Foot Care Assistant Programme
In Jamaica, there are eight (8) Chiropodist/Podiatrist, and all are practicing in the Private Sector. There are none to be found in the Government Health Centres of which there are 23 Hospitals, 56 Type I Health Centres, 85 Type II Health Centres, 40 Type III Health Centres, and 3 Type IV Health Centres. The population of Jamaica is 2.6 million. The Island is 150 miles long and 50 miles wide and is located in the Caribbean.
The management of diabetes embraces a multidisciplinary approach; therefore the Chiropodist/Podiatrist must be part of the team. The Chiropodist/Podiatrist is one who deals exclusively with ailments of the feet. In some countries, these professionals might be a luxury as it takes 3-4 years to train one. What is the solution to this problem? The solution is to train Foot Care Assistants similarly to how you have the Community Health Aids who are community based people who have been trained to administer basic health care at grass roots. When we talk about foot care we have to look at risk factors that could lead to amputation. Someone who goes into the hospital to have an amputation done it is not something that happened overnight. We have to look at what caused it in the first place.
Invariably when you question the patients about how they end up having a leg or digit amputated they will give you some sad story about the following factors:
Indeed these are the areas based on empirical evidence which we had and noted.
- Onychogryphosis – Thick crusty nails
- Involuted Nail – Curved nail
- Ingrown nails
- Hammer toes
- Callus – Hard skin
- Trauma – Injury
- The 5 different types of corns which most people are unaware of
All these conditions if left untreated can lead to gangrene and subsequent amputation. Many of these conditions can be identified and treated by the Foot Care Assistant at primary care level. The role of the Foot Care Assistant is to deal with basic foot care problems, especially in the rural areas based on the common condition identified.
The Foot Care Assistant programme started in 2000 which was sponsored by United Way of Jamaica, since then Novo Nordisk sponsored a Caribbean programme followed bythe German Embassy who sponsored the third programme 2005. Indeed, we have also exported it to other Caribbean countries and were even invited to Belize to train 12 Foot Care Assistants.