Dominica’s public health sector is making significant progress in the reduction of diabetes-related amputations.
According to data from the Health Promotion Resource Centre in the Ministry of Health, in 2012 there were twenty-seven such amputations (ten male and seventeen female amputees), down from a high of forty one in 2009 (fifteen male and twenty six female amputees).
Diabetes, a chronic non-communicable disease (CNCD), is the leading cause of death in Dominica and one of its complications, a foot ulcer, can lead to amputations.
Coordinator in the Health Promotion Resource Centre, Anthelia James, explained that there has been a twenty-eight percent decrease in diabetes-related amputations for the years 2008 to 2012.
During that same period, there have been at least 135 diabetic amputations.
Additionally, she gave the assurance that despite the worrying picture Dominica is now well on course to drastically reducing the number of diabetic amputations.
In September 2012, Health Minister, Julius Timothy, expressed the wish that diabetic amputations fall by ninety five percent within two years.
James concurs, “I think we are well on course, because everybody (health stakeholders) is very aware, everybody is trying…people are doing what they have to do…[including] those who do not work in health but are aligned to health.”
Concerned about the number of amputations and in response to the situation, the Ministry, along with its partners including the Pan American Health Organization (PAHO) and other stakeholders launched the Management of Diabetic Foot in Dominica Programme in June 2011.
James explained, “The programme was in different stages, what we wanted to do was to sensitize diabetics and their caregivers. These were one of the target groups. We also wanted to create more awareness among the healthcare workers so that they could be more vigilant when people with that disease [are attended to].”
“So [as part of the programme], you had the health care workers, diabetics and their families, caregivers, pedicurists. People were trained to examine their feet, so that you could identify what problems [exist].”
Further efforts against diabetic amputations included an advanced training of trainers workshop for health care professionals put on by the Dominica Diabetes Association and the Rotary Club of Dominica in collaboration with the International Diabetes Foundation in September 2012.
It formed part of the Step-By-Step (SBS) Foot Care Programme, and it involved the teaching of educational techniques, practical sessions, lectures and the treatment of people with diabetes.
Speaking to the programme’s current impact on the ground, Director of the Primary Health Care, Dr. Martin Christmas remarked, “It is certain that since the introduction of the SBS foot-care program, [in the] constant battle against CNCDs including diabetes, as well as the new foot-care policy, we have seen many less amputations due to diabetic foot complications. The culture of both the populace and the health care providers is changing for the better”.
James noted that while early progress is being made, long term behavioral change will take some time and stakeholders remain committed to pressing on.