After more than two years, Jinny Meot is finally able to bring Jennifer, her daughter, to the Northern Mindanao Medical Center (NMMC) in Cagayan de Oro City in Southern Philippines. Jennifer was born with clubfoot on January 2020, but a month after she started her treatment, the country went through a series of lockdowns to control the spread of Covid-19. She would have wanted to bring her daughter sooner when Covid-related restrictions have eased but she could not raise the money for their transportation and meals. Moved by her plight, the parish priest in their village paid for their weekly travel costs to the city for Jennifer’s treatment.
Two million children live with the pain and stigma of untreated clubfoot, a condition that affects at least 1 in 800 children globally (MiracleFeet.org). Clubfoot is a lower limb deformity where one foot or both feet are turned inward. It can be treated using the Ponseti Method which includes a series of casting, tenotomy (minor surgical procedure) and use of specialized shoes and braces. Jennifer is one of more than 3,500 babies born with clubfoot in the Philippines every year.
Early treatment
Treatment of clubfoot is time-sensitive. When the doctor determines that the child suffers from clubfoot, a series of weekly casting procedures is done as an initial step in most cases. But the treatment for children with clubfoot was greatly affected due to lockdowns, the shutdown of public transportation and health facilities prioritizing treatment of people with COVID-19. Since Jennifer is already two years old, her treatment may take longer than when she started as a baby. Barring health complications, and with uninterrupted and continuous treatment, Jennifer will soon be able to walk.
“I am always anxious that there will be a surge in cases and her treatment will stop and get delayed,” Rotchel Lambingit, 28, in her native tongue. Her first child, Abegail, now 11 months, has clubfoot. Rotchel’s fear is aggravated by the fact that she has bi-lateral clubfoot herself but never got the chance for a treatment that is available now. “I don’t want my daughter to experience the life of growing up with clubfoot.”
Rotchel lives four hours away from NMMC. Since she has a sister who lives in Cagayan de Oro City, they are able to stay a few days during the weekly treatment. But for Judy Ann and her four-month-old baby, Jian Markus, who lives in the same town as Rotchel, they need to prepare as early as 3 am to catch the 5 am bus. They have to be at the hospital by 12 noon to get a number, go through triage and wait for their number to be called. She and her husband don’t mind the difficult commute to the city because they see the improvement in their son’s feet every clinic visit.
Blaming mothers
Countries and cultures that consider women as main caregivers and responsible for taking care of children put extreme pressure and blame on mothers who give birth to children with disabilities.
Jinny used to blame herself for her daughter’s condition. She said that perhaps she didn’t take care of herself while pregnant or that she didn’t eat the right food. Rotchel also felt the same way. Since she has clubfoot, she regrets that she must had passed on the genes to her daughter. It was only after talking to the doctors and getting more information about clubfoot that they began to be more hopeful and less hard on themselves.
Dr. Rafael Mallilling, senior orthopedic resident at NMMC had to explain to a group of journalists that science and medicine have no conclusive evidence to explain what causes clubfoot. During their weekly clubfoot treatment day, he would make sure to remind parents to share information about clubfoot to other parents and to warn them about taking their children to see traditional healers (hilot) who would often conduct foot massages on babies with clubfoot that make the situation worse.
Hope for children with clubfoot
Without other underlying health conditions, more than 90% of clubfoot cases can be corrected if treated early. However, a mere 15% are able to get treatment due to lack of information and fear of medical costs.
The Philippine NGO Council on Population, Health and Welfare (PNGOC), an umbrella organization of NGOs located around the country, has been working on health and development issues since 1987. Through the support of MiracleFeet, a foundation based in North Carolina, USA, PNGOC is able to partner with 30 hospitals all over the country to offer treatment of clubfoot, at almost no cost.
While two thirds of the country are enrolled in the country’s public health insurance, or PhilHealth, more than half of health-related expenses are still out of pocket according to the 2017 National Demographic and Health Survey (NDHS). While clubfoot is mentioned in the benefit package under PhilHealth, the provision is only for “assistive-devices” such as wheelchairs, and other seating devices. Casting procedures can only be charged to PhilHealth once every three months. But in the case of children with clubfoot, multiple castings are required and may happen weekly. Without the support of national and local government run hospitals and MiracleFeet, treatment can cost between P300,000 to P500,000. The specialized shoes alone without the braces cost between P3,000 to P5,000 a pair and requires more than one pair as the child grows.
Every day, 95 Filipino children die from malnutrition (UNICEF Philippines). Filipino children are among the most undernourished in Southeast Asia. While clubfoot may not be related to poor nutrition of the mother, a child born into a poor family and with a debilitating illness like clubfoot, growth and development are affected.
“I am so grateful that my daughter is able to get treatment for free. Every week, our family just needs to save for our transportation and meals while getting her treatment. This makes me excited every week and I don’t feel tired at all. I know she will get better, and she won’t get teased and bullied like I was.” Rotchel said.
(Chi Laigo Vallido is the Executive Director of PNGOC. Those who wish to inquire and support the programs of PNGOC may reach Chi at info@pngoc.com).
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