net

http://www.uihealthcare.com/topics/medicaldepartments/orthopaedics/cl

ubfeet/egbert.html

Dr.'s Pirani and Crawford's contacts are:

Shafique Pirani, M.D

205-245 East Columbia Street

New Westminster

British Columbia, Canada V3L 3W4

Tel:

Fax:

piras @ aol.com

Haemish Crawford, M.D.

Starship Children's Hospital

Private Bag 92024

Auckland, New Zealand

Tel: 09-379-7440

Email: hacrawford @ xtra.co.nz or

hcrawford @ akldbonejointsurg.co.nz

>

> For some unknown genetic reason, clubfoot affects the children of

the

> South Pacific Islands for about 1 in 150 births, a rate 6 times

higher

> than that of Caucasians and the highest rate of occurrence in the

> world. This rate of incidence means that there are about 500

> Polynesian children born per year with clubfoot and 200-400 plus

> children in Papua New Guinea, but they are scattered among many

island

> groups in the South Pacific.

>

> On Wednesday, March 8th, 2006; a Ponseti method training program

will

> be presented at the Pacific Islands Surgeons Association

Conference in

> association with the Royal Australasian College of Surgeons. The

> meeting will be held at the Fiji Medical Center in Suva, Fiji as a

> part of a week long medical conference. Doctors will be there

from

> Tonga, Samoa, Fiji, Solomon Islands, Papua New Guinea and other

major

> island groups.

>

> The Ponseti method in the South Pacific is currently available in

> Auckland, New Zealand from Dr. Haemish Crawford of the Starship

> Children's Hospital and at the Honolulu Shriners Children's

Hospital

> in Hawaii from Dr. Nemechek and others. Dr. Haemish

Crawford

> and Dr. Shafique Pirani will be providing most of the training at

the

> meeting. Dr. Crawford was at the U of Iowa for a year fellowship

in

> 1999 and Dr. Pirani is one of the founders of the Uganda Clubfoot

> Project.

>

> We are hopeful that Ponseti method trained doctors and clinicians

can

> be available in each of the major island groups.

>

> Haemish Crawford, M.D.

> Starship Children's Hospital

> Private Bag 92024

> Auckland, New Zealand

> Tel: 09-379-7440

> Email: hacrawford@... or

> hcrawford@...

>

> Shafique Pirani, M.D.

> 205-245 East Columbia Street

> New Westminster

> British Columbia, Canada V3L 3W4

> Tel:

> Fax:

> piras@...

>

> I will be attending the meeting and will report back to you in a

> couple of weeks.

>

> and (3-17-99)

>

http://www.uihealthcare.com/topics/medicaldepartments/orthopaedics/cl

ub

> feet/egbert.html

>

>

> The following are the estimated number of children affected with

> clubfoot each year by island.

>

> Australia 241

> New Zealand 129 – approx. 80 who are Polynesian children

> Papua New Guinea 200-400 plus

> Solomon Islands 88

> Fiji 49

> Samoa 31

> American Samoa 14

> Tonga 15

> French Polynesia 29

> Vanatua 43

> Guam 27

> New Caledonia 28

> Federated States 11

> Marshall Islands 5

> Palua 2

> Siapan, Tinan, N.Marina 3

> Balance of Islands 86

>