A Continent on its Feet

I would like us to pay a visit to my beloved continent of Africa. A continent rich in resources, people, and undeniable natural beauty, while simultaneously riddled with its issues. One of the many problems that face the continent today is the state of healthcare in the majority of its countries. The lack of manpower and resources makes taking care of patients and managing diseases that much more challenging. Diabetes has become one of the leading diseases in the western world, and on the African continent, it is making its presence well known.   
Having lived on the continent for the majority of my life, I know a thing or two about the African diet. Our diet is rich in carbohydrate foods, our dishes filled with rice, yam, cassava, and bread. These types of foods, when eaten consistently, can increase blood sugar levels over an extended period and eventually lead to diabetes. (The mechanism of diabetes will be discussed in a future blog post). Therefore, it is not surprising that a study published in 2004 by Epidemiologist Dr. Sarah Wild suggested that the greatest increase in the number of diabetic patients is expected to occur in Asia and Africa by 2030. With the disease on the rise on the continent, the technology and methods to detect diabetes have not caught up.  According to the International Diabetes Federation’s current atlas, nearly two-thirds of Africans with diabetes are undiagnosed.
Foot complications in patients with diabetes are a major health concern. Cavanagh ET. Al (2008) asserts that complications from diabetes are most commonly found in the lower extremities. The complications arise because of damaged nerves and reduced blood flow to the lower area of the body.  This leads to the loss of sensation in the foot, which predisposes diabetic patients to unrecognized injury and ulcerations (Rahman et al., 2006). In many unfortunate cases, this can lead to infection and amputation (Charanga et. al (2004).   Losing parts of a limb or major amputations are the most feared problems in the diabetic population. In Africa, amputations and limb loss occur frequently.  Unfortunately, the lack of podiatry knowledge and practice makes the management of diabetic feet much more challenging. According to Dr. Andrew Clarke, a podiatrist in South Africa, diabetes has accounted for 60% of the non-traumatic lower extremity amputation in public hospitals in the Cape Town Metropole. In fact, every 30 seconds a lower limb is lost to diabetes, a staggering estimate!  In Lagos, Nigeria, diabetic foot ulcers account for 55% of amputations, and the procedure itself has a mortality rate of 20%.  That means that for every 10 amputations performed, 2 individuals will not survive.

The management of diabetic feet continues to be a challenge for healthcare professionals in Africa. Factors such as finances, lack of resources, inadequate training, education, and little government support have made the management of diabetes and its complications arduous. The training of qualified personnel’s such as podiatrists, medical doctors, nurses, and hospital administrators is in high demand to prevent the escalating effects of this debilitating disease.  Diabetes care in Africa is inefficient and needs to change; bold steps need to be taken to manage the condition and its complications properly.

By Daniel Okpare "Creator of HAPPY FEET (Medical-Health Blog)"
   Edited by Adjoa Bucknor, MD Candidate, Class of 2017 "Albert Einstein College of Medicine"