Diabetic foot is one of the most severe complications of diabetes mellitus, particularly among the less educated and poor. This can lead to devastating complications, amputation and death.Lack of awareness about the potential of loss of sensation and diminished blood supply in the limbs because of diabetes and its consequences is the prime reason why many people with diabetes land up with needless amputations. Due to inadequate knowledge, foot problems are often not presented to a health care professional. The health care professionals' lack of knowledge and ability to check for early signs of risks compounds the problem, and what can otherwise be managed with low cost preventive care and self care education becomes a life and limb threatening emergency.India currently has an estimated 50 million people living with diabetes and many cases of diabetic foot are not detected in time to avoid amputations. Therefore, the need to ensure proper foot care and treatment is substantial.The aim of the project is to improve diabetic foot care in Greater Bangalore area by training health care workers and setting up both foot care clinics and mobile foot care service to reduce days of hospitalisation.
This project is an extension of the recently completed WDF funded project Rural diabetic foot care, India (WDF05-142) which also was under the management of Jain Institute of Vascular Sciences (JIVAS). JIVAS have great experience in training health care workers to treat people with diabetic foot problems. Having helped built basic foot care services in the whole of Karnataka this new project aims at focusing activities to Greater Bangalore area in a new approach. Together, the two projects will cover a large area and provide foot care and treatment for numerous people.The methods to obtain the objective are threefold. The project seeks to train health care workers and volunteers; establish diabetic foot care clinics; and deliver "home care" in Greater Bangalore area.1) A one-month training course will be accomplished for health care workers with the objective of educating them in prevention, care and treatment of the diabetic foot. They will receive a certificate of their newly developed skills when they have completed an evaluation and a two-day refresher course. 66 health care workers will be trained and empowered during the project period.In addition to the training of health care workers, a batch consisting of two or more senior workers from 50 health related NGOs will be trained in basic diabetes care. The training will be conducted over a period over two years and they each have to complete two training modules. The first module consists of a 1½-day training program that mainly focuses on the basics of diabetes and the recognition of the various symptoms. Three months later, they will participate in a ½-day session to understand the difficulties in diabetes care. The senior NGO workers will further be trained in how to teach their fellow NGO colleagues in basic diabetes foot care and treatment. 2) 15 diabetic foot clinic will be established in already existing health care facilities. Eight will be set up in an urban area (Bangalore) and seven in semi-urban areas. Six out of the eight clinics established in Bangalore will be implemented during the first year and the remaining two will be set up in the second year. The clinics will also operate as referral clinics for surrounding areas and local hospitals. All maintenance, salaries and infrastructure is the responsibility of the local clinics.3) The mobile clinics will consist of five minivans. They will be equipped and serve as "home care" units to provide diabetic foot care and education for low resource people with diabetes foot ulcers who cannot travel to the clinics due to various reasons. The vans serve two objectives; to deliver home dressings and to deliver care at the doorsteps of impoverished urban population. Four of the vans will be stationed in an area of Greater Bangalore and they will individually be related to one of the above strengthened clinics. The fifth van will serve as a "roaming unit" which will be used both as a mobile clinic and to conduct camps. Once a week it will substitute the four vans when the staff of these vans need to report back to the coordinators. By delivering home based quality wound dressing care it is expected to reduce overall costs of caring for a diabetic wound which otherwise would require prolonged hospitalisation or frequent hospital visits both very difficult in an environment where people are very poor.
- 84 health care workers trained in diabetic foot care- 15 clinics established in and around Bangalore- 185376 patients seen in established clinics - 11814 patients seen during home visits