Free Diabetic Foot Care…in Pakistan

Ever since its establishment in March 2009, 120 patients with diabetic foot disease have received free treatment at the Diabetic Foot Care Clinic of the Pakistan Institute of Medical Sciences (PIMS). However, due to limited resources, patients do, at times, have to bear the cost of some drugs, specific tests not available at PIMS, and specialised foot wear necessary to prevent further damage to the affected foot.

According to consultant medical specialist and diabetologist Prof. Dr. Jamal Zafar, under whose supervision the clinic was established, the hospital has complete data of 101 patients; 29 patients lost to follow-up and the remaining 72 patients continued the follow-up till their treatment was completed.

Out of these 72 patients, 40 recovered completely and 29 recovered with disability i.e., they had minor or major amputations. Three patients died because of overwhelming sepsis developed due to delay in treatment; usually patients initially go to local quacks and general practitioners for treatment.

The cumulative rate of major and minor amputations at the PIMS Diabetic Foot Care Clinic stands at 40.27 per cent. These data suggest a tremendous success in treatment of such patients as the rate of amputation varies between 70-80 per cent in the absence of specialised diabetic foot care treatment facilities. Apart from this, the clinic also offers counselling for patients regarding foot care, diet plans, exercises and literature.

Minor debridements and dressing of wounds is done in the clinic, but if the wound is more complicated, then the patient is surgically managed by the Department of General Surgery under supervision of Prof. Dr. Tanvir Khaliq.

A certified dresser is also available at the clinic to provide specialised dressing facilities to patients at their homes so that they don’t have to visit the clinic on a daily basis for dressing, which is usually required for months. “This facility can be made available to patients in Islamabad and Rawalpindi at a very nominal cost if some NGO or philanthropist gets involved in bearing the cost,” Dr. Jamal pointed out.

The Diabetic Foot Care Clinic is working six days a week from 8 a.m. to 2:00 p.m. daily and registration is open for all diabetic patients, not only for treatment of patients having established diabetic foot disease, but also for counselling of diabetics regarding foot care, dietary and lifestyle modifications. A diabetes educationist is also available at the clinic every Monday and Thursday.

The PIMS Diabetic Foot Care Clinic is increasingly being recognised as a unique initiative of its kind in the whole region of Northern Punjab, NWFP, Kashmir and Northern Areas. The clinic follows a multidisciplinary approach for provision of care to diabetic patients in terms of prevention and treatment of a very common and disabling complication of diabetes i.e., diabetic foot disease, which is the commonest medical cause of amputation of extremities worldwide. “The idea behind the establishment of the clinic was not only to create awareness amongst diabetic patients regarding foot care, but also to provide specialised services to them under a single roof in terms of diabetic physician, surgeon and podiatrist,” says Dr. Sohaib Ejaz; resident in General Medicine, who has been specially trained and has got certification in diabetic foot care management. He added that all residents in the unit have been trained by seniors and are actively participating in diabetic foot care.