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"