1. NEW HORIZONS IN DIABETES FOOT CARE IN NIGERIA October 21 st 2015 Afokoghene Rita ISIAVWE FACE Medical Director & Consultant Endocrinologist Rainbow Specialist Medical Centre Lekki Phase 1 08030940649 www.rainbowspecialistMED.com

2. Outline Understanding the diabetes foot problem The Diabetes Podiatry Initiative, Nigeria Offloading Wound Care Summary Acknowledgements

3. Understanding the Diabetes foot problem

4. Pivotal event Marker of serious disease and co morbidities May lead to amputation of the affected limb Every 20 seconds a lower limb is amputated due to complications of diabetes

5. St Vincent's Declaration A set of goals for the health care of persons with DM. Aim of improving diabetes care The main target set for feet was to "reduce the numbers of limb amputations for diabetic gangrene by 50% in a five year period" Preventing foot complications in diabetes

6. ACTION PLANS  Regular, systematic screening of feet and legs  Immediate access to qualified foot care for those at high risk.  Systematic patient education in foot care.  Establishment of multidisciplinary teams to provide care for those with special needs.

7. What's New in Diabetes Foot Care in Nigeria

8. The Diabetes Podiatry Initiative Nigeria

9. DIABETES PODIATRY INITIATIVE NIGERIA Supported by World Diabetes Foundation Rainbow Specialist Medical Centre Podiatry Institute USA 2014 to 2017

10. A COLLABORATION PODIATRY INSTITUTE USA Rahn A. Ravenell, DPM – USA Team Leader RAINBOW SPECIALIST MEDICAL CENTRE Afokoghene R. Isiavwe FACE- Project coordinator The World Diabetes Foundation

11. Objectives Building local capacity in diabetes foot care Improving foot care in persons living with DM Preventing diabetes related foot amputations

12. Target Audience Health Care Practitioners Persons living with diabetes Diabetes Peer educators members of Diabetes Association of Nigeria

13. Selected Clinics and Hospitals General Hospital Marina 2 Lagos State PHCs – Eti-osa & Ibeju Lekki NNPC Medicals Military Hospital St Nicholas Hospital Rainbow Specialist Medical Centre St Kizito Nigerian Ports Authority Clinic Lagos University Teaching Hospital National Orthopedic Hospital Igbobi

14. Training of trainers Patient Foot care Education

15. Approach 1.Initial monthly one day - 2 hour training ( 2CME Points) 2.Providing foot care SCREENING kits to each trained institution 3.Annual 5 day DM foot care workshop by members of the Podiatry Institute USA (10 CME points) – next in August 2016 4.Continuous monitoring and supervision of the selected institutions 5.Referring at risk patients for free foot care training 6.follow up of patients with ulcer to heal or to amputation

16. 1 ST LAGOS PODIATRY & DIABETES FOOT CARE WORKSHOP – MARCH 2014

19. 2 ND LAGOS PODIATRY & DIABETES FOOT CARE WORKSHOP – AUGUST 2015

22. IMPACT SO FAR Regular foot screening at participating centers FOOT SCREENING MANUALS produced & distributed to healthcare professionals nationwide; simple enough for nurses to administer. Diabetes foot Care TRAINING MANUAL FOR HEALTHCARE PROFESSIONALS produced & distributed FOOT SCREENING BAGS distributed to 11 participating hospitals in Lagos Start up of foot care clinics at some of the different participating institutions Patient foot care education charts and booklets distributed to participating centers and Lagos State DAN.

23. IMPACT SO FAR 2 Establishment of multidisciplinary teams.  Work in progress: participants in the last two meetings have seen the need for synergy amongst the different stakeholders in the care of DMFS at the various participating institutions.

24. IMPACT SO FAR 3  Issues are being raised & successfully addressed e.g.  need for training of nurses on the art of wound care ‘’wound care nurses’’  use of modern & effective wound care products  Offloading of ulcers

25. Offloading shoes and insoles Therapeutic shoes Insoles wound care shoes locally available and affordable

26. Wound care New and effective wound care products now locally available

27. summary

28. Conclusion

29. YOU