Guided Reflection #3

  1. We have talked about stigmas and cultural biases in previous class periods. One of the main problems with musculoskeletal impairments and disabilities is the negative stigma associated with them. Where do you think this stigma originated and why? If you were a volunteer with a global health organization and you were tasked with changing the mindset behind these impairments, what would be your plan of action?

Unfortunately, musculoskeletal impairments and disabilities come with major negative stigma in many cultures. I believe this stigma has a work/bread-winner orientation. In developing countries, the main worry people have is surviving and taking care of the family. If you are a little overweight/well-fed, it proves that you are a successful hunter and gatherer, and that you provide adequately for your family. However, if you have a disability, especially as a male, a lot of the time you can no longer do that. This creates a terrible stigma that you are unsuccessful, undeserving, etc. You are shunned for not being able to do well for your family and ostracized from the community. I also think a second origin for the stigma against disability stems from religion or some sort of afterlife beliefs. It is common to say that a child born with clubfoot or someone that has suffered an amputation was “cursed” from the Devil and that the mother did something wrong to cause this to happen. If they believe this, then it becomes a “fact” to those who also believe it, not just an opinion. Religion is a wonderful thing to keep people strong and keep people going through hard times, but it can also be powerful in a very negative way. If someone truly believes their child or themselves are cursed by the Devil, it is very difficult to reverse that stigma and try and convince people otherwise. If I were tasked with changing the mindset behind these impairments, I would start with people who are successful and normal who have impairments. Seeing is believing, and if the people who believe disabilities are bad can see someone being successful and happy and healthy with one, maybe it would help shape their beliefs towards a more realistic idea that a disability is just that: nothing more. I think education would play a huge role in this as well. First, I would need to become very educated on their cultures and beliefs and why exactly they feel so negatively against disabled people. Then, I would need to not insult their culture or try and tear them from it, but more like adjust their beliefs to change from “undeserving and cursed” to maybe “unlucky and needing our help”. I don’t want to try and take away their culture or change what they believe, but I want to change their mindset to a more empathetic and helpful role instead of saying they are wrong and being irrational.

  1. Do you think there is a better way to cure clubfoot then by way of the Ponseti Method? If so explain your new method and describe why it would be better. If you do not think there is a better way to cure, what ways would you improve the Ponseti Method?

I personally think with my medical knowledge and experience, the Ponseti Method is the best option for curing clubfoot that we have right now. First, the alternative that is present right now is a corrective surgery. Ramin Bashi from the Journal of Pediatric Orthopedics quotes “The main treatment of neglected clubfoot is surgery including soft tissue release and different osteotomies” (p. 102). Since most of those who suffer from clubfoot are from developing countries, not only is that an unrealistic procedure for everyone in terms of accessibility and money, but also they often have ulcers that make them unsuitable for surgery (Bashi, Baghdadi, Shirazi, 2016, p. 102). The Ponseti method is a nonsurgical approach used for children ages 0-2 that consisted of manipulating the clubfoot in the desired direction for a certain amount of time, casting the clubfoot, and then bracing the feet as well. The modified Ponseti method discussed in the Bashi journal was the same technique however instead of only for 0-2 year old children, they tried it on up to 19 year olds and were successful! They had a 94% success rate for children ages 1-6, and an 85.7% success rate in children ages 7 and up ((Bashi, Baghdadi, Shirazi, 2016, p. 103). These children and teens had no hope prior to the Ponseti Method, and were set up to be beggars and homeless due to their disability. Thanks to this amazing method, they now have a chance at a normal life. If I were to improve the Ponseti method, I would start by increasing the age yet again to adults. If they thought it was only possible for ages 0-2 and then were mostly successful for up to 19 years of age, why should we stop? There are many adults whose lives are in shambles due to their uncorrected clubfoot. They are shunned from society, can’t walk, can’t hold jobs, and often their family has abandoned them. I would develop an even more intensive Ponseti Method and try it on ages 20-40. I would increase the time of manipulation from 3-5 minutes to 6-10 minutes, and increase its frequency before casting. I would also increase the time you wear the brace 24/7 and the cast, because the soft tissue of an adult is not very pliable anymore, making it difficult to reposition without surgery. However, with time and careful adjusting I think it could be possible to help an adult even 50% more than where they are now, and any improvement is good improvement.

  1. What is the Jaipur organization doing that makes it a successful global health initiative?

The Jaipur Organization is a fantastic example of a successful global health initiative. There are many factors that contribute to why this is true. First of all, the simplicity of their approach is astounding. They hold clinics where people literally just show up, get their stump measured, get their prosthetic placed, and they walk out with a new limb. For a person in a developing country that went from completely immobile to walking in less than 24 hours, this is so unbelievably meaningful and valuable to them and their family. Time is of the essence in these situations and the rapid speed at which the Jaipur Organization helps people is great. Second, the cost-effectiveness makes it realistic for people. It costs a small amount of money to produce both the Jaipur foot and knee, and it is free for those who come to get them. Not only are they free, but they provide lunch for the people that come all this way to seek treatment. When you have been out of a job for who knows how long, and are already living in an impoverished area, the fact that you can be treated free of charge is just absolutely incredible. Third, the high chance of patient adherence to treatment is very important. If the method of treatment is too difficult or time consuming, often the patient won’t continue it. In this case, the prosthetic they provide is durable, lasts a long time, and is easy to use for the patient. This ensures that many people will stick to wearing it, and wearing it properly. Fourth, their sensitivity to culture is what makes them such a great global health initiative. In developing countries, disabilities and impairments are negatively stigmatized like talked about earlier. The Jaipur Organization ensures that the Jaipur foot looks as similar to a real foot as possible. They make it so you can wear shoes or go barefoot, and many people won’t notice you are disabled. For a person that has been stigmatized, abandoned, and turned away from jobs their whole life due to this disability, this adherence to their culture makes it easy for the person to be accepted back into society and live a healthy, normal life. All of these combined make the Jaipur Organization one of the most incredibly successful global health initiatives of its time.

Works Cited

Bashi, Ramin Haj Zargar, Taghi Baghdadi. “Modified Ponseti Method of Treatment for       Correction of Neglected Clubfoot in   Older Children and Adolescents – a Preliminary    Report.” Journal of Pediatric Orthopaedics B 25.2 (2016): 99-103. Web. 23 May 2016.