A clubfoot cast being removed

COVID-19 has presented us all with the challenge of finding new ways to do all sorts of things we previously did in person. Hayley Stewart reports back from the Africa Clubfoot Training (ACT), who are using new online approaches to train health care workers in a variety of settings.

Around 150, 000 to 200,000 children born each year are affected by clubfoot, with approximately 80% of these in low- and middle-income countries. Without treatment, the condition becomes ‘neglected clubfoot’, a painful and disabling deformity that severely restricts the ability to walk in some cases. However, in up to 95% of cases, clubfoot can be treated successfully using the Ponseti method of treatment, especially if this is initiated early.

Run by the members of the Global Clubfoot Initiative (GCI), with support from our ReLAB-HS partner MiracleFeet, the original ACT course was designed over a period of two years with advisors from 18 countries, and trains health care workers from a wide range of levels in effective nonsurgical treatment of clubfoot. It comprises three integrated courses: A Train the Trainer course, and Basic and Advanced Clubfoot Treatment Provider Courses.

Earlier this month GCI officially launched their online ACT provision, with a webinar attended by 90 participants from over 30 different countries. ReLAB-HS funding made the launch possible and will help to further develop the ACT online offering.

GCI had already been looking into using online training, but when COVID-19 disrupted all but the most essential of face-to-face meetings, their online plans accelerated rapidly. They began to adapt their traditional face to face ACT course to be delivered in a variety of formats. This included synchronous online modules taught to groups all at the same time, and asynchronous online videos which meant participants could access learning at their own pace. The ACT online course consists of a mix of delivery methods with participants able to do some sections at their own pace (including interacting with a 3D digital clubfoot model) and others with the group. This variety of options has made allowances for different learning styles and paces, as well as the difficulties of poor internet connection, and in person training during the pandemic.

While completing the training for the first time would require a blended approach – online training supplemented by an in person practical session with a patient or rubber model, the team also tested out an asynchronous assignment where participants recorded themselves putting casts onto rubber legs. This then allowed trainers to provide feedback after the fact that participants could work on, ahead of a group reflection on all feedback in the final live session.

Three blended ACT courses have already been delivered in the Philippines and one in Zimbabwe in 2021, training a total number of 56 providers. A Filipino participant said, “The course was really great. It was specific with all of the necessary information needed. It was interactive and facilitated learning. Thank you.” While a Zimbabwean respondent said, “[The modules] are well structured and easy to follow through. It made my learning experience easier. I am an occupational therapist and it was my first time learning about Ponseti and it made a lot of sense. I am fully equipped to assess and treat clubfoot.”

In breakout sessions during the launch trainers spoke about the success of online training in general in increasing training numbers across a number of different courses and disciplines. Karen Moss from Steps Clubfoot Care in South Africa said, “We have had a much broader reach with our training courses. Where before we usually would have 20 attendees, on some courses we have reached 400, which has been amazing for South Africa’s CPD points”.

For those interested in learning more about the sessions and approach visit Global Clubfoot Initiative or send them an email.

Global Clubfoot Initiative (GCI) is a network of more than 30 organisations supporting the treatment of 30,000+ children annually in lower- and middle-income countries. Through advocacy, education and collaboration GCI and its members work towards their shared goal: that every child born with clubfoot should receive the treatment they need to live a life free from disability. GCI published its global strategy, RunFree 2030, with an ambition that by 2030 at least 70% of children will access the treatment that will prevent a lifetime of disability.  For more information: https://globalclubfoot.com/