Diabetes Advocacy Experience 1
Initial relevance of Diabetes Foot Clinic for Barbados Surgical bed occupancy 50% male ward and 80% female ward (Walrond & Ramesh, 1998) poor management of diabetes and the diabetic foot; inefficiencies of education for diabetics and health care providers, no protocols or systematic approaches. (Hennis et al 2004)
Step by step - improving diabetes foot care in the developing world 3 Funded by the World Diabetes Foundation (WDF) March 2003 Dar es Salaam
Step by Step Improving Diabetic Foot Care In The Developing World OBJECTIVES & METHODS The Step by Step programme (SbS) is a two year project. During the two years data collection is mandatory. The goal is to improve educational skills and the management of diabetic foot problems. Create a cascade effect and influence a sustainable process the region/country. An experienced national and international faculty is responsible for teaching and the practical sessions. Medical equipment and educational materials will are provided to all participants. (funding pending) 4
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Prevention Of Amputation Step by Step way 1 st Year 2 nd Year 900 limbs 1943 limbs DREAM Trust Salvaged Salvaged Pendsey SP. Current Diabetes Reports 435 438, 12 2007 6
UN Resolution Implementation project Step by Step India 2004 (WDF) Tanzania 2004 (WDF) Pakistan 2007 (WDF) Republic of Congo 2009 (WDF) Other African countries (Botswana, Guinee, Mali, Kenya) Egypt 2009 (WDF) Caribbean Region 2009 (funded by Rotary/WDF/IDF) 7
Partnership In February 2008 talks between Ledbury Rotary Club and the IDF led to an international agreement and partnership with IDF offering a start-up matching grant of 60,000 US$ 8
Caribbean Step by step Caribbean Step by step A unique collaboration of the International Diabetes Federation and Rotary Club of Ledbury and local Rotary clubs of the Caribbean
Comparison of prevalence of diabetes and ulcers in the step by step Caribbean islands 2011 (Population Consensus) Country Population size Assumed prevalence diabetes (15%) Assumed prevalence of ulcers (15%) Assumed prevalence diabetes (20%) Assumed prevalence of ulcers (20%) Trinidad & Tobago 1,056,608 158,491 23,774 211,322 31,698 154 Montserrat 5,118 768 115 1,024 335 Nevis 11,181 1,677 252 2,236 4,688 St. Lucia 156,260 23,439 3,516 31,252 8,400 Barbados 280,000 42,000 6,300 56,000 British Virgin 748 Islands 24,939 3,741 561 4,988 2,246 Saint Maarten 74,852 11,228 1,684 14,970 945 St. Kitts 31,515 4,727 709 6,303 2,603 Antigua 86,754 13,013 1,952 17,351 2,146 Dominica 71,540 10,731 1,610 14,308 2,995 Grenada 99,846 14,977 2,247 19,969 Total 1,898,613 284,792 42,719 379,723 56,958 10
2008 11
St. Kitts - Amputations From 1997-2011 The graph shows a steady increase in the amputations from 2005 to 2009 The rate plateaus from 2009 to 2010. The plateau comes after the implementation of the foot care program Further analysis will have to be done over the next few years to see if it results in a reduced amputation rate 12
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Reporting of training to date SACA region participants training SBS Mexico 18 1 Panama 100 1&2 Cuba 54 1 Dom. Rep. 48 1 Bolivia 122 1&2 Argentina 60 1&2 Brazil 40 1 Chile 1 Columbia 27 1 Peru 57 1&2 14
Train the foot trainer 2013 The Caribbean 15
Countries Ministry initial sign on SBS SBS revisited Established Diabetic foot clinics Tobago 2006 2013 Barbados 2008 2010 Diabetes center soon/ screening n teaching St. Lucia 2008 2013 Local challenges Dominica 2011/12 Screening and collecting data St. Kitts & Nevis 2011/12 Diabetes clinic/program implemented Antigua & Barbuda 2011 Screening and collecting data St. Maarten 2010 Screening BVI 2010 Screening Jamaica Diabetes center Guyana 2013 Grenada 2012/13 Basic Trinidad 2013 Dominican Rep. 2013 Basic Curacao 2013 - Haiti 2013 - Belize 2013 - Bermuda 2013 - St. Thomas 2013 - Suriname 2013 - Montserrat 2013 - Guatemala 2013 - Cayman Islands 2013 - Venezuela 2013 - Training started to be completed a two weeks 16
Limited data Outcomes to date Inconsistent communications with the RC, MOH and local chapters Inhibitions about the programs Accountability and collaborative efforts St Lucia and Barbados loss funding in 2011 due to lack of data in 2009 WDF IWGDF IDF/RC came on board to assist the program Improved access to some resources, monofilaments Network locally regionally internationally 17
Barriers over the years Lack of dedicated MOH support In appropriate communications within the system (filtering down from the CMO to the Chief Nursing and Medical officers) Clarity of the roles of all involved eg Rotary in St Lucia seemed to play a significant role to implement the program but reporting and follow through seemed to have been expected to fall into some else s territory and that individual is or was not aware Cultural attitudes Inadequate feedback team locally with accountability expectations (fine line to reassure accountability) passion? Finance? Limited human resources many persons are actively involved an other programs 18
Possible Needs Feedback from others in region: Full partnership and integration of the health ministries even if in the form of a committee to see it to fruition Easy to use forms for data collection universal system Currently being trialed A more integrative process regionally for eg: given the distance of origins and Caribbean and monitoring systemscurrently being investigated by IWGDF/IDF CWGDF as an affiliate of the IWGDF Further funding data: he next steps, tools for sustainability etc allocations possible if data, communications other factors logistics - resolved 19
Other private and public sector bodies Rotary local chapters The Caribbean working group on the diabetic foot (CWGDF)-NAC GLEPED (SACA) and other International working group on the diabetic foot/idf/wdf 20
Guidelines, international consensus, advice, Support as needed (financial or other), research IWGDF/IDF CWGDF Monitoring system and tools to see project to fruition Aid with local financial aid, personnel, building of teams and research stimulation, Local organisation Active with the MOH locally, additional local policing and monitoring systems, Feedback for change, positive or negatively other Building and multiplication of teams 21
BDF position is Advocacy to action Improved communications Removal of misconceptions Integration of key protocols and programs Becoming the thermostat of our environs and not the thermometer Thank you. Radical in design Simone@barbadosdiabetesfoundation.org