The Indus Hospital“Quality care, free of cost”

Clubfoot Program Overview for Ponseti International Board

October 1, 2011

Indus Hospital• Started in 2007

– Initial donation of $10M – provides care free of cost

• Located in low income locality of Karachi‐ Completely paper free

‐ Data available for research

• Service– 131 inpatient beds – plans to expand to 700 +– First 300 patients seen daily in walk-in screening clinics– 300-400 patients seen daily in specialist clinics– About 100 patients seen daily in TB clinic– Over 300 patients present daily to ER

Catchment Population

Free health care

Mapped study area 2.5M people within 10min bus ride. Serves Karachi pop = 18M

Offers unique clean environment

Pehla Qadam: Clubfoot Care Program

Indus Hospital Karachi

Mission

Eliminate untreated club foot

Goals

1. Develop a local sustainable model for club foot care in resource constrained settings

2. Create public awareness about club foot and its optimal management

3. Establish clubfoot treatment free of cost in Indus Hospital

Pehla Qadam Team• Indus Hospital

– Study, Implementation

• Ponseti International– Technical guidance, tools, networking

• Amer Haider and Munira Shamim– Pilot program and cost study sponsor– Support for Indus clinic and scale-up

Profile of Target Population

• No primary health service structure• No health insurance• Low literacy rates• Superstitions• Traditional healers, malpractice

Pilot Program Approach

• Community perceptions – Phase 1– FGD and IDIs conducted – Aug-Sep 2011– Preparation for enrollment – Sept 2011

• Clinic – Phase 2– Recruitment + treatment – Oct 11’ to Mar 12’– Treat 100 feet across ~ 70 infants– Implementation evaluation and iteration

• Costing study• Scale up

Current status

Pilot Project – Phase 1Community Perceptions

Ethical approval sought and obtained2 months durations (August-September 2011)

Focus Group Discussions and In-depth Interviews– Lady health workers– Families of affected children– People living with clubfoot– General community

Results - Causes of clubfoot

- Exposure to eclipses or lightening during pregnancy- Punishment from God/Will of God- Hygiene and Sanitation- Poor nutrition or other issues during pregnancy- Genetic, consanguinity

Results - Impact

- Emotional name calling, low self-esteem, isolation- Physical (reduced mobility, pain)- Social (lack of marriage prospects, difficulty in

obtaining education or employment)

Results - Treatment

- Not everyone aware of treatment- Treatment thought to be costly (in terms of the

treatment, transport, and time)- Alternative treatments often sought (religious,

traditional healers, traditional treatments)

Pilot Project – Phase 1Preparation for enrollment

• Developing tools for awareness, recruitment and clinical follow up based on FGDs/IDIs

• Code book developed for direct data entry in MIS (Indus is a paper-free hospital)

• Phase 2 proposal and tools to be submitted on Oct 1 for ethical approval

• Birthing centers, community leadership to be approached in Phase 2 identified

• Weekly casting clinics scheduled

Pilot Project – Phase 2Recruitment and Treatment

• Start : October 15, 2011 (6 month duration)• Awareness campaign in birthing centers, LHWs and

community leaders about club foot• Start of weekly casting clinics at Indus Hospital• Start of costing study• Concurrent data entry and outcome evaluation

– Will input into International Registry

• Analysis and preliminary report April 2012

Pilot Project Deliverables• Proposed Papers

– Outcomes of the Pilot Program– Economic, Cost/Benefit of Treating Clubfoot– Community Perceptions

• Tools– Brochure for awareness/recruitment– Pictorial Training manual – Socio-demographic , Economic Profile– Note: will use PIA clinical tools

Road Map

• Establish Indus Hospital as Ponseti International Association (PIA) chapter in Pakistan

• Expansion of the program– City, National– Create a Sustainable Model

• Scalability, Capacity, Personnel, Financial, M&E, Reduce Costs

– Work with PIA to help Regional/Global outreach

Proposal for PIA Board

• Adopt costing study and expand to get representative global data– Show significant ROI for eliminating untreated club foot– Identify global partners for next costing study

• Approach large foundations with ROI data– Show $20M+ investment in PIA is best bang for buck

• Next Steps– Create joint plan for global costing study

Contact

• USA– Amer Haider 408-234-0520,

amerhhh@gmail.com

• Pakistan– Lubna Samad lubna.samad@irdresearch.org

http://www.facebook.com/pages/Pehla-Qadam/213440218712868

Additional Information

Dr. Amin Chinoy

• Professor & Consultant Orthopedic Surgeon

• Head of Dept of Trauma & Orthopedics

• MBBS, FRCS– UK training

• Key interest: Pediatrics & Arthroplasty

• Principal Investigator – Pehla Qadam

Dr. Mansoor Ali Khan

• Orthopedic Surgeon• MBBS,FCPS

– AKU training– Clubfoot training at

University of Iowa, home of Ponseti International

• Interest in Pediatric Orthopedics

• Clinical team lead on Pehla Qadam

Dr. Lubna Samad

• Pediatric Surgeon • MD, MRCS, FCPS

– UK training

• Key interest: Global health delivery

• Responsible for programmatic management of Pehla Qadam

Shama Mohammed

• Director, Community Outreach

• MPA/ID– Kennedy School, Harvard

• Key interest: Community development

• Leading the qualitative study to gauge the knowledge, perceptions, and stigma related to clubfoot

Dr. Hamidah Hussain

• Physician/Public Health Specialist

• MBBS, MSc– London School of

Hygiene, Johns Hopkins

• Key interest: Health Financing

• Responsible for Cost of Illness studies and Cost Utility Analysis