PONSETI MANAGEMENT PROGRAM-FIRST CHILD IN WEST AFRICA

Little Kossi was born with Clubfoot. This condition causes the foot to grow inward, retarding normal growth and leaving the side of the foot where the bottom should be - crippling the child.


In many African cultures, this abnormality is viewed as a curse and makes a child an outcast. But Kossi's mother, Akouwa, took action to prevent that. She brought the 10-month-old baby to a Mercy Ships screening in Togo. He became the first patient in West Africa to take part in the Ponseti Management Program, now being established onboard the Africa Mercy .

The Ponseti technique, developed by Dr. Ignacio Ponseti over fifty years ago, is a series of casts that manipulate the foot gently into a more normal position. It requires only minor surgery to lengthen the Achilles tendon as the child grows. The child may need to wear some type of foot brace. The entire process requires 20 visits over four years. Kossi had both legs cast and manipulated and will be recast in three weeks.

The Mercy Ships Ponseti team, under the direction of Dr. James McDaniel, includes Dr. Frank Haydon and Dr. Gary Douglas. Dr. McDaniel enthusiastically describes the program: " It ' s the gold standard that has been used all over the world. But, unfortunately, all over the world does not include West Africa. So, we are starting this program in Togo - with the h op e that one of the other groups w ill help to keep the program going.

We will supply the cast materials and all the supplies for the six months we are here. We hope to manage at least 60 to 70 crippled children on this program. It will be taught, and those can teach it to others. So , we are delighted to be able to offer this opportunity to the children of West Africa."

MY VISIT WITH EDOH - A LIFE RESTORED! KPALIME, TOGO

1) Edoh in 1995 with a Mercy Ships nurse

2) Edoh in 2010 my visit to her village in Kpalime

3) Edoh's family at the base of the waterfall (me far left)

4) Edoh's family at their home

5) Interviewing Edoh & her mom

6) Edoh & mom after making Fufu for lunch

7) Edoh sitting during the interview

8) (L-R) Our translator, writer, Edoh, Me

9) Pounding casava to make Fufu

10) Lunch is served-Fufu & chicken

11-12) Edoh & family pick fresh fruit as a gift

13-14) Druming & dancing at the base of the waterfall

15) Very happy Edoh next to the waterfall

Hopping into the Land Rover, a four wheeler I love to drive, our communications team of 4 headed upcountry, 3 hrs north west from the port of Lome'. We drove through the grasslands and up into the hill country region of Kpalime, to visit one of our patients whom had surgery on the ship in 1995. Dodging huge potholes on both paved and gravel roads, stopping a few times along the way asking for directions, we found Edoh's home set on the edge of the dusty road at the base of a small mountain range where a beautiful cascading waterfall billowed down the mountain side.  

 A shy, young woman walked towards us, carrying a colorful bouquet of tropical flowers, a welcoming gift from the family.  Thirty family members joined her and we were ushered under the shade of a huge mango tree that stood in the centre of their small piece of land that housed a grass hut and open fire pit.

Edoh is the youngest of six children. When she was about four years old, her eye began to swell. Her mother, Afua, desperately tried to find help, going from hospital to hospital in Togo and Ghana. But no one could help her little girl.  By the time Edoh was nine, a massive facial tumor had displaced her left eye, distorted her cheek and mouth, and left her teeth protruding at odd angles from the edges of the mass. She struggled to eat and breathe. The tumor was literally stealing the breath of life from her - she was slowly suffocating.

In 1995, Afua heard Mercy Ships' had arrived in her country to offer free medical care, so she took Edoh to the medical pre screening day.  A huge crowd of approximately six thousand crushed into the stadium in Togo, almost tearing off the gate.   Most of the people were desperate for help and had been living lives of painful shame and rejection because of their abnormalities -viewed in some cases as a curse in their culture. Unable to work, or even live in society, they saw Mercy Ships as their only chance to have a normal life. They wanted a chance for a free surgery, the chance for a miracle.

But in the midst of all that suffering and desperate longing, a little girl's gasping struggle to breathe captured the attention of the crowd. Arms of compassion - some weak and some strong - lifted Edoh and passed her to the front of the long line.

Edoh remembers that moment - the moment that changed her life forever. She recalls, "I remember being lifted over the heads of the crowd and being passed along to the gate. A nurse saw me and said, 'This is the type of surgery we need to do.'"  And that day Edoh received an appointment card for surgery ... an appointment to receive life instead of death.

The doctors warned Afua that this was a difficult, risky case. But she wisely replied, "God gives children; God can take away. We will give it all to God and go ahead with the surgery." And her faith was rewarded. Edoh returned home to a very surprised community. "It's a miracle!" they exclaimed. And they held a big party to celebrate.

A year later, a maxillofacial surgeon, who had helped to remove the tumor, took Edoh to Germany for a second surgery on her lip. Then in 2003, she had another surgery on her lower eyelid.

And now, 15 years after her first surgery, this "walking miracle" was welcoming our team to her village.

Edoh happily described the transformation in her life. She recalled how she used to stay away from people. She couldn't go to school. She became very shy, hiding in her home. But now she can go everywhere - including school.  Edoh is a good student her mother explains.  After she completes her secondary education, Edoh wants to become a nurse to help others - just like the Mercy Ships nurses helped her she said.

What a blessed and rare opportunity to visit Edoh so many years later.  To witness the gift of a transformed life restored in this special child and to experience the fruit of our labour in this ministry.

As we brought our conversation to a closure, Edoh and her sisters pounded and pulped the locally grown casava into a traditional dish called fufu which was served alongside freshly stewed chicken in a spicy broth prepared for our lunch.

Not only did they prepare a lunch that probably cost them a months wages, but they hand picked and arranged a huge fruit basket of locally grown bananas, mangoes, avocadoes and pineapples as another gift of thanks for saving their daughters life.

The celebration arranged by the family continued at the "cascade," the waterfall that roars down the mountain behind Edoh's home.  Her brothers played the local drums, and everyone sang praises to God for His mercy toward Edoh. 

A smiling Edoh added, " If it wasn't for the Mercy Ship, maybe I would be dead. Mercy Ships changed that. I used to look in the mirror and feel pity for myself. But now I think about what happened to me, and it's all about God. I put everything in God's hands."

PRESIDENT OF TOGO VISITS THE AFM IN LOME'

Lomè, Togo, March 31, 2010 – President Faure Gnassingbe of the Republic of Togo visited the Africa Mercy to welcome the state-of-the-art hospital ship to his country.  He and his entourage were warmly greeted by Don and Deyon Stephens, Founders of Mercy Ships, 

Don Stephens with President of TogoPresident Gnassingbe was taken on a tour of the hospital wards, and made a point of stopping to visit with five young patients who recently had surgery onboard the ship.  Dr. Gary Parker, Chief Medical Officer, provided an overview of some of the life-transforming surgical procedures that occur daily onboard.

In his opening remarks, Don Stephens noted that this is the fourth time Mercy Ships has delivered hope and healing to the people of Togo.  In fact, in 1991 Togo was the first country to welcome Mercy Ships to West Africa, and was received warmly by President Gnassingbe’s father who served as President at that time.  Stephens said, “Your father and your country and your people are the nation that opened Africa to Mercy Ships.  So now, tens of thousands of Africans, particularly in West Africa, have been the beneficiaries because of the willingness of your father, your nation, and your people to open Africa to us.”

So far, over 9800 Togolese have attended medical screenings hoping to receive treatment from the Africa Mercy Volunteers onboard while others have come to be treated by Mercy Ships Eye and Dental Teams that are conducting services onshore.  The Africa Mercy Field Service is scheduled to continue in Togo through August offering free medical care to the Togolese people.  Mercy Ships is committed to serving as many people as possible regardless of ethnicity, political affiliation, or religious preference.

During the visit, Mr. Stephens presented a special gift to President Gnassingbe – a framed limited-edition print of a large painting by renowned artist, Rosa Branson of the United Kingdom, which is proudly displayed at the Mercy Ships International Operations Center in Garden Valley, Texas.  The painting depicts all of the ships that have served the organization as well as many of the people that have given tirelessly to Mercy Ships mission of serving the forgotten poor of the world..

President Gnassingbe responded, “We are touched by what we have seen.  We see the friendship you have for our Togolese people … and the power of our God.  Thank you very much.”

MERCY SHIPS TRAINING PONSETI CASTING LOME-TOGO

Clubfoot is an embryonic malformation causing a normal foot into becoming clubfoot during the second trimester. An ultrasound may detect it by the 16th week. This abnormality is very common in West African countries and can negatively affect a child’s life, often making them an outcast.

Mercy Ships doctors have initiated the Ponseti Management Program, developed over 50 years ago by Dr. Ignacio Ponseti and used throughout the world to correct Clubfoot. This is the first time it has been used in West Africa.

Dr. James McDaniel, Mercy Ships Ponseti team director began the program a month ago and since then, several children have received castings with positive results.

Baby Anne Akouette, one of a twin, had her first casting less than two weeks after birth.  According to Dr. James, "This is the ideal time to start because the bones so easily adapt to the position the cast is reinforcing". He added that, “we’re getting amazing corrections in the older children that we wouldn’t have cast in the past. They would have gone right to surgery.”
This is a favored program because it is gentle, safe, and effective. It requires a minor surgery to allow the Achilles tendon to grow with the foot. Other countries such as Uganda and Brazil now have a national program in place, and are correcting between 90 and 95 per cent of all Clubfoot cases.

 

The Mercy Ships team is working with the CNAO Clinic and Rehab Center in Lome, training ten members of the clinic's orthopedic team in the Ponseti technique. The training will provide the skills necessary for the clinic's team to further continue the casting progress for those children who have had a series of ponseti manipulations and recastings during this field service.  The training will also provide the team with skills to assist others in great need in their nation.

Following the casting, many of the children will need to wear a metal brace which connects to their shoes and meant to be worn at night while sleeping to maintain the correction achieved by casting.


The full cost for the four-year program per patient is one hundred dollars. But here in Africa, this is well beyond what most parents can afford.  Casting materials and all other needed supplies for 50 children will be provided by Mercy Ships during the six month field service.  It is hoped that funding can be found to keep the clinic supplied with materials for future cases of Clubfoot.

Dr. Frank Haydon, who developed such a brace, is teaching veteran Togolese shoe maker Albert Kpatchou Mawougnan the specifics required in the production of the brace. Albert has been making shoes for problem feet since 1980, when a local lawyer asked him to make an experimental pair for his child. Orthopedist Heabe Raiz, who has been with the clinic for four years, is taking a leading role in the Ponseti procedure and the proper use of the brace.