Finding a Low-Cost Treatment for Clubfoot

Written

Finding a Low-Cost Treatment for Clubfoot

Chesca Colloredo-Mansfeld’s journey from online retail to academia to a healthcare nonprofit has paid off in ways that can’t be measured.
“People had invested a lot in me,” Chesca Colloredo-Mansfeld says. “I thought it was important to give back.” | Lissa Gotwals

In 2004, a colleague approached Chesca Colloredo-Mansfeld in her office at the University of Iowa’s business school with a video in hand.

“We hear you have a passion for Africa,” he said, “and that you’re a strategy person.”

At the time, Colloredo-Mansfeld was director of the Hawkinson Institute, an investment banking program at UI’s Tippie College of Business, after having spent four years at the internet start-up eToys. The visitor explained that a doctor at the university, Ignacio V. Ponseti, had pioneered a comprehensive technique for treating clubfoot in the 1940s. Clubfoot is a birth defect that causes one or both feet to turn inward and upward, making it difficult to walk properly. It affects one in every 800 newborns worldwide.

Using gentle manipulation and serial casts, Ponseti’s technique gently and gradually guides a child’s tendons, ligaments, and bones into proper alignment without the need for major surgery.

“The colleague showed me a video of a boy standing in a doorway, and he had these twisted feet,” recalls Colloredo-Mansfeld, who received her MBA from Stanford Graduate School of Business in 1992. “He was about 10 years old, and you could see through the doorway all these other kids playing while he was standing there with his head hanging down.”

Of the 175,000 babies born with clubfoot worldwide each year, 90% are from countries with limited access to proper treatment. Colloredo-Mansfeld learned that Ponseti, in his 90s at the time, had a dying wish to export his treatment to impoverished countries, where for about $250 it offered a highly effective but low-cost solution to what otherwise can be a lifelong affliction.

Moved, she began thinking about how to solve that problem. In 2010, Colloredo-Mansfeld left behind her academic career to launch a nonprofit called MiracleFeet, which so far has helped 35,000 children in 26 countries by partnering with local healthcare professionals to create clubfoot programs. MiracleFeet, based in Chapel Hill, North Carolina, now has 19 full-time employees. An additional 20 people are based in India.

“I had been given these amazing opportunities, including a spot at Stanford GSB, but having a job and having a lovely family was not enough,” says the mother of three. “People had invested a lot in me, and I thought it was important to give back.”

Talk us through the early stages of developing MiracleFeet, from idea to funding to execution.

By the time this colleague came to ask for my help, the Ponseti method had finally been established as the gold-standard treatment in the U.S. When I got involved, doctors were basically saying, “Now that this method is totally embraced in the U.S. and Europe, we can take it to the rest of the world where very little treatment is available.” I started working with a handful of people in the orthopedic department at Iowa, but I actually got very frustrated.

Why?

The University of Iowa is a big research institution. A significant portion of funds raised would go to the university, as that’s what universities do to cover their overhead. I argued that we needed to set up a separate nonprofit and decide if we were training doctors or treating children, because our donors would need to understand the impact we were having. But none of this went down very well with the orthopedic surgeons. It was frustrating.

So they needed your help to take it worldwide?

That makes me sound like I’ve played a bigger role than I have. What I saw in this was that Dr. Ponseti had done the difficult part finding a better treatment. And I thought, how hard would it be to get something that makes so much sense out to the rest of the world? Compared with a lot of the world’s problems, solving clubfoot is not that difficult, although it has certainly been more challenging than I anticipated.

And then your husband (an anthropologist) took a job at the University of North Carolina and you left Iowa behind — but not the idea of helping solve this problem.

I just couldn’t get the image of this child out of my head, and I kept thinking this is what I really wanted and needed to do. My husband’s work often took us to Ecuador, and I’d see kids with untreated clubfoot and think, “This is nuts. There’s a solution for this.” I had grown up in Africa [as the daughter of a British diplomat] and always thought I would work in international development. Like many, I got caught up in a corporate career and raising our kids, but inside me was a deep desire to make a difference in the kind of places where I had grown up. Perhaps naively I thought that with the management and business skills I’ve been lucky enough to develop, I ought to be able to make a difference.

At some point, you connected with a group of parents who shared your interest in creating a nonprofit to tackle this issue.

There are so few problems where you have an obvious, low-cost, easy solution. We didn’t have to solve the problem; we just had to bring the solution to the kids who needed it.
Chesca Colloredo-Mansfeld

Yes; fortunately, I was put in touch with some parents who had children born with clubfoot, who wanted to make sure all kids had the treatment their children had had in the U.S. They had even come up with a name for the organization they wanted to create: MiracleFeet. After meeting them in New York, we started talking about the fact that we really needed to hire someone to focus on this full-time to actually make this happen. As I was flying back on the plane, I thought, “This is my chance. If I don’t do this now, when? I should just quit my job and offer to do this.” This is what led to the creation of MiracleFeet in 2010.

What appealed to you about that challenge?

This seemed like an implementation issue. There are so few problems where you have an obvious, low-cost, easy solution. I thought someone with an MBA ought to be able to roll this out. It was a good match with my skills. We didn’t have to solve the problem; we just had to bring the solution to the kids who needed it.

And the return on your investment?

MiracleFeet combines a simple solution with the opportunity to have an enormous impact on a child’s life. In many countries, there’s shame and stigma associated with having a child with a disability. Often, they’re not even allowed to go to school. They’re hidden away in the shadows of houses. They’re isolated, which means they’re at high risk of physical and sexual abuse. What’s the future for this child? It’s terrible. But if we can get in there within the first year of birth and provide a simple, safe medical intervention that costs us $250, that child will have all the opportunities of any other person. You’re putting that child’s life on a totally different trajectory.

In 2016, you were awarded a Google Impact Grant of $1 million. What impact did that have on the organization?

In the first phase, we used that money to revamp our data-collection system. We’ve always collected data on the children we help, because from the beginning we felt it was critical not only to monitor quality but also to track impact. The Google grant let us shift from a clunky PC-based system to a mobile phone-based app so that doctors in local clinics can collect patient information and take photographs of the feet at the point of treatment. It allows us to analyze the information and feed it back to our local partners in the clinics so they can see what’s going well and what they need to work on. It empowers them to improve their own programs and the outcomes for the kids.

And the second phase?

We’re connecting that system with an SMS system, so we can send messages to all the families. If a child doesn’t show up for their appointment, we can instantly send a text to the mother and say, “Sorry you missed your appointment. Is everything OK? What can we do to help you get here?” We also send out automated educational messages about how to handle the child during treatment. We are also using the funds to digitize the curriculum for training healthcare providers in the Ponseti method, and recently we’ve been experimenting with adding pressure sensors to the braces so we can monitor brace compliance.

So this project ricocheted from Iowa to North Carolina, all the way back to Stanford?

In 2012, I reached out to Stanford’s Design for Extreme Affordability program. They put two teams of students on our project who came up with a very cool new brace design that met all the medical specifications for a fraction of the cost. The MiracleFeet brace costs us less than $20 to produce and has all the functionality of a brace that costs $350 to $1,000 in the U.S. We have just launched our fifth project with the Extreme program, so it has been a terrific partnership. James M. Patell, Stuart Coulson, and Joan Youngblood Dorsey have been wonderfully generous and supportive of MiracleFeet’s work.

Any particular professors, books, or experiences you had as a student at Stanford GSB that helped shape your approach at MiracleFeet?

I tend to be the analytical type who loves spreadsheets, and I came in having worked for an investment bank, but I remember sitting in an organizational behavior class and thinking, “This is a whole different angle on business. I’ve never really thought about these issues.” Now I wish I’d paid more attention to that softer stuff, to HR, creating culture, and to organizational behavior and development. I was naive when I was there, but I look back and realize how important those other aspects are and how much I’m drawing on them now.

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