Alfie

I have written before about my work with kids affected by Congenital Talipes Equinovarus, commonly known as clubfoot.  This is Alfie.  He has clubfoot, but you wouldn't know it now.  He is four years old, much older than what is commonly considered to be treatable by non-surgical methods.  Until the day that these photos were taken, he had never stood using the soles of his feet.  Because of the birth defect, his feet were turned under so severely that he had learned to walk on what would ordinarily be the tops of his feet.

He comes from a remote part of the Southern Highlands Province of PNG.  His dad used all the money he had to bring Alfie to Kudjip, because he heard that there was someone here who could help his son.  However, he came not knowing that the treatment process takes many weeks.  He did not have anywhere to stay, and very little money for food.  Certainly, traveling back and forth every week was out of the question.  He was hoping that Alfie would be admitted to the hospital, or perhaps the problem could be corrected in a short time.

At the time they first came, our TB ward had only a few patients, and they all had been on treatment for a long time, so that they were not contagious.  I asked our hospital administrator, and received permission to allow Alfie and his dad to stay there for as long as it would take to complete his treatment.  As it turned out, on the first day they were here, they met someone they knew (probably a relative or an in-law) from back home, who now lives about an hour's walk from the hospital, and who invited them to stay there.

So treatment of Alfie's clubfoot began.  Many children his age are afraid of white people, are afraid of doctors, and afraid of loud machines.  Yet week after week Alfie would lay calmly on the treatment table while this white doctor would cut his casts off with a power cast saw, and would cooperate as I stretched the tight ligaments in his feet and placed them in new casts.  I was excited to see how quickly his feet responded to the treatment.  The callouses that had formed on the tops of his feet from walking on them were starting to soften.  After just 5 weeks the feet were turned right-side-up, and were ready for a minor operation to lengthen his Achilles' tendons, so his feet wouldn't point down.

The final stage in the treatment process is to wear a splint to maintain the position of the feet.  They wear it full-time for a few weeks, then at night for months or a few years if possible afterward.  I have managed to build my own splints.  They don't look high-tech, but they are quite functional.  I usually

use baby shoes that come from the US, which I attach to a piece of plywood with up-turned ends.  But Alfie is much bigger than most of the kids I treat.  None of the shoes in my stock are nearly big enough for him.  So, in the two weeks after his tendon-lengthening operation, I managed to get into Mount Hagen to shop for some shoes.  I found exactly 1 pair that were his size, stout and stiff, as I need for the splints.

So last week Alfie came for his final visit.  I removed the casts that had been on his feet for the two weeks after the tendon operation.  My heart was pounding as I picked him up off the treatment table and gave him a big hug.  Then I knelt down and gently lowered him to the floor.  I knew that after 7 weeks in casts his legs would be too weak to hold him up, so I held onto him as I lowered his feet to the floor.  (I'm crying now, as I try to type this!) With me supporting his weight, Alfie stood on the soles of his feet for the first time in his life!

I assembled the splint, using the shoes that I'd bought in Mount Hagen.  These were the first shoes that Alfie had ever worn!  At this stage I ordinarily ask the parents to bring the child back after 2 weeks, then every few weeks so I can check the feet, and repair or replace broken or outgrown splints.  This time I knew that it would be very hard for Alfie's dad to bring him back.  I instructed him as best I could, and encouraged him to come back after a few weeks if at all possible.  Then I prayed with this dedicated dad and patient calm little boy, and said "good-bye".  I hope I can see them again.

AB