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More than 240 million people in the world have diabetes. If not properly managed, their diabetes may result in severe complications such as diabetic foot complications.
An estimated 40-70% of all lower extremity amputations in Africa are associated with diabetes. Yet, studies have shown that the amputation rate can be reduced by more than 50% if the physicians and surgeons have the necessary training.
In Tanzania, 27% of patients admitted with diabetic foot complications die and more than 33% of the patients admitted to hospital with non-healing diabetic foot ulcers end up having part of their limb amputated.
Objective
The project seeks to reduce the level of drastic foot/leg amputations due to diabetes by teaching orthopaedic surgeons how to perform limb saving surgery.
Approach
The project is implemented by Abbas Medical Centre and the Muhimbili University College of Health Science in Dar es Salaam. It builds upon the same structures as established under the WDF funded projects "Diabetes foot care - Step by Step" (WDF03-056) and "A Step ahead of Step-by-Step" (WDF07-291).
The aim is to train 20 surgeons from 20 health centres all over Tanzania. It will be emphasised that the surgeons come from health centres with diabetes clinics at which diabetic foot courses have already been carried out under the two previous projects (WDF03-056 & WDF07-291). Moreover, a high rate of surgical procedures being performed at the health centre will also increase probability of selection for the training course.
The training course consists of a basic course, followed by an advanced course one year later. Both courses will have a three day duration. The project takes point of departure in the Step-by-Step model, takes it one step further by targeting the orthopaedic surgeons rather than the health care professionals providing the regular management of the diabetic foot.
The basic course is interactive in its design and will include practical workshops with less emphasis on traditional lectures. In addition to the surgical techniques, the basic course also focuses on regular care for the diabetic foot, highlighting the extent to which a non-healing ulcer may be brought to a healing stage without surgery. It is anticipated that this in itself may contribute to a reduced amputation rate as surgeons may refer a patient back for treatment instead of surgery.
One to two days will be spent in the operating theatre with demonstration of limb-saving surgical techniques. Upon completion of the course, the participants will receive a diagnostic and therapeutic basic foot instrument kit as well as surgical instruments.
After the basic course, the participating surgeons will return to their respective health centres where they will start implementing their new skills. In addition, they are expected to educate their colleagues and share the acquired knowledge and skills.
During the interim year, the surgeons should also keep track of their cases and fill out a questionnaire every four months.
One year after the basic course, the advanced course will be conducted. It will include advanced subjects and techniques as well as the management of complicated cases with a focus on limb-saving surgery. Moreover, there will be an evaluation of the activities carried out during the interim year for which all participants will present a report and a summary of the cases which they have seen and managed during this period.
Once the participants have returned to their health centres after the advanced course, they will implement their acquired skills. Follow-up visits by the project responsible will be carried out to ensure sustainability and quality of care.
Expected impact
- 20 surgeons from 20 different health centres across Tanzania participating in a basic and an advanced course on limb saving surgery techniques
- Amputation rate among the patients reduced by 50%
Results to date
- Educational materials, diagnostic, therapeutic and surgical instruments have been organised.
- 20 surgeons have confirmed their participation.
- Basic foot course has been conducted in August 2009.
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