Simple, but not easy. On my present trip to India, this phrase has come to mind in several contexts. CURE International India Trust (CIIT) is the umbrella under which the CURE Clubfoot Worldwide (CCW) program is administered and managed. I attended the CIIT board meeting, which has impressive and helpful members who are devoted to the continued good work and expansive growth of the program. To do this effectively, CIIT was registered as a trust, and several applications were made to be able to receive funds without tax consequence. Simple goals, but not an easy process – there are at least four approvals needed, and the ability to receive funds from outside of India on a more permanent basis still awaits. The government appropriately is concerned to vet our organization, ensuring we are legitimate and have fidelity to our mission. The authorities want evidence that we spend our money with integrity, but we cannot bring in funds until they grant approval.

Simple, but not easy.

I attended clubfoot training in Trivandrum, the capital of Kerala, the southwestern state in India. The Ponseti methodology and techniques are wonderfully and expertly taught by Dr. Mathew Varghese, the medical director of CCW-India/CIIT program. Dr. Mathew learned directly from the late Dr. Ponseti and has benefited from dialogs with Drs. Shafique Parani, Jose Morcuende, Norgrove Penny, and Chris Lavy – all well-respected clubfoot experts within the orthopedic community. While training, Dr. Mathew interspersed accounts of his own mistakes and lessons learned for the benefit of the professors and residents that came to the training. The subtleties and nuances of the Ponseti technique with regard to casting, performing the tenotomies, and bracing were clearly presented. Consistency – to use the Parani Score, two people to cast, proper brace, communications to parents – is preached throughout. Students hear lectures, use foot models, and observe real patient evaluations. The most time is spent on recognizing the exceptions and avoiding common mistakes. The salvation is in the details – good focus on specific issues is critical success. These lectures and hands-on training have been given almost 20 times by Dr. Mathew in India – and several dozen more times throughout CCW programs. Yet, the lessons learned and mistakes to avoid have been repeated from day one and will be again. Although the treatment and protocol is wonderfully straightforward and well documented, the next child’s clubfoot can be complex and require pertinent flexible judgment.

Simple, but not easy.

CCW employs counselors as an integral part of our program structure and process. The counselor becomes the liaison between the clinician and the family. The Ponseti method relies on the parent to be compliant with the use of foot abduction braces (FAB) once the child’s clubfoot is corrected through casting and a tenotomy. The bracing is a simple process – for a prescribed period of time the child wears it 24/7 (depending on the age of the child) and then post that time period when the child sleeps (naps and nighttime). It is simple – but it is not easy. The parent needs to recognize signs that the child’s foot is growing too large for the shoe in the FAB; they need to comfort the child if he/she becomes agitated with the brace in the middle of the night; they need to devote themselves to keep the appointments for evaluations. They can become nervous or disheartened; we give them our counselor’s mobile number to call anytime, because we know their job with the use of the brace is simply stated, but it not easy when they think they are all alone or don’t understand what to do.

Simple, but not easy.

Through 30 June 2012, CCW has been able to treat almost 29,000 new patients since 2006. CCW now has over 24 programs in 18 countries, with seven state programs in India alone. Once we receive approval for receiving outside funding in India, we can expand to nine more states due the increased generous funding of our partner miraclefeet. Additionally, the state governments of India provide great help through clinicians, clinic space, and casting supplies to complement the funding from miraclefeet, CBM, and Riverside Foundation. Organizations and residents of India – including school children – are beginning to give financial assistance. All this requires prudent record keeping, reporting to each partner, and increased program management capacity to match the expansion for helping more children and families in India. Raising the necessary funds, keeping within our budget, monitoring and maintaining quality, and establishing new programs – not only in India, but also in Africa, Central America, and the rest of Asia – is …

Simple, but not easy.

To those donors and partners who join with us and contribute to us financially, we say thank you. To those who provide great assistance through gifts-in-kind for our work, we are very grateful. To those who encourage, support, and pray for our benefit as we endeavor to serve children and their families – this is more appreciated than we can describe to you. We realize to do these significant things is simple to say, but not always easy to do. We thank you.