Miraclefeet in Managua

We met with Chesca, the Executive Director of Miraclefeet – a clubfoot non-profit based out of our very own North Carolina, and Janeen, her Director of Fundraising, last August to learn more about their organization and to tell them more about our project. It wasn’t long before we were discussing how our two initiatives could collaborate. Long story short: making this connection with Miraclefeet meant that Zach and I, thanks to their help, could finally add Latin America to our clubfoot adventure. By March, our tickets were booked to set off to Nicaragua in April.

What happened next only demonstrates the perseverance and determination of both the Nicaraguan and American Miraclefeet staff. Just a couple of weeks before we were to head off, Nicaragua suffered a series of relatively strong earthquakes. However, according to our talks with Miraclefeet, these earthquakes didn’t deter clubfoot treatment. In the midst of chaos, the in-country staff was so set on making sure patients were casted that there was even talk of moving the enormous clinics to a doctor’s home if the quakes continued and the hospital had to shut down. Because of the uncertainty of Nicaragua’s literal physical stability, our trip was postponed.

It wasn’t until a few days before our departure that Zach and I realized that June 23-27 was our last chance to include Nicaragua in our project. We set off with Leslie, Operations Manager at Miraclefeet, and flew to Managua. We arrived later Monday evening, dropped our bags at our Hotel, and then walked around the corner to a restaurant.

Of course, this blog post wouldn’t be complete if we didn’t give you a glimpse into our meals. Zach, Leslie, and I shared three appetizers: fried ripe plantains stuffed with melted cheese, tostones – fried unripe plantain patties topped with baked cheese and refried beans, and nacatamales – an iconic Nicaraguan dish of rice and pork cooked in plantain leaves. It was truly a delicious meal. We headed back to the hotel and fell asleep pretty early. We had a big day ahead of us.

Leslie, Zach, and I woke up bright and early Tuesday morning because Rebeca, Country Coordinator for the Nicaragua Clubfoot Program, picked us up at 6 a.m. to go to the main clinic. We arrived at the hospital before 7 a.m. It was amazing to see just how many mothers were waiting outside the clinic despite the early hour. Also waiting outside the clinic was Julio, our translator, and Katherine, the clubfoot clinic counselor. I’ll explain more about Katherine and her involvement with Miraclefeet in a moment. We walked through some very busy halls and entered a small office. Soon, we were greeted by Dr. Mario Sequeira Somoza and his colleague Dr. Julio Flores. Dr. Mario is one of the world’s leading Ponseti providers, and travels all over the world to help train other physicians. Dressed in a Winnie-the-Pooh smock and casting a complex case without any assisting technicians, Dr. Mario explained to us that his own son was born with clubfoot and received a multitude of surgeries. Clearly, clubfoot is a condition very near and dear to Dr. Mario’s heart. He also told us how he is trying to push the limits of the Ponseti Method. Initially, the method was thought to only be effective in young toddlers and newborns, however in recent years, many doctors (in many countries) have reported treating older children and even teenagers. Dr. Mario’s oldest patient is a 30 year old woman named Nubia who, according to Dr. Mario, is the oldest Ponseti patient in history.

Nubia walked into the clinic with a smile on her face and a cast on her leg. Because she is an adult, and stopped growing years ago, she has received about 20 casts so far – returning to the clinic weekly since last December. Dr. Mario and Rebeca showed us photos and videos of Nubia’s foot prior to her first cast. She walked on the top of her foot, just as Georgina in Ghana did. When her cast was removed, we saw that the bottom of her foot was now facing the floor. Still, even after this many casts, Dr. Mario explained to us that she was probably going to need surgery to completely correct the position of her foot.

Zach and I were very curious about Nubia’s clubfoot journey. Although Rebeca had scheduled several interviews in the afternoon, we wanted to make sure we got a chance to talk to Nubia on camera. Leslie, Julio, Zach, and I left the clinic a couple hours early, jumped in the bed of a pickup truck, and followed her back to her home. After about 40 minutes of driving, we arrived in a quiet little neighborhood in Ticuantepe – a small town just outside of Managua.

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During the interview, Nubia maintained her strong composure as she explained the emotional pain her clubfoot has caused. She felt marginalized simply because of her inability to wear sandals – a small part of life that might never seem like a luxury to most people. Nubia explained the pressure she felt having to financially support her family (which includes three of her own children) with limited employment options due to her clubfoot. Nubia started treatment three times, but had to discontinue them twice because the cost of transportation to the hospital was too high. Luckily, this time around, a friend, in whose truck we had just ridden, offered to sponsor her by driving her back and forth to the clinic weekly, which is why she has been able to continue treatment for such a long period of time. All four of us were taken aback by Nubia’s perseverance not only with her treatment, but in her strength to endure the emotional struggles which have burdened her for the last three decades. As the interview concluded, we saw Nubia’s face light up as her kids returned from school. We said our goodbyes, hopped back in the bed of the pickup truck and drove back to Managua.

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After taking a lunch break, where Zach enjoyed some empanadas and vigaron (cassava with fried pork rinds) and I devoured rice, beans, and plantains, we met up with Rebeca and Laura, a student intern from UNC working in Nicaragua for the summer. Rebeca drove us to Katherine’s house so we could finally hear her story. Katherine’s story is incredibly inspiring. Although she looks no older than 14, 23 year old Katherine is the mother of 20 month old Jean. When Jean was born with clubfoot, Katherine went to a few hospitals looking for treatment for her son, though at most places she was told that either her son would never walk or he would need extensive surgeries. Katherine wasn’t satisfied with those answers and decided to take matters into her own hands. She researched online, trying to find the best clubfoot doctors. After learning of the Ponseti Method, she personally emailed Dr. Morcuende in Iowa. Luckily, Dr. Morcuende knows Dr. Mario very well, and responded to Katherine, putting her in touch with him. Since then, Katherine has showed such incredible leadership at the clubfoot clinic. She teaches other mothers how to put on the braces and gives them tips on different parts of the treatment process. Miraclefeet recognized this leadership potential in her, and has now officially added her to the team as a counselor for the other mothers. We saw how crucial the counselors were in Ghana, and thought it was great that Miraclefeet recruited a fellow mother to guide parents through the process. The importance of emotional support for the parents of patients has been a motif throughout our travels, so we were glad to see that such measures are in place in Nicaragua.

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We concluded our interview with Katherine and headed to the home of another clubfoot family for a shorter interview since Julio needed to head back and it was late in the afternoon. While Zach interviewed the mother, Silvia, I played peek-a-boo with her 2 year old son. Rebeca and I tried to keep him entertained as Silvia told Zach why she though clubfoot awareness was important. She explained that if all mothers, even those without a child with clubfoot knew about it and knew where to get treatment, then they could help mothers of children with clubfoot searching for a solution. Essentially, there would be an entire network of educated mothers who would informally spread the knowledge between each other. As we finished the interview, I was able to get some good footage of her son running around (and riding on his miniature four-wheeler). After we said farewell to the family and to Julio, Rebeca and Laura dropped me, Leslie, and Zach off at our hotel. The three of us grabbed an early dinner and went to bed. Rebeca was going to be back to pick us up at the hotel bright and early again in the morning.

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