Diabetic FootCare in Kosovo Necessity for Multidisciplinary approach using Telemedicine Vjolca Kola, Podiatriste, Gjakove, Kosovo Margreet van Putten, MD, Eindhoven, The Netherlands Dashurije Koshi,MD, Gjakove, Kosovo Med@Tel Conference,April 9-11,2014 Luxembourg
Facts about the diabetic foot ± 160.000 diabetic patients in Kosovo ± 25% = ± 40.000 patients will develop foot problems due to: neuropathy vascular problems and/or limited joint mobility Of these 40.000 patients will ± 8.000 patients develop an ulcer ± 4-10% = 320-800 patients have to be amputated due to either vascular problems and/or infection 5-year survival is 10-30%!
Costs of diabetic foot problems Diabetic foot problems are very expensive These devastating complications of diabetes can be prevented by organising multidisciplinary (preventive) care and treatment (Int. Consensus on the Diabetic Foot 2011)
The Diabetic Foot in Kosovo NO diabetic foot awareness till 2004 I started a little foot clinic in my basement in 2005 I am educated as a Podiatriste at the School for Podiatry (Fonty s University)
Diabetic Foot Unawareness Very little number of diabetic patients showed up for foot care in my clinic reasons: Afraid? Unknown? No money! NO AWARENESS!
Foundation Podiatria Kosovo Help from the Netherlands from: Dr. Margreet van Putten Podiatrists (email/internet contact) Students in Podiatry graduation project = how to encourage diabetic foot care in Kosovo Podiatry practices + supply companies from Holland A software company to make a good patient registration possible
First Diabetic Foot Clinic Opening 25 th of April 2009 Dutch Ambassador in Kosovo Lots of media attention
New clinic since 2012 Better entrance and more hygienic
Results 177 diabetic patients consulted the foot clinic during the first year (2008-2009) In this first year: 64 feet showed an existing ulcer The ulcers differed from small neuropathic ulcers to severely infected mostly neuroischemic ulcers Up till now (2014) almost 1000 diabetic patients visited my clinic.
Examples of diabetic foot problems
Treatment SIMPLE treatment: Callus removal Honey bandages Off-loading
Debridement Callus removal with scalpel
Off loading Felt padding and orthoses as protection against pressure during walking
Re-ulcerations Too many re-ulcerations, due to: Lack of (personal) care Lack of good shoes!
Teaching professionals Knowing that good education of patients starts with educating professionals;help came from abroad The Diabetic Foot Care Assistant Program A basic course on screening of risk factors for ulceration + basic foot care developed by the Int Working Group on the Diabetic Foot
DFCA program in Gjakova 4 students in Podiatry from Holland helped to release the program Start: 1 weekend in April 2010 with lectures and practical instructions
Practical instruction on site
Inspection of shoes Mechanical stress through shoes: The good. The bad. The Ugly!
Goals for the future To make Diabetic Foot Care available in Gjakova Start an education for more Diabetic Foot Care Assistants Foundation of at least 10 foot clinics in Kosovo BUT the problem at this point is: Very small progress because of lack of interest of doctors and policymakers in health care AND lack of money
In conclusion Diabetic patients with foot problems can and should be treated much better in Kosovo A MULTIDISCIPLINARY CLINIC is the key to better treatment and less complications In Gjakova we would like to start the first multidisciplinary clinic together with an educational facility for nurses and doctors
Finally: the role of Telemedicine Using Telemedicine with it s sinchronuous and asynchronuous form for realising this goals. Using poperties of Telemedicine for lingink six Telemedicine Centers throughout Kosovo ; Linkage between telemedicine Center of Kosovo-Gjakova with National and International - wellknown centers in this field. Dr.Dashurije Koshi is the Coordinator of the Telemedicine Center in Gjakova-Kosovo We hope that Telemedicine will lead to more involvement of other professionals in the field of diabetes and the diabetic foot care
Special thanks to Dr.Margreet van Putten and Dr.Dashurije Koshi for helping me through my journey in treating diabetic foot in Kosovo At last but not least : Dr. Veronique Thouvenot who made my lecture today possible. Thank You for your attention