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Clubfoot care in the time of COVID-19: A front line view

At the start of lockdown in South Africa in March 2020, Steps Clubfoot Care immediately registered as an essential supplier so we could continue our work supporting clubfoot patients. Clubfoot is a time sensitive condition and early treatment is recommended, in the first few weeks of life.

While our core team has worked mostly from home, our Steps clinic coordinators are on the front line working side by side with health professionals in clubfoot clinics.

Ivy Muffler is a Steps clinic coordinator working at the weekly clubfoot clinics at Charlotte Maxeke Johannesburg Academic Hospital and Steve Biko Academic Hospital (Pretoria). Ivy says:

Clubfoot care in the time of COVID-19: A front line view

“Working as a Steps clinic coordinator during the COVID 19 pandemic has certainly been interesting.

“When the lockdown was first announced we were all filled with confusion and fear. My phone buzzed the whole day with patients wanting guidance on what they should do. Some wanted to rush back to their family homes, some were too scared to leave home. But they all knew that they didn’t want to discontinue treatment if it was still available, and they were worried about what a break in treatment would mean for their child’s progress.

“After the initial shock was over, things settled in quite quickly and most patients who were still in the active casting stage returned to the clinic for treatment. The parents were cooperative and understanding, and adhered to the new stricter safety protocols. They understood that these were exceptional times and that it would take us all working together as a team to make it through this time safely.

“When the numbers of COVID cases increased, they partially converted our consulting area in Charlotte Maxeke hospital into a paediatric casualty unit as the hospital was rapidly running out of space. That meant that half of the room where we apply our plasters was now filled with specialised emergency equipment. We had less space to work in and could only allow limited people inside the area.

Clubfoot care in the time of COVID-19: A front line view

“It also meant that this area was now considered an ‘orange zone’ or high risk area. It therefore became necessary for staff working inside the area to be dressed in full PPE at all times. This includes a gown or disposable hazmat suit, head cover, shoe cover, gloves, mask and visor or shield.

“The increase in use in PPE made it more challenging to communicate with parents. The mask and visor make it more difficult to talk which makes it harder to explain procedures to patients’ families and to give them support and guidance. It also made it more interesting working with the children.

A lot of what we do as Steps clinic coordinators is interaction with the children, so when they can’t see facial expressions, it leads to some curious looks. The children also love grabbing at the visor and mask which also makes things more interesting.

“Working in full PPE certainly has its challenges and I think it has increased fear in some of our parents, but all in all we’ve managed to make it work. We continuously cast patients every week. We do our all tenotomies in-clinic as theatres are reserved for emergencies.

Clubfoot care in the time of COVID-19: A front line view

“We manage to run a successful, busy clinic despite the challenges. We even had a clinic during a power outage a few weeks ago and had to cast patients in the dark!

“Our doctors and nurses are phenomenal and power through despite the risk and challenges they face. Our nurses do the work of three or four people at a time as the clinics are short staffed due to the pandemic.

Some of our nurses volunteered to go and work in the COVID-19 wards and have returned with terribly sad stories of the patients they have treated and lost. One of our nurses tragically lost her husband due to COVID-19 and she was also infected and ill. Our staff all tell stories of someone they lost, shortages in PPE, and shortages of equipment. You can see the sheer exhaustion on their faces. But they show up every day and give their best, because that’s what they were called to do.

“This is certainly a time none of us were prepared for, but it is astounding to see the determination and strength in not only our frontline workers but the parents of patients who risk everything to get treatment for their newborn babies, who ask for help at clinics near their homesteads, who follow up and don’t give up.”

To support a child through life-changing clubfoot treatment donate below.