Living In A Country Where There Are No Podiatrists

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By Kshitij Shankhdhar, MBBS, Dip. Diab.

     Would you believe that many centuries ago, it was a tradition in India that when a person used to visit someone, the host used to wash the feet of the guest to welcome him or her? Washing the feet of the guest was a gesture to express affection, respect and thankfulness for taking the pains of walking all the way.

     Many centuries ago, there were two childhood friends called Sudama and Krishna. They used to study together in Gurukul (an Indian village school). As time passed, they grew up and settled in different places and could not meet for many years. Sudama remained a simple villager while Krishna became the king (Hindu God Krishna).

     One day, Sudama’s wife thought that she should send her husband to meet his old friend Krishna with the hope that the generous king would give some wealth to Sudama. Sudama was reluctant to visit Krishna for this purpose but finally he agreed. It was a long journey and Sudama covered the distance on foot. Krishna offered a warm welcome to Sudama and yes, as per the traditional procedure, offered to wash the feet of the guest.

     As time passed, the scenario changed. People became less traditional. Unfortunately, the importance given to the feet also faded with time. Today, India has a population of over 1 billion people but we do not even have a single podiatrist or a qualified foot nurse. People with foot lesions usually present late to the doctor. This is especially the case for those with diabetes (due to associated diabetic neuropathy).
     There are more than 40 million people with diabetes in India. When people develop a foot lesion, they usually tend to neglect it in the beginning. This is a phase of “denial” when the patient refuses to admit that he or she has a problem. The patients try home remedies, visit a “quack” doctor and/or try alternative medicine and other modes of therapy. This is a phase of “therapeutic inertia” in which the patient is simply delaying proper investigation and treatment. By this time, both diabetes control and the diabetic foot lesion would have deteriorated, and now the patient faces the risk of amputation. He or she finally reaches a surgeon and diabetologist, who often have very little options left but to perform an amputation.

     India is a country with the highest number of people with diabetes. In India, more than 350 million people still live on less than a dollar a day and at least 80 million people go to bed hungry. On a positive note, India is one of the biggest manufacturers of footwear in the world. Clearly, there is huge potential for research and development in the realm of diabetic footwear in India. What we need is podiatric medicine in India.

     I say this despite having established the first diabetic foot clinic of North India with the Lucknow Diabetic Foot Care Clinic and Research Centre. Overall, I have guided the establishment of three diabetic foot clinics in India. As a diabetologist, I have presented my work at international conferences in diabetology organized by the International Diabetes Federation, the American Diabetes Association, the Canadian Diabetes Association, the European Association for the Study of Diabetes, the Diabetic Foot Study Group (EASD), the Diabetic Foot Global Conference and many others in different parts of the world.

     I am the only Indian doctor to be a Fellow of the American Professional Wound Care Association (APWCA) and I am a member of the Medical Advisory board of APWCA. I discovered the Samadhan System of offloading bodyweight for people with forefoot plantar lesions and this had been published on the Website of the International Working Group for the Diabetic Foot.

     Despite these accomplishments, I am interested in earning a DPM degree from a podiatry school in USA. While I am a diabetologist, I think it would be an interesting idea if I join a podiatry school where I teach diabetes care to the podiatry students while I am a podiatry student myself.

     I would like to earn a DPM degree because I believe both Indian and American foot care specialists can learn from one another. Hopefully, we can complement each other and possibly facilitate better outcomes for our patients.

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