Wound Care Haiti: Raising Awareness And Making A Difference For People With Diabetes
- Patrick DeHeer DPM FACFAS
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The non-profit organization I have started, Wound Care Haiti, was invited to participate in the World Diabetes Day by the Haitian Foundation for Diabetes and Cardiovascular Disease (FHADIMAC). I traveled to Haiti along with two colleagues, Timothy Syperek, DPM, and Robert Hatcher, DPM. The weeklong program was geared to help Wound Care Haiti and FHADIMAC establish a world class wound care center in Port-au-Prince, Haiti.
Haiti is one of the poorest countries in the Western hemisphere and has a population of about 9 million people, half of whom live in the capital of Port-Au-Prince. An epidemiology study by the FHADIMAC determined that the prevalence of diabetes in Haiti is 7 percent of the population. This would equate to approximately 63,000 patients with diabetes in Haiti. Using the “15-15” rule, that would put the amount of diabetic foot ulcers at approximately 9,500 and related amputations at approximately 1,425. The five-year survival rate for a lower extremity amputation is only 50 percent. This means almost 750 Haitians will die within five years of having a lower extremity amputation.
The good news, however, is that studies have shown that the number of amputations can be decreased by 45 to 80 percent with a dedicated wound clinic. This is the goal of Wound Care Haiti and FHADIMAC for the people of Haiti, and the promise I made to my Haitian brothers and sisters on World Diabetes Day.
We arrived in Port-Au-Prince on a Tuesday evening. We provided lectures to physicians (10 hours), nurses (five hours) and pedicurists (three hours) that covered all aspects of wound care. There were two hands-on workshops on total contact casting and football dressing application, indications and techniques. We did approximately three hours of clinic patient visits on Wednesday, Thursday and Friday between morning and afternoon lectures. We saw over 100 patients for the week.
We also did hospital rounds at the University Hospital and St. Francis de Sales each day. The cases we saw at the University Hospital were extreme. These cases were not something you would see in the United States as these patients would have had earlier and more aggressive intervention in the U.S. Most of these patients required above-the-knee or below-the-knee amputations, which significantly limited the amount of surgery performed on our trip.
We were able to do a transmetatarsal amputation and tendo-Achilles lengthening on one case and prevented a higher level amputation. We had several general surgeons and orthopedic surgeons observing the surgery. The equipment was severely limited. For example, we used a Gigli saw without handles for the metatarsal osteotomies but the case went very well.
At a World Diabetes Day program that took place in November at the Plaza Hotel in Port-Au-Prince. The FHADIMAC sponsored a fantastic educational program for the general public. I had the opportunity to speak on the importance of proper diabetic foot care and the prevention of complications in the diabetic foot.
The wound care center at the FHADIMAC facility is up and going with three general surgeons, the only vascular surgeon in Haiti and one orthopedic surgeon seeing patients. They are working closely with the endocrinologist of FHADIMAC to help provide a comprehensive patient care program. This program is just getting started and has a long way to go, but those of us involved with it are dedicated to Haiti and its people.
While supplies and equipment are lacking for now, we will continue to share our knowledge with Haitian physicians and nurses in order to raise awareness and help develop a referral center for those in need. Haitians deserve a wound care center comparable to any throughout the world. Wound Care Haiti is going to make this happen.