Club Foot or Foot Zambo

Club Foot, also called Foot Zambo, is a congenital malformation in which the affected foot, could be one or both, appears to have been rotated internally to the ankle. Often times it appears as if the person is walking on their ankles. It is a birth defect in which the foot is crooked or inverted inwards and downwards, resembling a golf club. Without treatment, affected people experience pain, discomfort and difficulty in mobility.

Before and After


  • Studies indicate that tendons have much denser tissues and equally more cells and less lax tissue than normal tissues. Therefore the ligaments and muscles are too tense to allow a correct placement of the bones with a simple manipulation.
  • Genetic or familial
  • Mechanical cause due to lack of space for the formation of the fetus during pregnancy
  • Neuromuscular diseases


In some cases, it is usually possible to visualize the malformation in the ultrasound study of the fetus at 20 weeks of gestation. The diagnosis is confirmed after birth, observing the shape of the foot down (equine) and inside (varus), and checking that by manipulation, not able to obtain a normal position.


There are two methods of treatment:·”French Method of Physical Therapy”: Use the fixation to maintain the correct posture. Foot manipulations begin within one to two weeks of birth.·

“Ponseti Method”: Consists of performing soft manipulations to obtain the best possible alignment with the plaster bandage. This pattern is repeated every week with complete correction of the deformity is achieved except the tipped position. At this point a small intervention should be performed, percutaneous Achilles tendon lengthening, with local anesthesia and no hospitalization is needed.

NPH case:

A seven year old boy living in one of NPH homes arrived in 2015 having difficulty walking. The diagnosis was obvious “Congenital Bilateral Club Foot”. The doctor from the NPH clinic consulted with several specialists in the country and abroad. After careful consideration of the case, the medical staff local and international decided to go for the conservative approach known as the Ponseti Method, before going with painful and invasive surgeries. After 10 months of weekly work changing the cast and physical therapy,  the patient was ready for minor surgery, elongation of the Achilles Tendon. After eight days he was dismissed from the hospital and has follow up with physical therapy. The treatment of club foot should start right away after birth. This boy was so lucky to arrive to NPH and get treatment since otherwise he would continue living on the streets and forever being the center for jokes and mocking.


PIE EQUINO VARO bilateral congénito, También llamado: Pie Zambo, es una malformación congénita, en la cual este aparece en punta (equino), y con la planta girada hacia adentro (varo).

Es un defecto de nacimiento, en el que el pie se encuentra torcido o invertido hacia adentro y hacia abajo, semejando un palo de golf. Sin tratamiento, las personas afectadas frecuentemente aparentan caminar apoyados en sus tobillos


  • Los estudios indican que los tendones tienen tejidos muchos más densos e igualmente más células y menos tejido laxos, que los tejidos normales. Por tanto los ligamentos y músculos están demasiados tensos para permitir una correcta colocación de los huesos con una simple manipulación.
  • Genética o familiar
  • Causa mecánica por falta de espacio para la formación del feto durante el embarazo.
  • Enfermedades neuromusculares.


En algunas ocasiones suele ser posible la visualización de la malformación en el estudio ecográfico del feto en las 20 semanas de gestación.

El diagnostico se confirma tras el nacimiento, observando la forma del pie hacia abajo (equino) y adentro (varo), y comprobando que por manipulación no somos capaces de obtener una posición normal.


Existen básicamente dos métodos de tratamiento:

“Método francés de fisioterapia”: Usa la fijación para mantener la postura correcta. Las manipulaciones del pie comienzan en una o dos semanas de nacidos.

“Método Ponseti”: Consiste en la realización de manipulaciones suaves hasta obtener la mejor alineación posible con el vendaje de yeso, esta pauta se repite cada semana, se consigue la corrección completa de la deformidad excepto la posición de puntillas. En este punto se debe realizar una pequeña intervención, alargamiento percutáneo del tendón de Aquiles, se realiza con anestesia local y no necesita hospitalización.

Este es el caso el niño de 7 años de edad quien ingreso en el 2015, con pie Equino Varo, este fue llevado con varios Especialistas, quienes ofrecían operaciones en los pies del niño, pero el tercer Traumatólogo lo refirió a Managua al Hospital de Especialidades de niños.

El niño, fue valorado por el especialista en Traumatología del hospital infantil, quien inicio un tratamiento conservador, según Método Ponseti, en Enero del 2016 y termino después de 10 meses , en Octubre del 2016 , fechas en la que ya le realizaron una cirugía de elongación del tendón de Aquiles. Fue dado de alta a los 8 días ya con sus pies alineados y continuidad por parte de Fisioterapia.

El niño ha tenido una buena evolución, sigue con sus actividades normales.

Foto de su llegada a NPH antes del tratamiento 2015

Dra Silvia Echaverry , Medico NPH Nicaragua and Julia Spettel, NPHI RMC Nicaragua, El Salvador, Peru and Bolivia

May is Mental Health Awareness Month

May is Mental Health Awareness Month and the first week of the month is dedicated to create children’s mental health awareness.

  • Mental Health is an important and integral part of the adolescents’ wellbeing.
  • Mental Health is not simply the presence or absence of symptoms. It includes general feeling and functioning, as well as having resilience when facing a setback.
  • Adolescence is a time where mental health disorders first appear.
  • Two- thirds of adults with psychiatric problems began between the ages of 15-25.
  • Most adolescents enjoy a positive mental health development, though more than a third of this group have experienced or currently are experiencing anxiety, depression symptoms or a debilitating mental health disorder.
  • Everyone feels worried or anxiety at times; adolescents experience strong emotions as part of their normal development but when symptoms persist for more than two weeks and interfere with their daily lives, it can be a warning sign for the adults caregivers.
  • Suicide deaths (usually prompted by a mental health disorder) globally surpass vehicle accidents at the age of 10-14, and is the second leading cause of death among 15-24 year olds.
  • Mental health support starts at the home, school and at the health professional office (physician or psychologist).
  • Adolescents should have access to Mental Health services breaking the barriers of stigma, ignorance and misunderstanding.

The maturation process in adolescents to adults is through changes and development, facing issues that most of them will overcome.

Key aspects in their development to empower youths:

  • Healthy relationships with peers and caring adults
  • Helping them to build a positive mental health & physical health habits as they grow and change
  • Coping, resilience, good judgment for good/right decisions
  • Healthy eating habits, exercise, preventing substance abuse
  • Inform and educate on reproductive health and teen pregnancy
  • Substance use and abuse 

Ways to support

  • Caring adults
  • Clinical prevention
  • Crisis intervention
  • Education

For all adults and peers living with adolescents or teenagers and according to the NIMH (National Institute of mental health – US) a child or teen might need help if they:

  • Often feel very angry or very worried
  • Have difficulty sleeping or eating
  • Are unable to enjoy pleasurable activities they used to enjoy
  • Isolate themselves and avoid social interactions
  • Feel grief for a long time after a loss or death
  • Use alcohol, tobacco, or other drugs
  • Exercise, diet, and/or binge eat obsessively
  • Hurt other people or destroy property
  • Have low or no energy
  • Feel like they can’t control their emotions
  • Have thoughts of suicide
  • Harm themselves (e.g., burning or cutting their skin)
  • Think their mind is being controlled or is out of control
  • Hear voices

At NPH a comprehensive assessment physical, developmental and psychological is given upon entrance and is monitored and followed up by the clinic staff (doctor and psychologist) if there is a mental health diagnosis. This helps to prevent future complications.

Most NPH children experience some sort of PTSD , because of their background before entering NPH and if they had suffered violence, abuse of any type of abandonment and neglect.

Around 2% need to have consultation with external specialists and have psychiatric treatment.

NPH uses an interdisciplinary team including physician, psychologist, occupational therapist, art therapist and physical therapist to support children.

NPHI Medical Services

Data from

US department of health and Human Services

NIH National Institute of Health

MGMH Movement for Global Mental Health

Today is World Malaria Day!

Countries where NPH works have a high prevalence of high-impact diseases, especially during the rainy season. Cleaning surroundings in our community is important to prevent the breeding sites of mosquitoes. Any collection of water is a threat for disease incubation. Fumigation and mosquito nets are necessary to prevent infectious, transmitted diseases such as zika, chikungunya, dengue or malaria.

The NPHI Medical Services team and local clinics work hard to apply our mission statement to our daily work: striving to reach an optimum health and wellbeing for children to live as healthy as possible. The success relies on the close cooperation between the Medical Services team and local staff, and establishing collaborative partnerships with local public health facilities and other NGOs.

Chikunguya in the Dominican Republic

The fever caused by the Chikunguya virus represents a new problem for the Ministry of Health in the Dominican Republic. Chikunguya began in February 2014, but before in December 2013, the Pan-American Health Organization, alerted the countries of the region of Americas. This disease for the first time affected the Dominican Republic, a very susceptible population, since it is transmitted by the mosquito Aedes aegypti. This type of mosquito is present in the entire country, which is the reason why a great number of cases were presented.

The origin of the word Chikunguya comes from the African language Makonde, which means: to bend by pain.

It is transmitted through the mosquito bite that can also produce dengue and yellow fever. This mosquito is easily recognized because it has a white circular stripe on the legs. When these mosquitoes bite a person with Chikunguya the transmission cycle starts.


  • Sudden high fever, accompanied by multiple bilateral or symmetrical pains of variable intensity. In some cases the pain is so intense that it produces functional disability.
  • After a few days, a pruritic macular rash may occur.
  • Other: headache, diffuse back pain, myalgia, nausea, vomiting and conjunctivitis.

Subacute and chronic symptoms can occur from days, months or even years from the onset of symptoms. The main manifestation is arthritis.

Among the atypical manifestations of Chikunguya is neurological, ocular, cardiovascular, dermatological, renal, damage among others.

Among the complications described associated with Chikunguya:

  • Respiratory failure
  • Cardiovascular decompensation
  • Meningoencephalitis
  • Acute hepatitis

Severe cutaneous manifestations:

  • Shock and bullous lesions

The majority of these manifestations are observed in patients over 65 years of age and in children younger than one year and in patients with chronic diseases, diabetes, lupus among others.

The diagnosis is basically clinical, starting from the definition of the case suspected and family, community or work contact with other cases.

The differential diagnosis should be made with disease prevalent in the country, dengue, for the following reasons:

  • They are viruses transmitted by the same vector
  • Clinical manifestations are similar

Among the differential diagnoses with other diseases :

  1. Leptospirosis
  2. Malaria
  3. Childhood exanthematic diseases
  4. HIV infection
  5. Infectious mononucleosis

Measures to prevent are:

  1. Avoid conserving water in containers outside, tanks of deposits or water for domestic use
  2. Avoid accumulating garbage among others

If you have symptoms, go to your nearest health center for care and treatment.

Contributed by: Dr. Maria Reyes

Family and Community Doctor, NPH Dominican Republic


Today is World Health Day!

The impact of NPH’s healthcare in developing countries is significant. We not only provide comprehensive care for the children living in NPH homes, but also for patients from the community and children attending NPH schools. NPH clinics support these students by providing: annual medical exams, nutrition, vision and hearing screening, dental care, immunizations, deworming twice a year, supporting and finding solutions for special cases identified during screening, health education, and therapies according to availability.

See or amazing statistics below or check out our videos in honor of World Health Day at:

NPH Healthcare
St. Damien Pediatric Hospital

The Common Ear Infection

The most common infections among NPH children, like in any other environment, are upper respiratory infections, and among them, ear infections or otitis which is a very frequent condition

An ear infection happens when a bacterial or viral infection affects the middle ear. Most ear infections happen when a child has previously had a cold for a few days.

Middle ear infections are also called otitis media. They are very common, especially in children between 6 months and 3 years of age. They are usually not serious and aren’t contagious, though can be painful because the inflammation and fluid buildup.

Ear infections can be chronic or acute. Acute ear infections are painful but don’t last more than a few days. Chronic ear infections they can recur many times. Chronic ear infections can cause permanent damage to the middle and inner ear and loss hearing.

Viruses or bacteria cause middle ear infections. Germs travel from the back of the throat when the Eustachian tube is swollen from a cold, causing infection in the middle ear. In some cases, children with an ear infection may also have fluid draining from the ear.

Some groups are more prone to have ear infections:

  • Children less than 5 years old, because they have shorter Eustachian tubes.
  • Children who attend daycare, because they tend to have more colds.
  • Babies who are being bottle fed, especially if they swallow milk while lying too flat, it can enter the Eustachian tube and increases the risk of an ear infection.


  • unexplained fever
  • trouble sleeping
  • tug or pull at their ears
  • difficulty hearing quiet sounds.

Día mundial de la Tuberculosis 2017 – World Tuberculosis Day 2017

La tuberculosis es una de las 10 principales causas de mortalidad en el mundo y junto con el VIH son las principales causas de muerte entre las enfermedades infecciosas.

Según la OMS en el 2015 se enfermaron 10,4 millones de personas (un millón de niños) de tuberculosis y 1,8 millones murieron por esta enfermedad. Desde el 2014 el número de las casos de tuberculosis en el mundo se ha incrementando. Más del 95% de las muertes por tuberculosis se producen en países con bajos y medianos ingresos.

La tuberculosis es una enfermedad crónica infecciosa, causada por una bacteria, llamada Mycobacterium tuberculosis. Usualmente afecta los pulmones pero puede afectar cualquier otro órgano del cuerpo. La infección se trasmite a través del aire.

Se calcula que una tercera parte de la población mundial tiene tuberculosis latente. Se trata de personas que están infectadas pero no enfermas y tampoco trasmiten la infección. Sin embargo a lo largo de su vida tienen un riesgo de enfermarse de la tuberculosis activa de 10%. Si tienen condiciones como VIH, diabetes, malnutrición el riesgo es mucho mayor. Los síntomas de la enfermedad activa más comunes son tos productiva, pérdida de peso, fiebre y debilidad. La enfermedad es prevenible y curable, aunque el tratamiento es largo. Usualmente la tuberculosis activa se trata con una combinación de 4 antibióticos durante 6 meses. Últimamente se han registrado más resistencias a los medicamentos antituberculosos que significa un reto para los médicos.

En los países de Latinoamerica la mayoría de los bebes recibe la vacuna de Tuberculosis, pero lamentablemente el efecto de esa vacuna es limitado y no puede prevenir una infección al largo plazo.

Cuando un niño llega como nuevo ingreso a NPH, en clínica se hace una prueba cutanea de tuberculosis, que puede detectar si el niño ha tenido contacto con el Mycobacterium Tuberculosis. Junto con una exploración exacta y una historia clínica detallada, el doctor determina si es necesario dar tratamiento o si hace falta hacer más diagnóstico o llevar el niño al especialista.

En NPH hemos tenido pocos casos de Tuberculosis activa. Ya que esta condición es contagiosa se tiene que aislar a los pacientes en clínica hasta que el medicamento ha tenido su efecto. Al mismo tiempo se tiene que hacer un cribado en toda la población por síntomas.


World Tuberculosis Day 2017

Tuberculosis is a chronic infectious disease caused by a bacterium called Mycobacterium tuberculosis. Usually the lungs are affected but any other part of the body can be affected, too. Infection is transmitted through the air.

It is estimated that one-third of the world’s population has latent tuberculosis. These are people who are infected but not sick and do not transmit the infection. However throughout their life they have a risk of becoming sick of active tuberculosis of 10%. If they have conditions like HIV, diabetes, malnutrition the risk is much bigger. The most common symptoms of active disease are productive cough, weight loss, fever, and weakness. The disease is preventable and curable, although the treatment is long. Usually active tuberculosis is treated with a combination of 4 antibiotics for 6 months. Recently more resistance to antitubercular drugs has been reported and implies a challenge for doctors.

Tuberculosis is one of the 10 leading causes of mortality in the world and together with HIV it is the leading cause of death among infectious diseases.

According to the WHO in 2015, 10.4 million people (one million children) got affected by tuberculosis and 1.8 million died from tuberculosis. Since 2014 the number of tuberculosis notifications in the world is increasing. More than 95% of tuberculosis deaths occur in low- and middle-income countries.

In Latin American countries most babies receive the Tuberculosis vaccine, but unfortunately the effect of that vaccine is limited and cannot prevent infection in the long term.

When a child newly arrives at NPH, a skin test for tuberculosis is performed in our own clinics, which can detect if the child has had contact with the Mycobacterium tuberculosis. Combined with an exact examination and a detailed medical history, the doctor determines if treatment is necessary or if more diagnosis or an appointment with a specialist is needed.

We have had few cases of active tuberculosis in NPH. Since this condition is contagious it is necessary to isolate those patients in clinic until the medicine has had its effect. At the same time, the whole population must be screened for symptoms.