Eritrea is a country situated in north-east Africa, across the Red sea from Yemen with a population of approx 4.5 million people. It is one of the poorest countries in the world and has suffered greatly as a result of a 30 year civil war. It gained independence in 1995. Since then the government has launched many initiatives to improve the lives if its people. They have been successful in reducing the incidence of malaria and infant mortality. They are also trying to provide clean drinking water in every village as well as toilets for every village. Schooling is compulsory for all children until at Grade 8.

The incidence of clubfoot is between 1 and 2 in every 1000 newborns. Every year approximately 170.000 children are born in Eritrea, of which 150 children will present with clubfoot deformity. Clubfoot is known to be the most common single deformity leading to disability. Affected individuals are unable to walk properly. In the developing world a physical disability is the biggest barrier to attending school. Children cannot attend school or assist with the daily work in rural homes. In Eritrea, children need to carry water home from school from the communal village well as well as to gather firewood for cooking and heating. It is estimated that up to 80% of the population are involved in farming and herding. In many cultures a visible deformity stigmatizes a child; they are hidden away from the public eye. Some cultures even see this and other deformities as a curse to the individual, family or tribe.

The Little Wings Foundation objective is to treat all children with clubfoot in Eritrea, enabling them to obtain an education and be a contributor within the family and their society. Children with clubfoot have no mental disadvantage and are therefore a great potential and resource to the country. If neglected or wrongly treated they turn into a financial and social burden to the family involved.

Tewelde Isaac is currently working in Asmara as a Local Project Manager for The Little Wings Foundation. He is able to treat children with clubfoot deformity independently. He has 25 years of experience, working at a German Pediatric Orthopaedic department in Stuttgart. Tewelde was trained in the Ponseti Method by Dr Marc Sinclair and was able to improve his skills under the guidance of Dr Oliver Eberhardt for many years. Mr. Tewelde previously worked at a local clubfoot clinic and has now teamed up with The Little Wings Foundation to build a country wide program for treatment and training. Tewelde is appointed to lead a growing program, based in Asmara, the goal being a countrywide coverage with satellite clinics in 3 to 4 other cities of the country. The Foundation covers expenses for all materials required to treat all clubfeet in the region as well as financial support for local workers in the project. In addition it is in the interest of the foundation to further education about treatment options in place and train health care providers throughout the country to provide the highest standard of clubfoot treatment available today.

Background:

The Ponseti Method is a simple and cost effective way to treat clubfoot. The long-term results show a more than 95% correction of all individuals treated by the Ponseti method. Enough evidence from many different countries has shown that the Ponseti method can be implemented as an effective, economic and workable treatment protocol for children with clubfoot deformity.

The treatment required includes corrective manipulation and casting for 5 weeks. A small procedure at the end of the casting session will lengthen the Achilles tendon and complete the correction of the clubfoot. In order to avoid recurrences, especially during the first 4 years, a brace needs to be worn, which can be manufactured locally at extremely low cost. The method has been implemented in other African countries such as Uganda and Malawi with great success.