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Don’t lose your limbs to diabetes

•Nigerian doctors in the Diaspora offer lifeline to diabetic patients

•Dr James Fullwood

Six years ago, about 10 medical doctors of Nigerian and Black–American descent, based in the United States of America got together with a common purpose—to stop preventable and unnecessary limb amputations in Nigeria as a result of foot ulcers and other complication of diabetes.

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Convinced about the need to establish extensive foot care education within the framework of a multi-disciplinary foot care system in the country, these Nigerians in the Diaspora formed a Not-for-profit organisation called: “The International Limb Salvage Foundation,” with primary focus on ensuring the essence of podiatry or podiatric medicine (branch of medicine devoted to study, diagnosis, and medical and surgical treatment of disorders of the foot, ankle and lower extremities).

Their worry was justified because Nigeria carries a high burden of diabetes even as a high percentage of this burden remains largely undiagnosed and untreated.

Indeed, the lifetime risk of persons with diabetes developing diabetic foot ulcers in Nigeria is as high as 25 percent in addition to suffering other lower limb complications.

Diabetic foot ulcer is a serious and potentially life-threatening complication of diabetes and multicentre observational studies of patients hospitalised for the malady show that the burden of diabetes is not only high but the incidence is on the rise.

This is worsened by the gaps in low level of foot care knowledge among the diabetic patients, over-dependence on self-medication and unorthodox medicine following development of foot ulceration, late hospital presentation, and high amputation and mortality rates, etc.

No doubt, limb salvage and extensive foot care education within the framework of a multi-disciplinary foot care team is highly desirable in Nigeria

An encounter with a couple of these Nigerian doctors:Dr. Kevin Adeleke and Dr. James Fullwood Jnr., was  an eye-opener. Adeleke who was born in Lagos, left Nigeria when he was only five months old, resides in Manhattan, New York, and is practicing emergency medicine in Queens, also in New York

His father was a Nigerian civil engineer and his mother was an American fashion designer and book editor. Adeleke earned a Bachelor of Science degree in Medical Technology from Morgan State University, Baltimore, Maryland, and a Medical Degree at the Chicago Medical School at the Rosalind Franklin School of Medicine and Science, in North Chicago, Illinois.

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Fullwood, on the other hand, specialises in foot and ankle-foot and ankle reconstruction and diabetic limb salvage. He is an associate clinical professor of surgery and biomechanics at Western University of Health Sciences. He is both a national and international speaker concerning podiatry and health policy.

An associate member of the American College of Foot and Ankle Surgeons and Fellow of the American College of Foot and Ankle Orthopedics and Medicine, Fullwood is a member and national delegate to the American Podiatric Medical Association and President of the Maine Podiatric Medical Association, amongst others.

Tracing the origins of the Limb Salvage Foundation, Adeleke and Fullwood recalled how Nigerian endocrinologist, Dr Afoke lsiavwe, Medical Director, Rainbow Specialist Hospital, Lagos,  got a grant from the National Diabetes Federation to create awareness on diabetes and diabetic foot in Nigeria.

“Dr Isiavwe partnered with doctors in the United States and obtained a grant to bring about training programmes based in Lagos, That grant ran for about three years and once the grant ran out, we decided that we would continue the work in Nigeria out of our own pockets, and we have done that for the last three years.

“We work with hospitals such as Gbagada General Hospital and the Rainbow Specialist Hospital. We are currently working with the Commissioner for Health in Kano State as well as the government there to bring back the government-based programme and to teach doctors and nurses in the north about diabetes.”

The doctors confirmed that they have been working with the Kano State government for about a year now and are planning to meet with them in June as well as having a programme starting later in October.

“We established ourselves in the United States in the State of Maine, the not-for-profit organization has begun to flourish, building its website, and working on its social media presence to bring about more awareness of diabetes and what they do as providers in Nigeria.

“We still talk with Dr Isiavwe as she is still very much part of the job that everyone is doing internationally. The scope of this NGO is limb salvage and so as far as emergency medicine is concerned limb salvage raises some overlaps.

“Patients presented in the emergency room with wounds or diabetic wounds or foot infections that are worsened from bad diabetes, and our resolve was all these should be treated immediately. The patient’s should be referred to the specialist immediately.”Lamenting the shortage of podiatrists in Nigeria, they expressed optimism that that once podiatry is widely available in Nigeria the Foundation would begin trainings on the speciality.

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“The most effective self-care is treating with a team approach, because there is so much information as far as medicine is concerned. There needs to be division of labour meaning that no doctor can know everything. Everyone is an expert in his or her portion of the field, and if everyone is an expert in their portion of the field then that leads to a high level of expertise in that specific practice.

“If we all work as a team then the expert in one portion can manage the patient and then refer the patient to another expert who has expertise in the portion.” The doctors remarked that statistics out there shows that diabetes is on the rise in Nigeria.

“There are several written papers on this trend and there is talk about as great as 50 per cent amputation rate when the patient presents with diabetes and undergoes some type of amputation that affects their livelihood and sometimes even leads to suicide.

“This development causes a strain on those families that need to work and need to be mobile to provide for their dependents. It makes it very difficult when someone loses a leg as a result of diabetes.

“We work with Dr Babajide Ogunlana, a podiatrist in Huston, Texas, who visits Nigeria every couple of months. He is advocating to the Medicine and Dentistry Council for the recognition of podiatry as a profession in Nigeria because of the problem that the endocrinologists are seeing in the country.”

Adeleke and Fullwood acknowledged that diabetic foot is an epidemic in Nigeria now, spreading from the North all the way through to the South and from cities like Lagos to the most rural parts of the country as well.

“The goal of our NGO is to teach as many nurses and doctors as possible, because when we leave we want the conversation to continue and we want to increase the level of care doctors are providing across the board because this is a team approach.

“It is different from other NGOs because this is a Foundation that raises money for education and training of nurses, doctors, and wound care providers across Nigeria to educate and treat patients with the diabetic foot disease.”

Giving a word of admonition, they said: “Everyday, when people with diabetes take their shower, they should examine their feet to make sure that there are no wounds, or sores because the thing with diabetes is that the nervous system doesn’t work very well.

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“Sometimes they do not feel the pains, and if you don’t feel pain you won’t know that there is a wound until it becomes infected and turns into an issue which progresses to amputation.

“The Foundation is working closely with the Diabetes Association of Nigeria and Gbagada General Hospital, Lagos. We have a formal relationship with the Diabetes Association of Nigeria and actually helped found it.

“There is a board now that is beginning to develop a platform for formal education in podiatry in Nigeria. The board has only been established for a year, Dr Babajide is also on that board and their job is to begin to develop ideas on how podiatry will be developed as a speciality in Nigeria.

“Podiatry  has developed quite significantly in the Western countries and there are many Nigerians who are podiatrists abroad who would like to offer their services in Nigeria. That’s one of the things policy makers can help with.”

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