ARMY OF EYES

Paediatric Screening Program

Building a Global Network for Early Musculoskeletal Diagnosis and

Connection to Care

A global paediatric musculoskeletal (MSK) screening and training initiative

Army of Eyes is a global paediatric musculoskeletal (MSK) screening and training initiative that began in South Africa and is now scaling into India with partnerships developing across the United Kingdom, United States and Canada.

At its core, Army of Eyes equips frontline health workers with the skills to recognise early signs of musculoskeletal disease (MSK) in children and connects them to timely, appropriate care - from rare conditions like Fibrodysplasia Ossificans Progressiva (FOP) to more common disorders such as Juvenile Idiopathic Arthritis (JIA).

The initiative is anchored in the concepts presented by the Paediatric Musculoskeletal Matters (PMM) International and PMM Nurse online educational platform, and builds on the validated pGALS (paediatric Gait, Arms, Legs, Spine) screening examination - pGALS is a rapid, evidence-based musculoskeletal screening tool designed specifically for use by non-specialists in everyday clinical practice, developed and championed by the University of Newcastle under the leadership of Professor Helen Foster and team.

Army of Eyes translates this evidence into action.

SOUTH AFRICA:
Proof of Concept in Action

South Africa is where Army of Eyes moved from concept to clinical impact.

Working in partnership with the Unjani Clinics Network and the Knowledge and Instructional Development Training Hub, University of Cape Town, the programme focuses on strengthening the recognition of MSK conditions at primary healthcare level - where most children first present.

THE CHALLENGE

Over 20 million children

under 18.

Only 10 paediatric rheumatologists nationwide.

Nearly half of surveyed nurses had never heard of pGALS.

Baseline confidence scores in

MSK history, examination

and red-flag recognition

were low.

THE INTERVENTION

CPD-accredited in-person and online training by paediatric rheumatologists and a physiotherapist.

Embedding pGALS into routine consultations for children aged 5–16.

Ongoing digital mentorship via the Tin Soldiers Global Clinician Champions Alliance

Development of practical “leave-behind” tools, including a mobile-friendly pGALS instructional video (developed with the Harry Crossley Children’s Nursing Development Unit, University of Cape Town) and MSK handbooks.

Early Outcomes (South Africa Pilot)

THE RESULTS

114 children screened.

Nearly 20% identified with abnormalities.

62.5% of referrals were

MSK-related.

Improved nurse confidence in MSK examination after training.

CONDITIONS IDENTIFIED INCLUDE:

JIA

Severe spinal deformities

Gait abnormalities

Clubfoot

Hypermobility

Neurological conditions requiring referral

MOST IMPORTANTLY

One new case of FOP was identified directly as a result of MSK training and awareness.

This is the “Trojan Horse” effect in action - embedding rare disease awareness into broader MSK training so that pattern recognition becomes possible in everyday care.

Case Study: FOP Identified
Through MSK Training

A five-year-old girl had previously undergone a biopsy for unexplained “lumps on the back.” Only after an Army of Eyes MSK teaching session did a paediatric registrar connect the dots. Classic features - short great toes, paraspinal masses, restricted neck mobility — were recognised as consistent with FOP. The case was re-evaluated, invasive procedures halted, and a multidisciplinary management pathway initiated.

The education and training has likely altered the child’s long-term trajectory.

INDIA:
Scaling Through National Infrastructure

Following the South African pilot, Army of Eyes is now actively rolling out in India where scale and infrastructure create extraordinary opportunities. India is home to 472 million children, yet national child screening programmes currently include very limited MSK assessment beyond obvious deformities.

PILOT TERRITORY: West Garo Hills, Meghalaya

MEGHALAYA, INDIA:

Population of 0.8 million

1,209 villages

5 District Early Intervention

Centres (DEICs)

7,000+ ASHA workers

PROGRESS TO DATE

20 Medical officers and physiotherapists trained in pGALS (Q4 2025)

Plans to train approximately 100 additional healthcare workers in 2026

Longitudinal data collection underway to assess referral pattern changes and reduction in neglected MSK diagnoses have been trained by orthopaedic surgeons involved in the Army of Eyes project.

THE INDIA ROLLOUT FOCUSES ON:

Adapting pGALS training for ASHAs and district-level teams

Embedding MSK screening within existing child health pathways

Strengthening referral links to tertiary centres

Generating implementation data over 18 months

EDUCATIONAL ASSETS: Built for Global Reach

Army of Eyes is developing a suite of adaptable educational resources

EDUCATIONAL

RESOURCES:

MSK Diagnostic Handbook (including integrated FOP guidance)
Step-by-step pGALS instructional video
Pocket flip-books and red-flag checklists
Mobile first micro-learning delivered through WhatsApp
AI-driven multilingual adaptations

ALL MATERIALS DESIGNED FOR INTEGRATION INTO:

The Tin Soldiers platform
PMM International and PMM Nurse platforms
Undergraduate and continuing professional education environments

PMM’s platform alone reaches over 1.4 million users globally, creating a powerful dissemination pathway for the Army of Eyes educational model.

DEVELOPING PARTNERSHIPS:
Building a Global Network

While South Africa and India are the primary implementation territories, Army of Eyes is actively building partnerships in:

United

Kingdom

Via PMM and

PMM Nurses

United States

Sports physical and primary care pathway pilots under

discussion

Canada

Early-stage

planning

The long-term vision is a distributed global network of trained eyes; frontline clinicians able to recognise musculoskeletal red flags early, regardless of geography.