In 2014 the International Diabetes Federation reported that Pacific Island countries account for eight of the top ten countries in the world for diabetes prevalence, with some rates as high as 37%. The increasing burden diabetes is placing on social and health systems in the region, makes the prevention and treatment of Diabetes complications a priority. Foot wounds (ulcers) are amongst the most common complications of uncontrolled diabetes. People with diabetes are more susceptible to developing foot ulcers that are slower to heal. Currently in many Pacific countries, untreated, infected diabetic foot ulcers often lead to multiple amputations and sometimes death. In Suva, Fiji there is one lower limb amputation every ten to twelve hours.
However, the World Health Organisation estimates that 50% of all hospital admissions and amputations as a result of diabetes can be prevented with appropriate foot care. A Diabetic Foot Clinic allows all aspects of diabetic foot care to happen at the same time, alongside other medical and surgical services. Preventing amputations is beneficial for the client, their family and their community; it also has the potential to reduce health care costs by decreasing hospital admissions and on-going amputee management costs (including Prosthetic devices).
Motivation Australia and the Samoa National Health Service have been working together over the last six months to introduce the Diabetic Foot Clinic (DFC) into outpatient medical services. This has been achieved through the Samoa Integrated Mobility Device Service project (SIMDES). For more information on SIMDES, click here, or download a SIMDES project flyer.
The DFC provides wound care including debridement and dressing, orthotic offloading devices and diabetes education for clients at risk of amputation. At each DFC appointment clients see the Nurse, Podiatrist and the Orthotist working as a team.
Crucially, the DFC team has linked with other National Health Service (NHS) departments through referrals to Dietary Services, Physiotherapy, Eye Clinic, Medical and Surgical Doctors and the MDS.
The DFC Clinic has been very successful, with the following key outcomes:
- The multi-disciplinary team (MDT): The MDT has been key to the success of the DFC, with team members bringing a broad range of knowledge and skills to benefit the DFC clients. Knowledge and skills shared amongst the team members has also raised the overall capacity of the team to provide effective services.
- Change in attitudes: A change in clients’ attitudes and behaviour has been one of the biggest successes noted by the DFC team with many clients taking more control of and responsibility for their health. This is attributed to effective communication as part of client education, as it enables clients to understand what is happening, providing motivation to continue with their treatment. Positive outcomes of treatments and the sharing of stories between clients is also key to these changes.
- Wound healing: Consistent progress of wound healing has been a positive outcome for the DFC client group. The service has seen high numbers of serious surgical and diabetic wounds heal in a relatively short period of time.
“With their advice on controlling my blood sugar levels in order for my ulcers to heal, it has changed my diet a lot too. Not only do they focus on my foot wounds, but they’re concerned about my health in general as well”
(words of a client of the DFC)
During the recent six-month evaluation, there was strong support from NHS management for the continuation of the DFC, ensuring on-going MDT management of clients with diabetic foot ulcers. This is fantastic news for all involved and will hopefully lead to the reduction of diabetes related amputations in the future.