By Misbah Anjum and Assad Abbas for ReLAB-HS
Anabia, a lively six-year-old living in Master Abad village in the district of Swat, Pakistan, was born with clubfoot. According to available data, it is estimated that 7,500 children are born with clubfoot annually in Pakistan. Unfortunately, Anabia’s condition went untreated due to her parents’ lack of awareness of both the condition and available treatment. Living in a remote area where access to education and awareness of rehabilitation are limited, Anabia and her family faced significant discrimination due to the stigma associated with clubfoot. Some of the villagers perceived Anabia’s condition as a divine punishment, while others attributed it to superstitions, such as lunar eclipses. Her parents were concerned about Anabia’s future, and this compounded their anxieties.
Anabia herself felt disheartened, comparing herself to other children who could run and play freely. She often avoided playing outside due to taunts and teasing from other children about her feet.
“I would not go to play outside … as children will make fun of my feet calling me bad names,” Anabia recalls.
Complicating the situation further, services were not available at the local primary care facility, and no one in the community was capable of guiding Anabia’s parents to available treatment.
This changed, however, with the intervention of Learning, Acting, and Building for Rehabilitation in Health Systems (ReLAB-HS). To address the gap in services for individuals like Anabia, ReLAB-HS trained Lady Health Workers (LHWs) (Pakistan’s cadre of community health workers) in Swat on how to identify and refer individuals with rehabilitation and assistive technology needs. Additionally, ReLAB-HS trained medical doctors at the primary care facilities receiving clients referred by LHWs. These doctors assess clients for rehabilitation needs, provide basic rehabilitation services, and refer clients to advanced rehabilitation services as needed. Nazia Ali, a dedicated LHW from Anabia’s village, participated in these crucial trainings.
During a routine check-up, Nazia identified Anabia’s clubfoot condition and reassured her parents that effective treatment options were available. She promptly referred Anabia to the specialized rehabilitation department at the district-based Saidu Group of Teaching Hospitals in Swat for further assessment and care.
Hesitant at first, Anabia’s parents eventually agreed to pursue treatment for their daughter. Despite the logistical hurdles of traveling from their remote village to the city for medical appointments, they remained steadfast in their commitment to her treatment. Anabia received comprehensive treatment at the hospital’s rehabilitation department, which a Swat-based ReLAB-HS project officer supported by monitoring her progress and ensuring follow-up visits were scheduled. Additionally, Nazia continued to visit Anabia at home and shared progress updates with the primary care provider and ReLAB-HS to facilitate the arrangement of any needed care.
The collective efforts of ReLAB-HS, LHWs, and Anabia’s parents paid off as Anabia’s clubfoot was successfully corrected, allowing her to regain mobility and independence. This intervention not only improved Anabia’s physical health but also her emotional well-being, as she now can play with her peers outside and can go to school with full confidence. In addition, her recovery brought immense relief to her parents, who are now encouraged by her improved mobility. Expanding the role of LHWs like Nazia to include identifying and facilitating access to life-changing rehabilitation services showcases the potential impact of integrating rehabilitation and assistive technology services into community outreach efforts and primary health care.
The identification and referral of Anabia by a ReLAB-HS-trained LHW has increased awareness of rehabilitation services within the community. Integrating services at the community and primary care levels improved her access to treatment, setting a precedent for a healthier future for numerous individuals with functional difficulties. This collaborative endeavor signifies progress toward the overarching goal of ensuring universal access to rehabilitation and assistive technology services for all.