Fighting diabetic foot complications

A mobile unit screens feet in rural India, using sophisticated technology.

Globally, diabetes is responsible for more than 1 million amputations every year, and next to injuries caused by accidents, diabetes is the most common cause of lower limb amputations, according to the International Diabetes Federation.

A project in Karnataka, India is preventing diabetes related amputations in rural areas by taking advanced high level of technology and a committed network of volunteers into a joint collaboration.

The project is run by Jain Institute of Vascular Sciences (Jivas) and has as its goal to train health care professionals to screen and educate diabetes patients and to prevent diabetes related foot complications. The patients are offered screening and education when attending ten clinics in the rural areas, as well as a mobile unit travelling the rural areas, all established by the project.

The approach has been to train health care professionals during a month long course providing both academic education as well as hands on practice. Following this training the health care professionals have returned to their communities to establish and strengthen diabetes clinics.

So far 40 health care professionals from all over India have been trained. Ten foot care clinics have been set up and have been functioning since June 2007, catering for 14,110 patients. Three of the clinics have even started their own outreach activities and satellite clinics. The initial goal was to provide foot care, education and counselling to 12,000 people through outreach activities.

Evaluation on wheels

Another important arm of the project is the development of a mobile unit. Each month, a well equipped bus conducts around 20 visits in rural areas surrounding Bangalore, which means that 295 visits have been conducted so far.

The mobile unit is a state of the art specially equipped vehicle containing a couch, foot examination chair, a fully equipped foot lab including computerised foot pressure scanning system, a biothesiometer, a Doppler scan and temperature sensing devices. The van is fitted with a generator which is necessary visiting rural areas.

All the staff members of the mobile clinic, including the drivers, secretary, and ward boys, have been trained to use the equipment in the mobile clinic and are trained to counsel the patients about preventive foot care.

Supplementing the van, 22 diabetes screening and foot evaluation camps have been held, and a total of 12,442 patients have been evaluated; 9,558 during visits and additional 2,884 during camps.

Spreading activities like ripples in a pond

Outside the core activities funded by the World Diabetes Foundation, Jivas is cooperating with social organisations to further expand the effect of screening and education. One of these organisations is GASS, Grameena Abyudaya Seva Samsthe, who operates a community based service to children with cerebral palsy and covers 200 remote villages without ready access to health care. GASS builds on an existing system of conducting camps and evaluating patients.

The Jivas project has trained their existing network of 40 volunteers enabling them to screen for diabetes, to evaluate feet to detect signs of diabetic foot and to counsel patients about proper footwear and other aspects related to diabetes.

The volunteers have visited 80 villages to detect diabetes, to check blood sugar and to offer counselling. Patients with identified problems are brought to the GASS clinic for evaluation. So far 1,800 patients have been evaluated and 23 new cases have been detected out of a covered population of over 100,000.

This project is receiving funding from Dr Majeed of Sami Labs and has received a glucometer donated by Rosch.

Empowered despite a poor situation

One of the volunteers of GASS was actually diagnosed with type 2 diabetes as an effect of the cooperation, as she was visiting a screening and foot evaluation camp.

42 year old Mrs. Gajalakshmi’s feet are at high risk of injury as she walks several kilometres each day to do the volunteer work. Once enlightened about her disease, she is now taking care of her diabetes. Despite her vulnerable situation, she is taking part in an initiative that empowers other women who have lost the use of their feet partly or fully, because of diabetes.

Mrs. Gajalakshmi has learned to take care of her feet through the JIVAS project, now she empowers others.

The women are mobilised through participating in a small and self containing embroidery industry, and are thereby given renewed self confidence, avoiding the stigma of being disabled and not being able to contribute to their family income.

Communication Manager of the World Diabetes Foundation, Mr. Jamal Butt met her during a visit to the Jivas project in February 2008, and was very impressed and intrigued with her stamina and commitment: “Meeting Mrs. Gajalakshmi and seeing how she manages to take care of her self and on top of that is able to help and motivate other poor and disadvantaged people to join the screening programme is truly inspiring. The Jivas project, with her story as an example, proves that if you have committed and compassionate people involved as local volunteers, the chances of multiplying the effect of a supported project is much greater", her says.

"The mere fact that the project is delivering the most advanced foot care treatment and screening results combined with local knowledge and volunteers is a star example on how innovative projects can be replicated and methods used in mobile eye care programme can be used to implement sustainable foot care projects in the most remote areas of South India”, Mr Jamal Butt adds. 

Why diabetic foot is worth preventing

Everyone suffering from diabetes is at risk of developing “neuropathy” a condition where nerves in the feet are damaged. The most common result of neuropathy is loss of feeling in the feet, and this can if not taken care of, might as well be a starting point for developing severe damage to the feet of a person with diabetes.

Habits like walking barefoot indoors as well as outdoors increase the risk of stepping on sharp objects or burning the foot sole, but ordinary foot problems like blisters and corns can also develop wounds. Small undetected injuries can grow to major ulcers before the person inflicted eventually visits the doctor. Poor blood circulation, due to diabetes, makes it difficult for a wound to heal. Gangrene quickly develops and amputation is the only mean to eventually save the persons life.

The Jivas project approaches the diabetic foot problem in the cultural setting; in India people for social and religious reasons often walk bare footed. Foot wear is rarely worn inside the house, and most diabetic foot injuries are actually afflicted while indoors.

In addition, a very large segment of people with diabetes from non urban and rural areas are manual workers and are typically the breadwinners of the entire family; the loss of a limb can be devastating for the whole family.

Read more about the project

This page was last updated 4-23-2008 by jrb.wdf