Due to inadequate knowledge people with diabetes often ignore their symptoms, particularly foot problems, and often reach qualified care providers late. Early detection of foot problems can prevent severe complications and amputation.Given that Orissa (India’s eleventh largest state and one of the poorest) only has 12 diabetologists it is not difficult to imagine that most people with diabetes have poor access to preventive foot care. Awareness, education, and low cost preventive care can considerably reduce the risk of amputations and the consequent suffering, economic burden and resulting impoverishment from this generally preventable complication of diabetes.The main objective is to reduce the number of people developing advanced foot problems caused by diabetes with 25 % by training health care professionals, establishing several foot care centres and a mobile foot clinic.
The Cuttack Diabetes Research Foundation has taken the initiative to implement this project supported by the Ministry of Health, Government of Orissa and Kanungo Institute of Diabetes Specialities.Three complimentary actions will be initiated in order to improve foot care for people with diabetes as well as to decrease the prevalence of diabetes related complications.Firstly, six diabetic foot care centres will be established in six different districts of Orissa. The centres will be established in already existing hospitals and they will be open for consultations every day all year round. In addition to this, a mobile clinic will be equipped with the necessary diabetes equipment to conduct visits in rural areas of Orissa. When the staff of the mobile clinic discovers foot problems, they will refer the patients to the district foot care centres for further treatment and care.Secondly, 4 doctors and 4 nurses from each of the six districts, totalling 24 doctors and 24 nurses, will be trained in general diabetes care and diabetes foot care. The training will be conducted during a two day training session by diabetologists and foot care specialists. Every fourth month throughout the project period, there will be a follow-up training session for both doctors and nurses. The trained doctors will together with specialists from KIDS train Accredited Social and Health Agent (ASHA) workers and anganwadi workers. Each trained person will be provided with a diabetic foot care kit to provide doorstep foot care service in rural areas of Orissa. They will provide general diabetes counselling and perform basic foot care to people with diabetes. Like the mobile clinic, the ASHA and anganwadi workers will refer complicated cases to the district diabetes centres.Finally, 10 awareness and screening camps will be conducted each month. The camps will cover 8-10 villages and target 500-600 people at each camp. A foot care specialist and a nurse will screen all people attending the camps for raised glucose levels and people detected with diabetes will be encouraged to participate in the foot care programme. The mobile clinic will be the centre of the camps and be equipped with a small operation theatre to treat those requiring minor surgical interventions for their foot problems. Awareness will be created by distributing education material, organise video shows and educate people in adequate foot care. Education materials such as posters, leaflets, brochures, booklets, CDs etc. will be adjusted to the local language and disseminated at the camps.In order to put diabetes on the political agenda, a monthly newspaper on diabetes prevention and control will be produced and disseminated amongst policy makers, government departments, civil societies, health associations and to all participants in the foot care program. Furthermore, workshops will be conducted for NGOs, policy makers etc. in order to address the problems with diabetes and related complications.
• 6 diabetes and foot care centres established• 1 mobile foot care unit procured and equipped• 24 doctors and 24 nurses trained in diabetes and diabetic foot care• 300 ASHA & 300 Anganwadi community health workers empowered to perform doorstep foot care service in rural areas of Orissa• 360 screening camps conducted reaching 180,000 people• IEC materials produced