Latest update May 13th, 2024 12:59 AM
Feb 04, 2009 Editorial
In our edition of yesterday, Minister of Health, Dr Leslie Ramsammy, was reported to have announced that his Ministry will soon embark on a campaign to encourage Guyanese to pay closer attention to their feet. He was not pushing foot fetishism onto an unsuspecting population but alerting us to the need for all of us to be aware of the deadly connection between diabetes and foot ulcers precipitated by the disease.
Overall, diabetes has become one of the world’s main disablers and killers. Apart from the obvious connection with renal failure and kidney diseases worldwide and in Guyana, it is the leading cause of blindness and a major factor in the development of cardiovascular and heart diseases, as well as of neuropathy (nerve diseases).
However, all these pathologies arise out of largely silent though deadly processes working through from within the body. Foot ulcers, on the other hand, arise from the outside of the feet and are thus visible in their early stages.
Foot disorders such as ulceration, infection, and gangrene are the leading causes of hospitalisation in patients with diabetes mellitus or Type 2 diabetes, which affects adults. Yet, for all of this, too often the ulcers are allowed to develop beyond control and result in either foot amputations or even death. Diabetes is the leading cause of foot amputations in the world and in 2007 it was announced that we had forty diabetes-related amputations here in Guyana. Anecdotal evidence would suggest that this figure is on the low side.
Last year, Dr. Ramsammy claimed that thirty thousand people suffer from the disease in Guyana. These figures seemed out of sync with the numbers that show up when foreign medical teams visit Guyana and offer free clinics.
Most involved health workers believe that the numbers are also much higher. He said that diabetic foot disease is recognized as the major cause for hospital admission in the diabetic population. At the G.P.H.C, this problem is the single most common reason for admission to the surgical ward (30 percent of all admissions) with 60 percent spending more than one week in the hospital.
Back in September 2007, the Minister announced the opening of the Diabetes Foot Centre (DFC) at the Georgetown Hospital for the prevention, diagnosis and treatment of diabetic foot disease and promised that in three years time every hospital in the country will also have a DFC facility.
The Minister is now reported to have said with the implementation of the programme, “there has been a reduction in the number of amputations in Guyana”. We have some doubts about this claim, in light of the ambiguities in the 2007 figures and would appreciate if the figures on amputation for 2008, which should include those from all medical institutions – including private ones – can be released with the comparable figures for 2007.
This rigorous reporting of the facts is necessary because we do believe Dr Ramsammy’s warnings on the dangers of untreated diabetic-related foot ulcers and it is important to learn whether our interventions are having positive impacts.
The Minister expatiated on the “fancy equipment” utilised by the DFC at Georgetown Hospital for screening and diagnosis – but what about the treatment aspects? Removable cast walkers, or specialised non-pressure shoes, is the mainstay of initial treatment but we have been informed that these are not utilised at the DFC.
Pressure relief using total contact casts (TTC’s) is considered the optimal method of management for neuropathic ulcers. Are they utilised at DFC? We understand that the traditional bandages, which demand just as high a skill level from the nurses that apply and remove them to avoid iatrogenic lesions have remained the mainstay. Do we have, and are we maintaining the requisite skill level at the DFC?
The genetically engineered platelet-derived growth factor becaplermin (Regranex gel) is approved for use on neuropathic diabetic foot ulcers and can expedite healing. Is this available in Guyana? We are a poor and developing country and we understand that we face funding constraints on many of the innovations that can improve our living conditions. However, we must set standards for our performance in line with those in comparable environments.
In the drive to deal with the devastating scourge of foot amputations arising from diabetic ulcers, we cannot afford compromises. Or false promises.
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