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

Building on the South African pilot, Army of Eyes is now scaling in India, where national infrastructure and population size create one of the most significant opportunities globally for early MSK detection. India is home to more than 472 million children, yet MSK screening remains largely absent from national child health programmes.

Army of Eyes is addressing this gap by embedding MSK assessment into existing government systems through partnership with the Rashtriya Bal Swasthya Karyakram (RBSK).

Tin Soldiers has been working alongside RBSK in Meghalaya and Andhra Pradesh, supporting both screening programmes and specialised interventions. The integration of pGALS into this system represents a critical step toward institutionalising MSK screening at scale.

MEGHALAYA

Implementation at District Level

27 healthcare professionals trained, including medical officers and physiotherapists

Deployment across 1,200+ villages supported by ASHA workers and DEIC centres

Introduction of pGALS within routine RBSK screening pathways

Use of posters, flipbooks and handbooks to support clinical practice

ANDHRA PRADESHA

Statewide Scale-Up

Rollout across 34 District Early Intervention Centres

60 healthcare professionals trained to date, with further cohorts underway

Multidisciplinary training including paediatricians, therapists and orthopaedic specialists

Strengthened referral pathways linking primary care to specialist services

By embedding MSK screening within RBSK, Army of Eyes has the potential to reach millions of children annually, shifting early diagnosis from a specialist function to a routine part of child healthcare.

EDUCATIONAL INNOVATION: Designed for Scale

A defining strength of Army of Eyes is its focus on practical, scalable education, ensuring that knowledge translates into action at the point of care.

The programme is supported by a growing suite of adaptable resources, including:

MSK diagnostic handbooks with integrated rare disease guidance
Pocket flip-books and red-flag checklists
Mobile-first micro-learning delivered through WhatsApp
AI-driven multilingual adaptations

At the centre of this ecosystem is the pGALS training video series, led by Dr Waheba Slamang.

The two-part series combines step-by-step clinical instruction with real-world demonstrations on children with JIA and FOP, highlighting key abnormalities and red flag signs.

These videos are designed for use across both frontline and formal training environments and are already embedded within nurse education programmes.

Importantly, they represent the first integration of FOP into mainstream MSK screening education - reinforcing the programme’s “Trojan Horse” approach to rare disease recognition.

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.