Diabetes Advocacy Experience€¦ · In February 2008 talks between Ledbury Rotary Club and the IDF...

Diabetes Advocacy Experience

November 2013 S.McConnie 1

Initial relevance of Diabetes Foot Clinic for

Barbados

Surgical bed occupancy 50% male ward and 80% female ward (Walrond &

Ramesh, 1998)

poor management of diabetes and the diabetic foot;

inefficiencies of education for diabetics and health care providers,

•no protocols or systematic approaches. (Hennis et al 2004)

“Step by step” - improving diabetes

foot care in the developing world

Funded by the World Diabetes Foundation (WDF)

March 2003 Dar es Salaam November 2013 S.McConnie 3

• The Step by Step programme (SbS) is a two year project.

• During the two years data collection is mandatory.

• The goal is to improve educational skills and the management of diabetic

foot problems.

• Create a cascade effect and influence a sustainable process the region/country.

• An experienced national and international faculty is responsible for

teaching and the practical sessions.

• Medical equipment and educational materials will are provided to all

participants. (funding pending)

“Step by Step” Improving Diabetic Foot Care In The Developing World

OBJECTIVES & METHODS


Prevention Of Amputation

Step – by – Step way

1st Year 2nd Year

900 limbs 1943 limbs

Salvaged Salvaged

Pendsey SP. Current Diabetes Reports 435 – 438, 12 – 2007

DREAM Trust


UN Resolution Implementation project

Step by Step India 2004 (WDF)

Tanzania 2004 (WDF)

Pakistan 2007 (WDF)

Republic of Congo 2009 (WDF)

Other African countries (Botswana, Guinee, Mali, Kenya)

Egypt 2009 (WDF)

Caribbean Region 2009

(funded by Rotary/WDF/IDF)


Partnership

In February 2008 talks between

Ledbury Rotary Club and the IDF

led to an international agreement

and partnership

with IDF

offering a

start-up

matching

grant of

60,000 US$


Caribbean Step by step Caribbean Step by step

A unique collaboration of the International Diabetes Federation and Rotary Club of Ledbury and local Rotary clubs of the Caribbean

Comparison of prevalence of diabetes and ulcers in the step by step Caribbean islands

2011 (Population Consensus)

Country Population size

Assumed

prevalence

diabetes

(15%)

Assumed

prevalence

of ulcers

(15%)

Assumed

prevalence

diabetes

(20%)

Assumed

prevalence of

ulcers (20%)

Trinidad &

Tobago 1,056,608 158,491

23,774

211,322 31,698

Montserrat 5,118 768

115

1,024

154

Nevis 11,181 1,677

252

2,236

335

St. Lucia 156,260 23,439

3,516

31,252

4,688

Barbados 280,000 42,000

6,300

56,000

8,400

British Virgin

Islands 24,939 3,741

561

4,988

748

Saint Maarten 74,852 11,228

1,684

14,970

2,246

St. Kitts 31,515 4,727

709

6,303

945

Antigua 86,754 13,013

1,952

17,351

2,603

Dominica 71,540 10,731

1,610

14,308

2,146

Grenada 99,846 14,977

2,247

19,969

2,995

Total 1,898,613 284,792

42,719

379,723 56,958

10 November 2013 S.McConnie

2008


St. Kitts - Amputations From 1997-2011

The graph shows a steady

increase in the amputations

from 2005 to 2009

The rate plateaus from 2009

to 2010.

The plateau comes after the

implementation of the foot

care program

Further analysis will have to be

done over the next few years

to see if it results in a reduced

amputation rate


Reporting of training to date


SACA region participants training SBS

Mexico 18 1

Panama 100 1&2

Cuba 54 1

Dom. Rep. 48 1

Bolivia 122 1&2

Argentina 60 1&2

Brazil 40 1

Chile 1

Columbia 27 1

Peru 57 1&2

Train the foot trainer 2013


The Caribbean


Countries Ministry initial sign on SBS SBS revisited Established Diabetic foot clinics

Tobago 2006 2013

Barbados 2008 2010 Diabetes center soon/ screening n teaching

St. Lucia 2008 2013 Local challenges

Dominica 2011/12 Screening and collecting data

St. Kitts & Nevis 2011/12 Diabetes clinic/program implemented

Antigua & Barbuda 2011 Screening and collecting data

St. Maarten 2010 Screening

BVI 2010 Screening

Jamaica Diabetes center

Guyana 2013

Grenada 2012/13 Basic Training started to be completed a two weeks

Trinidad 2013

Dominican Rep. 2013 Basic

Curacao 2013 -

Haiti 2013 -

Belize 2013 -

Bermuda 2013 -

St. Thomas 2013 -

Suriname 2013 -

Montserrat 2013 -

Guatemala 2013 -

Cayman Islands 2013 -

Venezuela 2013 -

Outcomes to date


Limited data

Inconsistent communications with the RC, MOH and local chapters

Inhibitions about the programs

Accountability and collaborative efforts

St Lucia and Barbados loss funding in 2011 due to lack of data in 2009 WDF

IWGDF – IDF/RC came on board to assist the program

Improved access to some resources, monofilaments

Network locally regionally internationally

Barriers over the years

Lack of dedicated MOH support

In appropriate communications within the system (filtering down from the CMO to the Chief Nursing and Medical officers)

Clarity of the roles of all involved eg Rotary in St Lucia seemed to play a significant role to implement the program but reporting and follow through seemed to have been expected to fall into some else’s territory and that individual is or was not aware

Cultural attitudes

Inadequate feedback team locally with accountability expectations (fine line to reassure accountability) passion? Finance?

Limited human resources– many persons are actively involved an other programs


Possible Needs

Feedback from others in region:

Full partnership and integration of the health ministries even if in the form of a committee to see it to fruition

Easy to use forms for data collection – universal system

Currently being trialed

A more integrative process regionally for eg: given the distance of origins and Caribbean and monitoring systems- currently being investigated by IWGDF/IDF

CWGDF as an affiliate of the IWGDF

Further funding – data: he next steps, tools for sustainability etc allocations possible if data, communications other factors logistics - resolved



The Caribbean working group on the diabetic foot (CWGDF)-NAC

Other private and public sector bodies

GLEPED (SACA) and

other

International working group on the diabetic

foot/IDF/WDF

Rotary local chapters

IWGDF/IDF

• Guidelines, international consensus, advice,

• Support as needed (financial or other), research

CWGDF

• Monitoring system and tools to see project to fruition

• Aid with local financial aid, personnel, building of teams and research stimulation,

Local organisation

• Active with the MOH locally, additional local policing and monitoring systems,

• Feedback for change, positive or negatively other

• Building and multiplication of teams


BDF position is Advocacy to action

November 2013 S.McConnie [email protected]

Improved communications

Removal of misconceptions

Integration of key protocols and programs

Becoming the thermostat of our environs and not the thermometer

Radical in design

Thank you.

Diabetes Advocacy Experience€¦ · In February 2008 talks between Ledbury Rotary Club and the IDF...

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