Diabetic Foot Centre to open branches in other regions

Jul 24, 2011 News

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Eleven years after being a diabetic Jagdeo Biswah confronted one of his worst nightmares, when recently several toes were amputated from both legs.
Staring blankly at empty gaps in his feet where toes once were, Biswah is worried about what his future holds.
He has been undergoing foot treatment at the Diabetic Foot Clinic, located at the Georgetown Public Hospital Corporation (GPHC). Three weeks ago what started out as a minor sore (in his opinion) was actually a foot ulcer at its worst. Owing to the quick detection of the ulcer, Biswah was admitted for treatment.

He visits the facility regularly and receives medications free of cost. In addition, whenever he is unable to attend the clinic he visits the health centre within his district for medications.
Biswah is among the 40,000 adults in Guyana who are diabetics and among the 20 to 30 persons who visit the Diabetic Foot Centre daily between Mondays and Fridays. The clinic has been established since July 2008 and came out of a collaboration between GPHC and the Canadian Association of General Surgeons.
According to Dr. Indira Bhoj, the objectives of the Diabetic Foot Centre are to prevent ulcers and the reduction of the number of amputations. She added that up to one in every four persons who have diabetes is susceptible to ulcers.
Diabetes is a chronic condition associated with abnormally high levels of sugar (glucose) in the blood. Some of the symptoms associated with this chronic non-communicable disease include increased urine output, thirst, and hunger as well as fatigue.
Dr. Bhoj emphasized that because of neuropathy (a diabetic complication involving the numbness of feet or loss of protective sensation) people with diabetes are more likely to get foot ulcers.
In achieving one of the clinic’s goals of preventing ulcers, health workers in various health facilities were trained to conduct 60 second screening. Dr. Bhoj posited that key opinion leaders created exercises from training received from their Canadian counterparts and disseminated lessons through workshops to local health workers. This allows the easy detection of persons with high risk for ulcer formation.
Detection of foot ulcers at these facilities is the entrance to the Diabetic Foot Centre and the facility is operated via appointments. Dr. Bhoj emphasized that when patients visit the facility for the first time they are registered and given a date to return. This is done during the morning shift of the clinic.
She stressed that when a case is an emergency, the patient would go to the Accident and Emergency Unit where he or she would undergo an initial evaluation and treatment and then be placed in a ward in GPHC.
The admitted patients would undergo treatment by nurses of the clinic during the afternoon shift.
She emphasized that establishing Diabetic Foot Centres along the Coastland, and in Regions Two, Three, Four, Five, Six and Ten, are on the agenda. This anticipated expansion comes under phase two of the Guyana Diabetic Foot Project.
Phase one of the project saw the establishment of the existing Diabetic Foot Centre at GPHC.
The Guyana Diabetic Foot Project is a collaborative effort between the Ministry of Health and the Canadian International Development Agency.
Amputation prevention is of major importance to the facility as it is cognizant of the negative effect the loss of limb may have on persons and their family life. During this stage, effort is placed on dressing, the utilization of inter-professional practices, and evidence based medicine to treat wounds.
It was noted that the treatment of foot ulcers and strategies used to prevent amputation is case specific. However, glycemic control, wound care, and debridement (remove at an optimal time the dead tissue) are utilized in this phase.
Dr. Bhoj stated that the inter-professional approach has helped the clinic execute its mandate effectively. Every health care professional involved in the process is equipped to assist and treat patients.
She alluded to the fact that local nurses were trained in the International Inter-Professional Wound Care course in Canada. “The nurses are very capable in treating wounds,” Dr. Bhoj stated.
In addition to being staffed with doctors and nurses, the facility is equipped with visiting nutritionist, physiotherapist, and rehab assistant. Dr. Bhoj added that the facility has a faculty in Canada and in event there is a serious case the faculty is contacted for advice.
The facility engages the GPHC surgical and medical teams on a daily basis for consultations and advice on patient care.
Like many other treatments to work or to prevent injuries from deteriorating, patients need to adhere to simple lifestyle advices from their healthcare professionals.
Dr. Bhoj emphasized that a healthy diet comprising less carbohydrate, more fruits and vegetables, and proteins coupled with regular exercise a diabetic may have long life with less complications.
As a part of medical care, the Diabetic Foot Centre attempts to address individual patient centered concerns to ensure positive outcomes.
Biswah noted that he has been taking the advice from the nutritionist concerning his diet. He knows the road is rough and his doubts about walking and working are affecting him. However, he is optimistic that the Diabetic Foot Centre would be there for him.

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