In 2016 the project Enhancing Diabetes Prevention and Self-management, WDF14-899, was nearing its end, and WDF and HelpAge International were reviewing its achievements.
These included a new, nationwide network of diabetes self-help groups and 40,000 people screened for diabetes. Data collected by the project, however, were cause for concern.
“The data showed that Kyrgyzstan still faces many challenges in relation to diabetes and NCD care,” says Nurdin Satarov, a programme manager with HelpAge International. “Despite government and civil society efforts, the country’s NCD burden is increasing, access to drugs and health care personnel is still a challenge, and preventive care is inadequate - especially for diabetes complications.”
One of those complications – diabetes foot – was especially troubling, he says.
“The number of amputations in Kyrgyzstan is one of the largest among the CIS countries. According to the national register on diabetes, 26,087 patients with neuropathy and 1,386 patients with diabetes foot syndrome were registered in 2016.”
To fix this, systemic change was needed, Mr Satarov and his team believed.
“The country did not apply a multidisciplinary approach, which involves doctors of several specialties and nurses working together to establish an optimal solution for successful treatment,” he says. “There were no guidelines and protocols for surgical treatment of diabetic foot. And timely diagnosis and treatment was not carried out. Patients and society were not sufficiently informed about how to take care of their feet, and how important it is to start treating diabetic foot in time.”
But how to tackle this huge problem in a country with no tradition for diabetes foot care and no certified podiatrists? Mr Satarov and WDF had an idea.
Help from a Centre of Excellence
Since 2007, WDF has worked to strengthen knowledge- and best-practise sharing between its partners in a variety of ways. One of these is the Foundation’s Peer Programme. The programme designates WDF partners and institutions as ‘Centres of Excellence’ – and when other partners need the expertise they have, the programme can send them there to learn.
To kick-start diabetes footcare in Kyrgyzstan, Mr Satarov applied to send Dr Valeria Knyazeva, a Kyrgyz endocrinologist with an interest in diabetes foot care, to one of these Centres of Excellence - Dr Mohan’s Diabetes Education Academy in Chennai, India.
Dr Knyazeva was accepted, and enrolled in Dr Mohan’s Academy in March 2017, where she was trained within detection, treatment, management and prevention of diabetes related foot complications.
“It was a pleasure for us to have Dr Valeriya Knyazeva with us,” Dr Mohan says. “We have an ongoing relationship with the World Diabetes Foundation who have sent us several peers in the past for training in diabetes, doctors from countries in Africa and Asia. The WDF Peer programme is excellent because not only doctors but also nurses and other paramedical workers are trained, and it has been mutually beneficial experience.”
Creating this in-country diabetes footcare capacity was the kick-start that Kyrgyzstan needed. Next, HelpAge worked with WDF to develop a footcare programme for the country, which is now being implemented with funding from WDF: Enhancing prevention and treatment of diabetic foot in Kyrgyzstan, WDF17-1497.
“The WDF peer programme was instrumental in creating needed diabetes footcare capacity in Kyrgyzstan. Now the new project will create ripple effects, using a classic train-the-trainer setup to spread the benefits of Dr Knyazeva’s training,” explains Mette Skar, WDF Programme Manager. ”She has already trained nine doctors to diagnose, treat and follow-up diabetes foot complications. In addition to this, 200 doctors and 60 nurses working at primary level will receive basic diabetes foot care training.”
The plan is for these healthcare professionals to form multidisciplinary teams. The teams will provide diabetes foot-related services at seven specialised diabetes foot rooms the project is establishing, and at 65 primary level health centres the project is strengthening across the country.
Timely, relevant and needed
On a recent visit to Kyrgyzstan, Ms Skar joined 19 local residents in a primary health centre to hear a diabetes foot presentation from one of the newly trained endocrinologists. She was impressed with what she saw.
“The field visit confirmed that project WDF17-1497 is a very timely and relevant intervention addressing a clear need,” Ms Skar says. “The groundwork has been laid and the partners are at a crucial point to roll out the foot care model across the country.”
Mr Satarov agrees.
“Today, family practitioners and endocrinologists are starting to pay more attention to diabetes foot,” he says. “We hope that they will work even more on this, that multidisciplinary teams are established in each family practitioner centre and they work as a team to prevent and treat diabetes foot syndrome and other complications.”