Managing diabetes through a holistic approach to good health

Ramdeyol Ramdhar was a heavy-duty mechanic and later a successful marine engineer, but he is also diabetic and now limits himself to tending his garden and his poultry.

The still vibrant 62-year-old, reflecting on the 14 years that he has been living with the illness, said though his life has changed drastically, he refuses to be controlled by the disease. “I’m not shorting myself of anything. If I want to have a little something to eat, like chicken with the skin or my lil duck and maybe to have a little drink, I do it for one day and after that I go back to my normal routine,” he said, adding that he is fully capable of getting his blood sugar back to a normal level.

Asked if diabetes was the reason for his retirement, Ramdhar said, “I ready to go back right now but this is what is grounding me [looking at his leg]. I don’t want the foot to come off and I got to be hopping around.”

Ramdeyol Ramdhar

The father of five related that he was 48 years old when he discovered he was a first-stage diabetic. “I was feeling weak and just not my usual self so I went to a dispensary and they did some tests and found out I had excessive sugar in my system,” he recalled. Ramdhar said he was given medication but noticed that the treatment was not enough and as such, decided to visit a private doctor two years later.

At that time, he realized that there was numbness in his foot, which was a circulation problem. “He was treating me but I didn’t see no progress,” he related.

In 2008, Ramdhar said, he decided to visit the George-town Public Hospital (GPH) where he met with a doctor and was referred to the Diabetic Foot Centre which had just been established at the time.

He noted that he had gone to the West Demerara Regional Hospital and La Grange Health Centre but was never given the sort of treatment he received at the Diabetic Foot Centre. “The circulation problem improved… before I couldn’t feel anything. They have it in compression. They dress the ulcer and compress it and within every two weeks they change it,” he explained, adding that at the other two clinics they would provide dressing but not the compression service. “I prefer to come here,” Ramdhar stated.

Dr Indira Bhoj, the only medical doctor at the Diabetic Foot Centre, explained that the centre has taken on a holistic approach to patient care; it is not just caring for patients’ feet. At the centre, patients learn about a proper diet, exercise, and other concerns such as screening for high cholesterol and blood pressure monitoring.

She told Stabroek News that being closely linked to the surgery department and the medical department of the GPH, there is a greater opportunity for the centre to focus on what is best for patients’ health care.

Dr Bhoj emphasized that she is not working alone, but has the support of the surgery department and the medical department. She observed that at times it’s hard to distinguish whether she is the one helping the surgeons or if the surgeons are helping her “because we work together as a team.”

With this multifaceted approach, Dr Bhoj said, the patient gets the best outcome.

Ramdhar said the staff at the centre are very friendly and helpful to him and that he has so far been satisfied with the service provided. “Because of them I feel much better… things improve,” he said

He further stated that he visits the Diabetic Foot Centre every seven days and has since seen fast improvement in his left foot, which is the one affected.

Said Dr Bhoj, “Roughly we see about 15-25 patients in the morning and in the afternoon, about 5-6 ward patients and that’s been the steady rate that we’ve got…,” said.

She explained that the outpatient clinic in the morning sees patients who are stable enough to be managed at home. “That doesn’t mean that we are the only ones doing their home care or managing their diabetes. They will from time to time go to the health centre as well and more than likely get their daily dressings at the health centre,” she said.

She added that there is a Canadian facility which the centre relies on in difficult cases; “I can consult with either the surgical ward [of the GPHC] or with the Canadian facility and they are able to help.”

Ramdhar is now a stage-two diabetic and he said that the ulcers he has are situated around his ankle and they “go and come. The ulcers restrict my movements because I can’t put too much pressure on my foot but at the same time I have to exercise it.

“In stage one and stage two, you can go on tablets and monitor it with exercise, what you eat, frequent testing of your blood sugar and make sure it is at a level you would feel healthy with, but at the latter stage, stage three, that is the complete breakdown of the skin and ulceration and you have to get insulin,” Ramdhar explained.

“I don’t see the possibility of reaching to stage three,” he confidently said, noting that as long as persons manage to keep it under control, they won’t have to worry about it advancing.

Dr Bhoj noted that one of the services that make the centre such a success is the rehab aspect of the diabetic foot care. The centre, she said, is equipped with tools like the surgical shoes which are given to people who have difficulty with pressure distribution on their feet. This helps to heal ulcers faster and if they need their footwear modified, this can be done.

“We are not doing anything that is magical, in the sense that we work with the tools that we have that every health centre should have and then maybe one or two special pieces of equipment, but we are not using very expensive dressing; we’re not using hard-to-obtain materials… so it is not something that is extraordinary. It’s the best use of available resources to get better outcomes,” she said. The foot centre has empowered staff members to do wound care, so nurses have been trained in this regard.

Dr Bhoj noted that there are several factors that cause a person to develop diabetes and this may include genetic reasons, but there are also other environmental or lifestyle factors that can cause this sort of dysfunctional metabolism of the blood sugar. “So it’s not one cause, it’s a multi-factorial etiology,” she said.

She explained that apart from hereditary factors, risk factors may include lifestyle, obesity and for type 1 diabetes, there are some viral agents that can cause this type of attack.

As a precaution, she said, one should do everything to promote good health. “You can actually stay healthy, live a healthier life without diabetes for a very long period of time just by making healthier lifestyle choices, staying in a healthy weight, using appropriate diet, maintaining an appropriate physical activity level, exercising, those things do help even if we have hereditary factors,” she explained.

Reduced
amputation

Before 2008, Dr Bhoj stated, the amputation rate was very high and there has since been a significant reduction – about 46% – in the major amputation rate since the start of the Diabetic Foot Centre.
Dr Bhoj further stated that the Ministry of Health is involved in creating similar facilities in the coastal regions, in the heavily populated areas such as Regions 2, 3, 4, 5, 6 and Region 10.
The doctor shared a personal success story that she said was the moment she actually realized that very good work was being done at the centre.

A patient, she recalled, had had a foot ulcer for years which was not healing regardless of the efforts she made to have the proper dressing on the wounds while going to her health centre. “So earlier this year, she came to the Diabetic Foot Centre and we realized that the ulcer was in an abnormal pressure spot and so what we did, we offloaded that area from the pressure and we fitted her with a shoe and within 3-4 months that ulcer closed and this is a lady that had an ulcer for years,” Dr Bhoj noted with a smile.

Diabetes poses a major public health problem in Guyana and according to a Ministry of Health release nearly 40,000 persons are living with it and there are perhaps another 20,000 who have not been diagnosed.

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