WITH an estimated 350,000 people afflicted with diabetes in Jamaica, the prevalence of the disease has created a growing demand for occupations dedicated to treating those living with it.

In addition to physicians dedicated to the treatment of diabetes, there are podiatrists or chiropodists, who are specially trained to the bachelors’ degree level to treat problems of the feet and ankles.

Podiatry is the term used in the United States, while the United Kingdom prefers chiropody. These professionals can become doctors of podiatric medicine after four additional years in medical school.

The occurrence of foot problems associated with diabetes has resulted in the need for foot care assistants to treat basic afflictions of the foot, and lay diabetes educators who teach people in communities about the disease and how to care for themselves.

Last month, 29 foot care specialists graduated after completing a three-month course, developed by the Diabetes Association of Jamaica (DAJ) and sponsored by the National Health Foundation (NHF) to the tune of $2.5 million.

The trainees, who were selected by the DAJ and the Ministry of Health, received lectures from a number of health care professionals ,including physicians, chiropodists, nutritionists and reflexologists. They underwent practical exercises with inmates at golden age homes and infirmaries, the Women’s Outreach Centre, and at the NHF’s community health days across the island.

Diabetes mellitus, said to be the second leading cause of death on the island, is a metabolic disorder characterised by hyperglycemia (high blood sugar) and other signs. Diabetes can cause many complications if it is not adequately controlled, including cardiovascular disease, chronic renal failure, retinal damage (which can lead to blindness), nerve damage and poor healing of wounds, particularly on the feet.

The condition can lead to gangrene, which may require amputation of the lower limbs. Gangrene is the death of cells and subsequent decay of body tissues caused by infection or thrombosis or lack of blood flow.

Adequate treatment of diabetes, as well as increased emphasis on blood pressure control and lifestyle factors – such as smoking and managing a healthy body weight – may improve the risk profile of most complications.

DAJ executive director Owen Bernard said the course was developed because of the acute shortage of people to treat diabetic feet.

“We realised that we had to take the foot care component and develop a separate course because of the importance of foot care in the management of diabetes,” he said. “This course trains persons in treating common conditions of the nails, as well as corns and callouses – all of these conditions can be prevented at the primary level.”

Diabetic feet should not be treated without proper training, as happens in many instances in Jamaica today.

“Pedicurists are not medically trained and they are doing many things with good intention, but with disastrous effects,” Bernard said.

There are about 350 amputations of diabetic feet in public hospitals alone each year – a number which the DAJ boss hopes the foot care assistants will help to reduce.

“There are no podiatrists in the government services so we saw it as a desperate need. You cannot have effective diabetes management without foot care… It is unacceptable that because a person has a bad foot that they are going to lose it,” he said.

World-renowned Jamaican expert on diabetes, Professor Errol Morrison, speaking at the graduation ceremony at the Terra Nova All Suite Hotel in Kingston recently, said the treatment of diabetes in the island had come a long way.

“I remember in my earlier years I developed a slogan ‘if you soak the foot you’re going to get soaked’ because by putting the feet in warm water, you are predisposing them to even greater problems, which can lead to gangrene and amputations,” he said.

The professor said the DAJ had begun to look at the possibility of introducing a degree programme in chiropody/podiatry in Jamaica and commended the Ministry of Health for allowing the association to deliver the course, as similar efforts to train people in areas of health care were not always welcomed by health professionals.

“I remember fighting the good fight to get the Nurses Association to recognise that we could train people to take blood pressure at home. It may come to you as a natural thing now… So to get to the point where they are allowing these courses is a big breakthrough,” he said.

Dr Eva Lewis-Fuller of the Ministry of Health acknowledged there was resistance from medical professions to such courses, but said the ministry was responding to the changing disease patterns in the country.

“Historically, the well-defined professional groups hold on to their territory very jealously. Nurses will say this is part of their portfolio and will not want other persons to do it… We (in medicine) have made regulations that make it very difficult for others to come into the profession,” she said, adding that such attitudes would have to change in the interest of public health care.

“We are going to break down some of these walls and share the functions if we are to meet the needs of the population,” she said.

The newly trained foot care assistants, some of whom have worked in health care for years, are grateful for their new skills.

“It has made us more aware of the things that can happen to the diabetic foot, and know what to look for when we are out there in the field,” said Velma Forsythe, a community health aide from Cornwall Barracks, Portland.

She expects to put her new skills to work at the Moore Town Health Centre and surrounding districts.

For others like 41-year-old Dave Henningham, it presents a new challenge.

“When I found out that this condition (diabetic feet) was so widespread, I just put my head to it,” said the former taxi driver from Blackwoods, Clarendon.

He is excited about working for the NHF on its community outreach days.

Racquel Zink, 23, a health technician at the DAJ, expects to go far in the field, but admits that treating the sometimes smelly, gangrenous feet took some getting used to.

“I have to admit that at first it wasn’t easy, especially when you go into the infirmaries. But then I got used to it. Once you are protected (with gloves), it’s alright,” she said.

NHF chairman Ryland Campbell said the money invested in the course was worth it.

“The $2.5 million being spent on this training programme, we expect, will result in the improvement of the health of diabetics and a reduction in the number of amputations in Jamaica,” he said.

He added that of the 124,000 NHF card holders, 47,500 or 38 per cent were diabetics and that 50 per cent of those enrolled for diabetes used the card to obtain benefits.

The DAJ has started to recruit the next cohort of students for the foot care assistants course, which is scheduled to begin in May.

“There are no particular requirements for the course, but they will be selected for communication skills, and other attributes. Also, we are looking for people in different areas of the island to address the need,” Bernard said.