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The twinkle toes project: Changing lives one step at a time

1 August 2007


The Twinkle Toes Project is an international development program created to serve a two-fold purpose: to create a skilled workforce to meet the footcare needs of underserved geriatric and diabetic populations in Nicaragua, and to train a group of at-risk teenage women in marketable skills that they can use to support themselves financially through employment in footcare and/or nail care services.

The Twinkle Toes Project was conceived and birthed through the collaborative effort of three international parties: The Jessie F. Richardson (JFR) Foundation of Clackamas, Oregon, is a charitable non-profit organization that has established multiple social service programs in the United States and in Nicaragua to meet the needs of underserved geriatric populations. It sought to address the footcare needs of geriatric and diabetic populations in Nicaragua in response to the high prevalence of diabetes among Latinos, lack of podiatric services and limited access of geriatrics to adequate healthcare. For the Twinkle Toes Project, Keren Brown Wilson, founder and CEO of the JFR Foundation, developed the curriculum about aging-related changes, acute and chronic conditions common among the elderly, and business practices. She taught those portions of the curriculum during the Twinkle Toes Pilot Program in Managua, Nicaragua in May 2007. Asociacion Quincho Barrilete is a charitable Catholic organization in Managua, Nicaragua, that serves the needs of high-risk youths. It assists children and adolescents, aged 7-18 years, who are victims of sexual expluilalion, prostitution, forced child labor, family violence, sexual violence, substance abuse, and/or homelessness. The services provided by Quincho Barrilete to this fragile population include psychological counseling, family and social support, medical care, education and vocational training, legal representation, housing and meals. It sought to create a more secure future for some of its students by giving them vocational training and certification for work in the healthcare and/or nail care sector. It identified a group of seven teenage women from among its students who demonstrated maturity and commitment to successfully complete the Twinkle Toes Pilot Program, and helped to administrate logistics for the didactic and externship weeks. Molly Soasey and Aimee Stein are graduate students in the School of Physician Assistant Studies at Pacific University in Forest Grove, Oregon. They were recruited to contribute their skills and expertise to tie together the needs of the JFR Foundation and Quincho Barrilete: development of the medical curriculum and the curriculum for massage, manicure and pedicure procedures; Spanish language proficiency; teaching ability; and youthfulness to bridge the generation gap with the students. Soasey and Stein were the principal instructors during the didactic week of the Twinkle Toes Pilot Program.

Seven female students, aged 14-18 years, and five adult "buddies" participated in the Twinkle Toes Pilot Program. This program consisted of five eight-hour days of teaching and training topics including aging-related changes, acute and chronic conditions in the elderly; diabetes and its complications; conditions of the hands, feet and nails; massage, manicure and pedicure; and business management. Following the didactic portion, students complete a five-day externship to practice and develop their skills at hand and foot exams, recognition of pathologic conditions, simple treatment modalities, massage, manicure and pedicure. All seven students were present for the entirety of both portions of the program, successfully completed their knowledge and skills proficiency exams, and graduated from the program with "Twinkle Toes Clinician" certification.

The goals of the Twinkle Toes Project were partially achieved, in that a thorough curriculum was developed and a training program was implemented that demonstrated the capacity to educate and train students in basic skills for geriatric and diabetic footcare, massage, manicure and pedicure. To date, however, the students of the pilot program are still enrolled at Quincho Barrilete, and have not had the opportunity to find employment in footcare or nail care services. Thus, there is no guarantee that they will be able to use the skills gained through the Twinkle Toes Project to enhance their employment opportunities or financial status. Neither is there a guarantee that geriatric and diabetic patients will receive improved footcare as a result of the Twinkle Toes Project. Even so, forces remain in action to support the future accomplishment of these goals. The seven students will participate in monthly continuing education seminars and will receive business mentorship and training. A local doctor is working to establish employment prospects for the students in community health clinics, nursing care facilities and senior centers.

Apart from the opportunities for the participants of the pilot program, the Twinkle Toes Project has future viability in several avenues. Quincho Barrilete plans to train groups of students like those in the pilot program on a biannual basis. The JFR Foundation, together with a local doctor and nurse, will use the Twinkle Toes curriculum to train a group of Nicaraguan nurses in geriatric and diabetic footcare in November 2007, with an eye to expanding that training program to impact nurses nationwide and on an ongoing basis. And still in its conceptual stage is an idea to take the Twinkle Toes curriculum to rural parts of Nicaragua, where members of the Volunteer Brigade (community-based healthcare assistants) could be trained to improve early identification of health complications among geriatrics and diabetics, implement preventative and treatment measures, and know when to refer ailing community members on to higher levels of medical care. Only time will tell what the ultimate success of the Twinkle Toes Project will be. Although life offers us no guarantees, hope always remains.


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