Pehla Qadam is a treatment project at Indus Hospital, Karachi Pakistan. We presented the project and related research plan to the Ponseti International Association Board of Directors in October.

1. The Indus Hospital
“Quality care, free of cost”
Clubfoot Program Overview for
Ponseti International Board
October 1, 2011

3. 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

4. Catchment Population
Free health care
Mapped study area
2.5M people within
10min bus ride.
Serves Karachi pop =
18M
Offers unique clean
environment

6. Pehla Qadam: Clubfoot Care Program
Indus Hospital Karachi

7. Mission
Eliminate untreated club foot

8. 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

9. 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

11. Profile of Target Population
• No primary health service structure
• No health insurance
• Low literacy rates
• Superstitions
• Traditional healers, malpractice

12. 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

13. Current status

14. Pilot Project – Phase 1
Community Perceptions
Ethical approval sought and obtained
2 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

15. 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

16. Results - Impact
- Emotional name calling, low self-esteem, isolation
- Physical (reduced mobility, pain)
- Social (lack of marriage prospects, difficulty in
obtaining education or employment)

17. 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)

18. Pilot Project – Phase 1
Preparation 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

19. Pilot Project – Phase 2
Recruitment 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

20. 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

21. 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

22. 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

23. 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

24. Additional Information

25. 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

26. 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

27. Dr. Lubna Samad
• Pediatric Surgeon
• MD, MRCS, FCPS
– UK training
• Key interest: Global
health delivery
• Responsible for
programmatic
management of Pehla
Qadam

28. 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

29. 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