Podiatric Health
Section Newsletter
Winter 2007

Message from the Chair

Continuing With The Positive Momentum

It is an honor to serve as chair of the APHA Podiatry Section.  I am fortunate to follow behind a great Section chair, Patricia Moore, DPM, who has done a spectacular job increasing the numbers of our section.  We must continue to augment the numbers so podiatry is no longer in jeopardy of losing its section status.  The minimum membership for the section is 250.  Raising our figures is the number one objective for my term. An easy challenge for each of us is to recruit one podiatric peer to join our section. Please consider meeting this challenge.

Every health care provider advocates for public health when they educate their patients about proper health care.  Interestingly enough, most physicians don’t realize they are public health advocates doing this.  The American Podiatric Medical Association has two public relations campaigns annually that in reality are public health awareness topics -- Foot Health Awareness Month in April and Diabetes Awareness Month in November.  As a Section, we should maximize these two events to educate the public. 

There are other APHA Sections, such as Gerontology, that would be perfect partners for us.  The baby boomers will shortly be on Medicare and in need of our services.  This is an opportunity where both groups can synergize and come out winners with the American public the biggest champion.  Get involved. The personal satisfaction you will receive from a job well done is immeasurable.

Our section has an opportunity this year to further work with APMA to showcase to the public health world the importance of podiatric medicine to the health of our country. Let’s continue the recognition that the public health world has of podiatric medicine by supporting the podiatrists active in our section and joining up to contribute to this worthy effort.

Chris Robertozzi, DPM

Chair, Podiatric Section

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Boston Meeting Recap

I was happy to see all our dedicated members and many new faces in attendence at the APHA Annual Meeting in Boston.  My tenure as our Section chair has been an extended one, and I am confident in handing over my duties to Chris Robertozzi, DPM, who will continue to lead our section with continued success.

This year we have seen growth in our membership numbers. This would not have happened without the assistance of APMA and especially Rodney Peele, JD.  My sincere thanks and appreciation for this help. We need to continue this steady growth and make sure that our members are retained.

The highlight of this meeting was the premiere of Public Health and Podiatric Medicine: Principles and Practice, 2^nd Edition; Editor: Arthur E. Helfand, DPM. This publication signifies that podiatric medicine is well-recognized within the public health world as a significant provider of community health care. Our section will spread the word about this text especially to our podiatric colleges and encourage its usage in community health course curriculums.

I will continue to be an active section member and remind all members that attending an annual meeting, next year being held in Washington, D.C., is a great experience. The opportunity the APHA Annual Meeting provides in networking alone is worth the time away from home.

Pat Moore, DPM

Outgoing Section Chair

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Section Election Results

Below are the 2006 elected leaders for the Podiatric Section.  The Podiatric Section had 29.25 percent of its members participating in the election. Overall APHA members participation in this year’s section elections was 15.70 percent. Way to go, Podiatry!

Chair-Elect:             Janet Simon, DPM, MEd

Secretary:               Rodney Peele, JD

Section Council:       Neil Horsely, DPM, MS

                             Frank Spinosa, DPM

                             Sylvia Virbulis, DPM

Governing Council:    Anthony Iorio, DPM, MPH

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Podiatric Health Section Minutes

Sunday, Nov. 4, 2006

Westin Boston Waterfront

Douglas Room

Chair Patricia Moore opens the meeting (9:15 a.m.).

In attendance are:

Patricia Moore, DPM  Chair                      pmdpm@aol.com                        (574) 277-5390

Janet Simon, DPM     Incoming Chair Elect  janetpod@aol.com                     (505) 239-0229

Phill Ward, DPM        Action Board            peward@apma.org                     (910) 295-9262

                             APMA Trustee

Marvin Rubin, DPM     TFAIR, Action Board  drmarvinrubin@aol.com               (419) 471-9451

Neil Horsley, DPM      Governing Council     neil.horsley@rosalindfranklin.edu   (773) 531-3434

Donald Saye, DPM     scientific presenter   donsaye@qwest.net                   (505) 842-1291

Charles Kurtzer, DPM Exposition exhibitor   CMKURTZER DPM@aol.com

Art Helfand, DPM      author                    aehelfand@aol.com

Drew Harris, DPM                                   harrisdr@umdnj.edu                    (732) 235-4908

Eugene Dannels, DPM, USPHS                   eugene.dannels@ihs.gov             (602) 263-1509

Victory Horsley, DPM                              docvic@footdrhorsley.com           (314) 498-9816

Leslie Campbell, DPM                              lcampbell@verizon.net                (972) 747-5800

Rodney Peele, Esq.    Secretary                rdpeele@apma.org                     (301) 581-9230

John Carson                                          johnrcarson@msn.com                (301) 714-0655

Visitors will include Giorgio Piccagli (APHA Executive Board), Harry Perlstadt, Brian Saylor, Joyce Gaufin, Fran Atkinson (APHA component affairs director), Tanisha Battle (APHA component affairs coordinator), Jeff Wilkinson (MPHA executive director), and Mrs. Helfand.

1.       APHA Executive Board candidate Giorgio Piccagli, PhD, MPH, introduces himself to the Section  (9:18).

2.       APHA Executive Board candidate Harry Perlstadt, PhD, MPH, introduces himself to the Section (9:30).

          a)       Supported by Craig Gastwirth, DPM.

3.       APHA Executive Board candidate Brian Saylor, PhD, MPH, introduces himself to the Section (9:38).

          a)       Recognizes need for podiatric medical services for diabetics in Alaska.

Break (10:00)

4        Inter-Sectional Councail Steering Committee liaison Joyce Gaufin introduces herself to the Section (10:04).

          a)       Vision Care and Podiatric sections are secondary professional organizations.

          b)       Steven Wallace (Gerontology) will be new liaison.

5.       Section members discuss Section membership (10:15).

          a)       Dr. Moore presents data showing percentage of active podiatrists who belong to POD is higher than percentage of other specialists in other sections.

          b)       Dr. Rubin reports that TFAIR will probably retain proposed minimum 250 members for sections.

6.       Dr. Dannels presents Carson with award from National Council of Indian Health Podiatrists (10:42).

          a)       Dr. Dannels recalls that Carson once took him out to lunch and convinced him to become a podiatrist.  Dr. Dannels says that public health service podiatry program would not exist if not for Carson.  Dr. Dannels reports that DPMs serve in all but one region for IHS.

7.       Section members discuss Second Edition of Public Health and Podiatric Medicine edited by Dr. Helfand (10:47).

          In 1969, Leonard Levy, DPM, MPH, was the first and only DPM/MPH.  Dr. Levy honored for 40 years membership in APHA at Boston meeting.

Break (11:00).

Dr. Moore presents certificates to Section members.

8.       Section members discussion Governing Council representation (11:15).

          Tony Iorio, DPM, and Dr. Rubin to hold POD seats on Governing Council next year.

9.       Section members discuss Governing Council candidates (11:20).

10.     Jeff Wilkinson, executive director of Massachusetts Podiatric Medical Association, introduces himself to the Section          (11:35).

          a)       Dr. Rubin requests Section members join their state affiliates.

11.     Section members discuss need for abstracts for next APHA meeting (11:40).

12.     Dr. Simon raises possibility of proposing The Nation's Health insert/page “Healthy You” topics on diabetic feet, walking   programs, aging and feet, or newborns and feet (11:45).

          a)       Task force on Healthy You: Dr. Simon, Dr. Campbell to work with APMA Trustee Joseph Caporusso, DPM, and APMA staff.

13.     Dr. Rubin plans to propose a newborn foot screening policy statement for next APHA meeting (11:50).

          a)       Section plans to sponsor policy statement.

          b)       Dr. Helfand, Dr. Harris agree to help with strategy.

          c)       Peele agrees to help with language.

14.     Section members discuss need for APHA policy statement supporting Title XIX legislation (11:55).

          a)       Dr. Ward, Carson, and Peele agree to investigate further with APMA.

15.     Section members discuss section membership retention (12:00 p.m.).

          a)       Dr. Dannels volunteers to call expiring members before membership ends.

          b)       Dr. Kurtzer recommends bullet point presentation on POD for use at regional/state meetings.

          c)       Membership task force:  Dr. Moore, Dr. Simon, Dr. Robertozzi, Dr. Ward, Dr. N. Horsley, Dr. Dannels, Dr. Kurtzer, and Peele

16.     Section members discuss Section newsletter items (12:10).

          a)       Include information about APHA committees to encourage POD participation.

          b)       Include POD Annual Meeting minutes.

          c)       Include information about APHA Action Board.

          d)       Distribute newsletter and APHA membership forms to APMA House of Delegates in March.

17.     Section members discuss Section strategic plan (12:20).

          a)       Encourage Section members to join affiliates.

          b)       Encourage more podiatric medical papers in APHA Journal.

          c)       Reduce departure from Section.

          d)       Membership drive.

          e)       More representatives on APHA Committees.

18.     Section members discuss section requirements/expectations (12:30).

          a)       Task force on section requirements:  Dr. Moore, Dr. Robertozzi, Dr. Dannels, Dr. Ward, Dr. Rubin, and Peele

19.     Dr. Moore makes final comments (12:35).

Meeting adjourns (12:40 p.m.).

Eugene Dannels, DPM, presents John Carson

with award from National Council of

Indian Health Podiatrists

Section Chair Pat Moore, DPM, with

Phill Ward, DPM

Pat Moore, DPM, with Dr. and Mrs. Helfand    

Pat Moore, DPM, with Neil Horsely, DPM

Section member and exhibitor with

American Physicians Fellowship

Charles Kurtzer, DPM: Podiatric Section Exhibit

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Newly Updated Manual Explores Future Quality of Foot Health Care

Public Health and Podiatric Medicine:

Principles and Practice 2^nd Edition

Editor: Arthur E. Helfand, DPM

Washington, D.C., December 13, 2006 - The comprehensive authority on podiatric medicine, Public Health and Podiatric Medicine, now features the expertise of new contributors who explore the link between foot health and public medicine.

Like its previous edition, Public Health and Podiatric Medicine serves as a text for practitioners, students and individuals in both the podiatry and public health professions. Published by APHA Press, the publishing unit of APHA, the manual sets the standard for foot health as a public health issue and addresses future podiatric issues as society ages and patients run the risk of losing their mobility from complications related to chronic diseases.

The manual has also added new information or expanded upon existing text in the areas of HIV/AIDS; the history of health care for the human foot; international activities in public health and podiatric medicine; emergency and disaster preparedness; and the need for policies relating to the development of health care, in addition to the history of public health and podiatric medicine. Podiatric public health is broadly defined as a special area of podiatric medicine that focuses on the science and art of preventing and controlling disorders, diseases and malfunctions of the human foot and the promotion of podiatric public health through organized community activities.

Public Health and Podiatric Medicine, authored by podiatrists, blends maturity, experience and vitality to reflect the best of podiatric public health. The book’s editor, Arthur E. Helfand, DPM, professor emeritus at the Temple University School of Podiatric Medicine, says the newly revised edition brings together all of the book’s original contributors and adds a new group of professionals who form the base for the future of podiatric public health. Helfand also serves as adjunct professor of medicine at the Temple School of Medicine and a member of the honorary staffs at Temple University Hospital, Thomas Jefferson University Hospital and Temple University Children’s Medical Center.

“We need to be concerned about the future quality of podiatric medical care, the delivery of care and the availability of podiatric care for generations to come,” Helfand writes.

“Contributions to this text by the distinguished authors will enlighten readers to the experiences in taking care of one of the most debilitating but often neglected health problems,” writes Norman Klombers, DPM, retired executive director of the American Podiatric Medical Association, in the book’s foreword.

“While physicians (generalists and specialists), nurses and other health care professionals are audiences to profit best from the presentation of this material, the value of patient education should not be lost in this equation,” Klombers writes. “Suggesting only that loss of limb is a consequence of diabetes, peripheral vascular disease or neglect of apparently minor foot lesions is inadequate.”

Ordering Information: Published by the American Public Health Association, 2006, ISBN: 978-0-875530-71-0, 589 pages, cost is $55.95 ($39.16 for APHA members), plus shipping and handling. To order, call toll free (888) 320-APHA; fax (888) 361-APHA; e-mail apha@pbd.com or visit APHA’s Web site: www.aphabookstore.org.

Please send your request for a review copy on letterhead to APHA Publications Marketing, 800 I Street, NW, Washington, D.C. 20001-3710, or fax to (202) 777-2531.

# # #

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Scenes from Dr. Helfand’s Booksigning during APHA Annual Meeting

Art Helfand, DPM, with John Carson

Art Helfand, DPM, with Eugene Dannels, DPM,
contributor author

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Elements of APMA's "Knock Your Socks Off" Campaign: How to Perform a Diabetic Foot Exam

Last year, diabetes contributed to close to 82,000 amputations. Podiatrists are often the first doctors to diagnose diabetes since the feet can show signs and symptoms of serious systemic conditions. However, the feet are frequently overlooked during annual checkups. The American Podiatric Medical Association (APMA) has embarked in a nationwide diabetes campaign called “Knock Your Socks Off” to educate patients and primary care physicians about the importance of early diabetes detection through simple foot screenings. In a roundtable discussion, Dr. Joseph Caporusso, an APMA Board of Trustees Member and APMA Public Education & Information Committee chair, will:

Learning Objectives:

• Emphasize the importance of identifying those “at risk” for diabetic complications such as foot ulcers and neuropathy.
• Explain how to perform three types of diabetic foot screenings; visual, comprehensive and sensory exams.
• Analyze what method of treatment would be best for the patient based on the foot exam outcome.
• Discuss how to reach out to “at risk” patients with diabetes educational materials.
• Participants can understand how to:
• Identify who is a candidate for a diabetic foot exam.
• Apply a diabetic foot exam in routine patient check-ups.
• Recognize the value of integrating diabetes educational materials into patients’ care.
• At the conclusion of the session, participants will be able to:
• Perform three types of diabetic foot exams based on patients’ needs.
• Distribute diabetes educational materials to patients.
• Refer patients to a podiatric physician based on foot exam results.

Keywords: Diabetes, Public Health Education and Health Promotion

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Review of American Podiatric Medical Association's Walking Survey

The American Podiatric Medical Association (APMA) established the Clinical Practice Advisory Committee (CPAC) for the purpose of gathering data from podiatric practices and developing research projects whose goal was to identify protocols that, when followed, would result in increased prevention and superior treatment outcomes. The first area of focus that CPAC selected was walking. One of the most effective treatments for the health problems and complications related to obesity is walking, because it has a positive impact on blood pressure, cholesterol levels, blood sugar levels, and other objectively measured bodily functions known to be associated with the reduction or prevention of complications of disease. The first step undertaken by the committee was the 2005 APMA Walking Survey, conducted by Allan H. Fisher, Jr., PhD, and Associates, under the auspices of APMA.

After reviewing and analyzing the survey results, Al Fisher Associates, Inc., made the following six recommendations: (1) Develop a checklist of the injuries most frequently sustained by walkers, to be used in assisting with patient education; (2) Assemble the strategies found successful in getting patients to walk more into a Walking Guide; (3) Utilize the positive findings in various marketing initiatives; (4) Share the data on shoe recommendations with industry; (5) Share the powerful success stories with other health care professions and the general public; and (6) Conduct research, such as studies utilizing before-and-after-treatment measurement of the time patients spend walking, to determine which treatment modalities most affect patient walking activity and patient health.

Learning Objectives:

• Familiarize attendees with the results of the APMA 2005 walking survey. Utilize the results of the survey to enable attendees to develop an appropriate walking program for their patients and understand the health benefits of a walking program.

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Alpha Lipoic Acid: An Alternative Treatment for Diabetic Neuropathy

The uncontrolled hyperglycemia often associated with diabetes puts the diabetic patient at risk for increased oxidative damage and eventual peripheral neuropathy. Studies have shown that alpha lipoic acid (ALA) significantly reduces the burning, sharp pain and numbness of neuropathy. Alpha lipoic acid, also known as thioctic acid, is a powerful, natural antioxidant slowly becoming recognized as having some unique properties in the therapy and prevention of a broad range of diseases, including diabetic peripheral neuropathy. In addition to being a powerful antioxidant, alpha lipoic acid plays a role in blood sugar control by helping the body use glucose. Studies have shown the potent antioxidant properties of ALA prevents healthy cells from getting damaged by unstable oxygen molecules called free radicals. In fact, this vitamin-like compound has proved to be many times more potent than the antioxidants vitamin C and E. In addition, ALA is both water and fat soluble making it a so-called “universal antioxidant” and explaining its increased potency. Mayo Clinic has conducted studies on the effectiveness of ALA in the treatment of diabetic neuropathy with results showing a rapid improvement in pain or numbness as well as a marked increase in nerve conduction. Researchers have also found ALA to be very safe with no known complications.

Learning Objectives: At the conclusion of the session, the participant (learner) will be able to

• Describe the benefits of alpha lipoic acid.
• Explain the causes of diabetic neuropathy.
• Discuss how alpha lipoic acid can prevent diabetic neuropathy.
• Discuss how alpha lipoic acid aids in blood sugar control.
• Discuss benefits of natural vs. pharmaceutical treatment in neuropathy.

Keywords: Diabetes, Vitamins

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Biofilms, Recurring and Antibiotic Resistant Infections

A biofilm colony is a complex structured interdependent community of a single species or a mixture of species of bacteria and/or fungi and may be different strains of the same species of microorganisms enclosed in a self-produced polymeric matrix known as a biofilm. Biofilms are commonly produced by microorganisms and adhere to environmental surfaces, medical devices and necrotic and living tissues that have sufficient moisture and nutrients to maintain their survival. Most if not all, microorganisms commonly produce biofilms. Bacteria in a biofilm resist conventional methods of culturing and antimicrobials by interacting with each other and coordinating their activities in a cooperative effort much like a community effort. Bacteria within the biofilm have a much higher minimum bactericidal concentration than the same strain of bacteria outside the biofilm. Thus, clinically safe levels of antibiotics are not usually effective in eliminating bacteria in the biofilm. The cause for the resistance to treatment and conventional methods for culturing is unclear, but is multifactorial and varies with the organisms and the strain of the organisms in the biofilm. The biofilm is constantly changing and bacteria within may be removed by trauma or for various other reasons bacteria may separate from the biofilm. This may result in recurring local or systemic infectious disease. The treatment of biofilm-related infections is complex and beyond the scope of this abstract. In addition, definitive treatment for biofilm infections, for the most part, remains in the sphere of research studies that have yet to reach clinical practice.

Learning Objectives:

• The attendee will understand one reason why some infections recur despite adequate antibiotic treatment and why some wound fail to heal.

Keywords: Antibiotic Resistance

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Eliminating the Number One Preventable Risk Factor for Lower Limb Disease and Amputations

Peripheral arterial occlusive disease (PAD) affecting the lower extremities is a very common problem in the Western Hemisphere and is generally considered a disease of the elderly population, especially of those over 65. About 12 percent of the US population is 65 years or older, and this figure will likely increase to over 22 percent by the year 2040. Therefore, the impact of vascular disease affecting these individuals will be significant both from a quality of life and public health standpoint. Also, with an ever- increasing incidence of type II diabetes, PAD is becoming more prevalent and common, even in the younger population. The challenge to the medical community is to develop a cost-effective strategy for the early detection and management of PAD and more importantly a more effective strategy of prevention and the elimination of risk factors. The harmful effects of cigarette smoking have been abundantly documented, and the link between smoking and PAD is evident. The use of tobacco is the most prevalent risk factor, not only for development of PAD, but also of death. Cigarette smoking is certainly the most prevalent and preventable complicating factor involved in lower limb ischemia and disease, contributing to increased incidence of amputations and higher rates of early death. Many studies have demonstrated the dramatic improvement of health after smoking cessation. The illegalization of cigarettes would not only save billions in financial public health resources, but also decrease cardiovascular morbidity dramatically and save thousands of lives each year.

Learning Objectives:

• prevention of preventable risk factors as they relate to improvement of lower limb disease and overall health.
• curbing health care costs and resources by eliminating the cause of one of the top preventable causes of morbidity and mortality.

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At the Forefront of Care for Geriatrics with Diabetes: An Improvement Project to Better Patient Care and Change Practice Behavior of Optometrists and Podiatrists

Podiatrists and optometrists are the primary health care providers of foot and eye care in America and are often the first to identify pedal and ocular complications in older Americans with diabetes. An initiative to improve upon the practice behavior of these limited licensed physicians to reduce the complications of lower extremity amputation and blindness is the impetus behind our improvement project.

Our goal is to increase the screening of diabetics for peripheral arterial disease, distal peripheral neuropathy and retinopathy. We will strive to see that this population group has semiannual ABI and monofilament testing by podiatrists along with an annual dilated eye exam by optometrists.

In the present health care system we have a variety of self managed and physician managed/coordinated plans, and while third party payers have directed their energies to quality performance measures through primary care physicians with incentive programs affecting all providers, many of the early signs and symptoms related to the complications of diabetes are brought first to DPMs and ODs as older patients have traditionally entered those practices on their own.

In the present environment where the large majority of Medicare patients are not in PCP controlled insurance products, the need to establish and implement quality measures for specialists such as DPM and OD providers is lacking. By bringing this initiative forward a new specialist driven approach to the complications of chronic disease management and a benefit compensation system directed toward the specialist provider will serve as a future model for others.

Learning Objectives:

At the conclusion of this poster presentation the viewer will be able to

1) recognize the significance of monofilament and ABI screening as well as annual dilated eye exams in the adult diabetic patient.

2) begin to formulate specialist driven quality measures in the recognition and management of complications associated with a chronic disease.

3) apply this improvement project to their own daily work in screening patients for retinopathy, peripheral arterial disease and distal peripheral neuropathy.

Keywords: Quality Improvement, Diabetes

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Increased Fall-Risk Associated with Diabetic Peripheral Neuropathy

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APHA Student Assembly Alumni Database

This year, the APHA-SA Opportunities Committee provided more resources to students regarding scholarships, conferences, job postings, potential employers, and fellowships/internships. In addition to these endeavors, the committee revamped the Student Assembly Alumni Database. The Alumni Database is meant to not only allow the SA to keep track of their past members, but it also provides current and potential students access to learn about possible careers in the public health field.

To access the Alumni Database, students can visit the SA Web site (www.aphastudents.org) and click on the Opportunities Committee page. Here students can look at job positions that public health professionals currently in the field hold. Prospective public health students could access this database and view jobs that people with public health degrees have to gain a better understanding of the wide variety of career paths available to them. Alumni range from recent graduates working in fellowships or entry-level positions to seasoned health professionals with well-established research agendas.

The SA Opportunities Committee co-chairs are working to increase participation of SA alumni in the Alumni Database. Anyone who at one time was a member of the Student Assembly (previously the Public Health Student Caucus) can visit the Web site, complete the form available on the Opportunities Committee Web page (www.aphastudents.org/phso_alumni_db.php) and return it to jlcremeens@aol.com. This endeavor depends on the cooperation of SA alumni. With APHA-SA alumni support, the Database can become a wonderful resource for the next generation of public health students. We hope you will consider taking a few moments to add yourself to the Alumni Database. 

If you have any questions or want more information, please feel free to contact Jennifer Cremeens or Anna Pollack, the Opportunities Committee co-chairs, at opportunities@apahstudents.org.

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Bioterrorism/All-hazards Preparedness Available Free

Podiatric physicians are encouraged to take the first of a series of courses in bioterrorism/all-hazards preparedness included in a grant project funded to Nova Southeastern University College of Osteopathic Medicine by the U.S. Public Health Service, Health Resources and Services Administration as physicians. The first course is available without cost and is completely on-line. Registration is done online, and a certificate of completion is granted upon completion. Access is obtained at www.nova.edu/allhazards

This initial course is designed to develop an awareness of the various acts of bioterrorism, weapons of mass destruction, man-made non-intentional disasters, and natural disasters. For further information contact Leonard A. Levy, DPM, MPH, associate dean for education, planning and research, director, Center on Bioterrorism and All-hazards preparedness, Nova Southeastern University College of Osteopathic Medicine, levyleon@nsu.nova.edu or (954) 262-1469.

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Consensus Public Health Recommendations for Physical Activity

Statements from the American College of Sports Medicine/Centers for Disease Control and Prevention, American Heart Association, NIH, the U.S. Surgeon General, and U.S. Dietary Guidelines 2005 conclude: 

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Member News

PHILIP H. DEMP, DPM, MA, MS, PhD, FIMA , adjunct clinical professor, Temple University School of Podiatric Medicine and adjunct professor, Temple University Department of Mathematics, wishes to report that the research project entitled, "Development of a Geometric Forefoot Model: A Tool of Clinical Decision Making" has been officially funded by the National Institutes of Health.  The ultimate object of this research is to develop a mathematical model of the metatarsal length pattern that is sensitive to aberrant function and can be used to plan more effective conservative and surgical treatments.

Dr. Demp has also been elected a Fellow of the Institute of Mathematics and its Applications. The Institute is the professional and learned society for qualified and practicing mathematicians.  

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CURE International visit to Haiti

11-26-06 Sunday : I arrived in Port-Au-Prince, Haiti at about 4 p.m. EST and was met by a driver from Healing Hands Haiti. I was then taken to the Healing Hands guest house and spent the evening there. I met a group from Healing Hands Canada who were winding up their week-long trip.

11-27-06 Monday : I boarded a plane for Jacmel at 8:30 a.m. and landed about 9 a.m. I was met at the airport by Jane MacRae, the executive director for Pazapa (a children's orthopedic program). At Pazapa there was a meeting with Jane, Tony Antoine (therapy technician), Dr. Jean Herve Rozan (orthopedic surgeon for the area, including covering St. Coix), and Mareka MacRae (Jane's daughter and support staff at Pazapa). We initially discussed CURE International and their role in the clubfoot project in Jacmel specifically and Haiti in general. I reviewed a log on surgical and casting cases performed at Pazapa (the surgical cases were performed by U.S. doctors with Dr. Rozan assisting and learning). Then we discussed the post-cast bracing protocol and reviewed some of the braces that are currently being used. I showed the staff the Steenbek brace from Africa and gave them the pattern and instructions on the brace design. I was able to meet the man they use to make their braces and shoes. I discussed the brace design and material used in detail with the group. We talked at great lengths about the importance of a post-cast bracing program to long-term success. We also discussed getting the mothers involved in the treatment by "passing the baton" to them after the casting is completed and their importance in the role of their children's outcome. I also discussed treating the bracing program as a public health matter, with in-home compliance follow-ups.

After our meeting, six patients were evaluated in the clinic and scored with the Pirani scoring system. When I first brought up the importance of scoring the patients for documentation, evaluation and tenotomy planning; there was a feeling it was too complicated and could not be implemented. I broke the scoring system down for Dr. Rozan and Tony and we went through the first patient together as I scored the patient, explaining the how and why for each score I gave. After this, Dr. Rozan began scoring the patients, and I would check his results. He picked it up very quickly. With some questioning on my part about why the numbers were important and what they indicated, he could see how they are useful in the treatment protocol (especially in tenotomy timing!!!). We used the patient record provided by CURE to document, and I went through this paperwork with them. Additionally during this evaluation period, treatment recommendations for each child were made and documented in the chart for further follow-up. Tony did not grasp the scoring system as quickly as Dr. Rozan, which is to be expected. The "Tonys" need to know the Pirani scoring system also, as they are the ones seeing the children with each casting, unlike the orthopedic surgeon. I went over the system one more time with Tony after lunch and hopefully it helped to clear things up for him. He would benefit from scoring patients on his own with supervision on each case to go over his results and correct any errors until he fully understands the Pirani scoring system.

Following the evaluations we casted three patients with five total casts. Both Tony and Dr. Rozan did the castings as I monitored them. There were a few technical things that needed to be cleared up, one of the major ones was above the knee vs. below the knee as they had been told that both were acceptable (one person told them only AK and one person told them BK). I quickly informed them that the Ponseti method is only AK and not BK. Another issue is they have: the mothers take off the casts the night before the children come in to be recasted. I explained the best option was to take off the cast in the clinic setting, then manipulate and cast (that what they were doing was costing them some of the correction they had obtained in the cast). The next best option for them is to have the mothers take off the cast just prior to coming into the clinic (lessening the time out of the cast compared to the night before). As for the casting technique itself, I am pretty sure they are not performing the "magic move" of cavus reduction by supinating the forefoot to place it on the same plane as the rearfoot in the first cast with no abduction. I think they are going straight into abduction on the first cast. Another concern is they are not extending the cast beneath the toes and cutting back the dorsal aspect to help stretch out the long flexor tendons. I explained this to them and they picked up on it very quickly. I think a cast knife would be helpful for this, this is what Dr. Ponseti prefers to use and I think it is also the best tool (and they are cheap). I am not sure they understood the supination only in the first cast, and also worry they may be trying to correct the equinus much too soon during the casting. My recommendation is more supervised casting and these technical aspects would easily be corrected.

That evening I had a wonderful dinner at Jane's house and returned to my room at Guy's guesthouse. I found Pazapa to be delightful and those who work there eager to learn and easy to work with. The primary concern with Pazapa and an affiliation with CURE International was the use of the children and their treatment being tied to evangelizing of the children's parents. I told Jane I would check on the exact nature of this concern and get back to her. If this is more voluntary than mandatory, there should be no problem. All in all, I found Pazapa to be a pleasure and enjoyed my time there.

Sincerely,

Patrick A. DeHeer, DPM
8246 Ethan Dr.

Fishers, IN 46038

317-557-6710

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How to Find the Needles in Web Haystacks

A vast amount of information is available on the Internet. But there's no standardized list of subject headings or defined structure to help you find all (and only) the Web sites relevant to your topic. Wesleyan University Library offers some basic advice for sorting through the enormous amounts of materials online and "Finding Information on the Web," including:

When searching the free Web, it is important first to determine what specifically you are looking for, and then decide which of these avenues is best suited to your purposes:

1.      State your research topic in the form of a question; treat your research project as an attempt to find a specific answer for a specific question.

2.      Analyze your topic: List terms and ideas that describe your topic. List synonyms for those terms, along with broader and narrower topics, categories, and terms. List names (authors, organizations, etc.), titles, abbreviations, and acronyms associated with your topic.

3.      Determine what sort of an answer you need: From what subject or discipline perspective are you looking at this topic? Do you need scholarly or popular sources? Everything you can find on the topic, or just something brief? Do you want an overview of a broad topic, a narrow aspect of a topic, a specific fact, etc? How familiar are you with this topic?

4.      Select the appropriate search avenues... and use them.

5.      Evaluate your results: Are the results relevant, or do you need to change your search strategy? Do you have what you need to answer your question? Do you need to rephrase your question?

6.      Repeat as necessary.

Click here for Wesleyan's explanations of various search avenues as well as links to guidelines for evaluating resources you find online.

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