Sunday, April 10, 2016

Meet baby Serah

Once again, I need to apologize for the long silence on our blog!  I always struggle with keeping up during the second half of the outreach.  The weeks tick past at a scary-fast pace, and the end of our time in Mada is rapidly approaching.  More updates are coming very soon, but for now I want to share a the story of one of our patients! 
Serah was 7 months old when her mama brought her to the Mercy Ships screening. She was selected as one of the patients that we would treat together with the clinicians at CHUT (Centre Hospitalier Universitaire de Toamasina). Her feet have now been fully corrected with the ponseti method, and her treatment was provided at the local clinic by local clinicians! 
Here's the story from the fantastic communications team here on board (with photo captions from me):

Sandrine’s elation turned to shock when her longed-for daughter was born. The baby’s tiny feet were twisted at severe right angles, facing inward. The heartbroken mother tearfully wrapped Serah’s disfigured feet and could not find the courage to look at them again for three days.

Sarah's feet before treatment
Sandrine’s husband had been delighted about his daughter’s birth, but he felt ill when he learned about her clubfeet. He feared her options for the future in Madagascar would be limited. He thought the disability would prevent Serah from marrying and establishing a family support network of her own.
Sandrine shares, “I was embarrassed about my baby. People were looking at her – everyone’s eyes were on her.” And Serah’s grandmother cried with despair.
The midwife was able to help the family understand there was hope for Serah because Mercy Ships was returning to Madagascar. She assured them the hospital ship’s Ponseti program had corrected many babies’ clubfeet in the past year. They could help Serah too.
Sandrine took her baby to a screening day after the Mercy Ship docked. When she received an appointment card for treatment, she held Serah close and danced for joy around her garden. Hope had finally arrived!

Back in September, in the early days of Serah's treatment, Nick demonstrated how to put the casts on and correctly manipulate the foot.

When Serah was seven months old, they began weekly visits to the Mercy Ships Ponseti clinic. The treatment protocol, developed by Dr. Ignacio V. Ponseti, corrects congenital clubfoot without invasive surgery. According to lead orthopedic surgeon Dr Frank Haydon (USA), this method of reversing clubfoot conditions needs minimal specialized equipment, which makes it ideal for developing nations. The key is local adoption of the program. “It can’t be guaranteed by a charity or by government. It must be sustained by the culture,” he explains.

Dr. Edouard and Nick assess Serah's feet together. In the background are Tiana, Olivier and Josiane who are physical therapists.  Since september, they have all been developing their skills in the Ponseti method, and are now very proficient.

Ponseti team crewmembers Nick (AUS) and Suzanne Veltjens (USA) collaborated with several Malagasy physiotherapists led by Dr Razafindravoanjo. He comments, “We have treated 15 children with perfect results (100% correction). Now we can treat children up to three years old. Maybe in the future there will be no older people with clubfeet in Madagascar because now we have three years in which to treat children with this condition!”
Each week’s therapy began with Serah and the other babies happily playing in water tubs while their mothers soaked off the previous week’s plaster casts and chatted.

Bathtime/cast removal for baby Serah and her clubfoot buddy, Francia.  We have the cutest patients!
Serah grew used to the physio team “playing” with her bent feet – gently stretching and manipulating – focusing one week on one degree and direction of foot flexion and then focusing the next week on a different direction. After each session, Serah’s feet were held in the newly attained position by fresh plaster casts on her wriggling and kicking legs.
Serah had a total of six little casts consecutively on both legs before her tenotomy procedure. This snip of her Achilles tendons allowed her feet to fully pop into the final corrected position. To maintain this ultimate degree of foot flexion, she wore miniature foot braces for three months.

Serah sporting her foot abduction braces.  After three months of wearing them all day, she needs to only wear them at night to keep her feet from relapsing.  (Kinda like wearing a retainer after having braces for the teeth.)  She will need to wear braces until about age 4, then the correction is permanent. 

Over months of therapy, the Ponseti team helped Sandrine understand how vital her commitment to Serah’s ongoing treatment is. In the final stage (the longest of the treatment), Sandrine must ensure Serah wears the supplied foot braces every single night until she is four or five years old.  Only then will Serah’s clubfeet be permanently corrected.
Sandrine says, “I was so sad, but now I am overjoyed. Now we’re going to show Serah off, saying, ‘Here we are! Come and see my baby!’ I am very happy now she has 'real' feet.”

When Serah takes her first steps, she will be just like all her little toddler friends. No one will be able to tell she was born with a disability.
Serah will never remember living with the burden of bilateral clubfeet, but Sandrine will never forget the life-sentence of disability her daughter was saved from.  “My mother cried before. We won’t cry now – we will dance!”

Serah being a little Ponseti method model for the camera and showing off her new feet! :)

Story by Sharon Walls
Edited by Nancy Predaina
Photos by Katie Keegan, Justine Forrest and Ruben Plomp

Bonus pictures: The communications team recently visited Serah's family in their home to interview are a few snapshots:

I'm hoping that we get to see Serah take her first steps before we leave Madagascar, she turned one year old in February.  She wasn't quite walking at her last appointment, but maybe she will at the next one.  I'll try to snap a picture if she does :)