Many of the Caribbean islands have a very high prevalence of diabetes. Barbados for instance has an estimated prevalence between 20% and 25%. The high prevalence of diabetes coupled with less than optimal care has resulted in a high rate of complications amongst people with diabetes. In St. Lucia, another island nation located northwest of Barbados, the prevalence of lower-extremity amputations is three-fold that of the USA. A number of reasons may explain the high prevalence in the Caribbean island nations. However, lack of knowledge both among the general population, people with diabetes and health professionals seems to be key - especially when it comes to preventing diabetes complications such as diabetic foot.To increase knowledge among these groups and to improve diabetic foot care, this project will use a modified version of the Step-by-Step framework developed under the WDF funded project Diabetes foot care - Step-by-Step (WDF03-056) implemented in India and Tanzania. The overall aim of the project is to promote and prevent diabetic foot complications.
The project will be implemented in both Barbados and St. Lucia. The proximity of the two islands, located in the eastern Caribbean, makes it worthwhile to combine the activities and carry them out with the same set-up. The populations of Barbados and St. Lucia total 290,000 and 170,000 people, respectively. Different partners will be in charge of the implementation in the two countries. The Barbados Diabetes Foundation will lead the project in Barbados whereas the St. Lucia project will be led by the St. Lucia Diabetic and Hypertensive Association. The Ministries of Health in both countries have declared their support for the project in addition to other organisations such as the Rotary Club in both countries; the Diabetes Association of Barbados; the University of West Indies and the St. Lucia Medical and Dental Association. To strengthen skills and enhance knowledge on diabetic foot and diabetic foot care, a basic and an advanced training course for health care providers based on the model outlined in the Step-by-Step framework will be arranged. Both courses will last for two to three days. The basic course will teach the participants about the principles of basic foot care education and practical management guidelines. The course will also include practical training in basic foot care. A year after the basic course, the participants will be expected to participate in the advanced course. This course will include an evaluation of the activities of the past year and training on more advanced aspects of diabetic foot care. Nineteen health care teams - ten from Barbados and nine from St. Lucia - consisting of medical doctors and nurses/paramedic will be trained.After completing the basic course, all teams will be equipped with a proper set of instruments as well as educational materials and patient assessment forms. The trained health care teams will strengthen the already existing primary care clinics to provide podiatry care on the two islands by conducting screening for diabetic foot and providing preventive care and treatment. The health care teams will also educate diabetes patients and the general population about preventive measures for diabetic foot problems and thereby increase awareness on the issue. In addition, the teams that receive training will disseminate their learning to other health care providers in their work setting. The program will facilitate development of algorithms for foot care to enable and encourage multidisciplinary teamwork and unify diabetes care services. It is expected that as a result of this project the number of amputations due to diabetic foot will be reduced by 50% over time.
• 220 doctors and nurses were trained