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Plans are underway to reduce the economic burden that diabetic foot conditions are having on the government of Barbados. So says Dr. Ingrid Cumberbatch, Medical Officer in the Ministry of Health. She was speaking at the recently concluded Step-by Step programme, held at the headquarters of the Pan-American Health Organisation (PAHO).


A foot with a fake callus

The two-day training seminar, entitled ‘Basic Care for Improving Foot Care In Barbados’was coordinated by the Barbados Diabetes Foundation and the Ministry of Health. It focused on strengthening the skills and enhancing the knowledge, of local primary health care providers, on diabetic foot and diabetic foot care. Members of the local nursing and doctor fraternity received training on the principles of basic foot care education as well on basic foot and wound care.

Dr. Cumberbatch, explained that the ‘diabetic foot’ has posed a significant economic cost on the health care system in Barbados.

“People with diabetes are at risk for nerve damage and problems with the supply of blood to their feet. Nerve damage results in a reduced ability to feel pain and, as a consequence, injuries often go unnoticed. These factors can lead to the development of foot ulcers and other foot wounds, as well as infection. Left untreated, infected foot ulcers can ultimately cause amputation, which means prolonged hospitalization, rehabilitation, and an increased need for home care and social services.”

Current statistics show that 80 % of the female surgical beds at the Queen Elizabeth Hospital and 50% of the male beds are utilised by persons with diabetes-related foot diseases and lower limb amputations. It is estimated the economic cost of adequately treating all the diabetics in Barbados is approximately US$ 110 million, a significant financial burden.

These alarming statistics emphasise the urgent need for implementing the Step-by-Step programme in Barbados.


Dr. Ingrid Cumberbatch, Medical Officer, Ministry of Health

Ms. Simone McConnie, coordinator of the Step-by-Step programme agreed with Dr. Cumberbatch, she believes one of the benefits of the Step-by-Step programme is its focus on prevention.

“There are several ways of dealing with diabetic foot conditions and amputation is the last resort. Despite being one of the most serious and costly complications of diabetes, foot complications are often overlooked but can be effectively prevented.

The health care burden created by the ‘diabetic foot’ can be significantly reduced by regular and thorough inspection of the feet, education of patients and health care providers on preventative foot care and early warning signs, early referral and good clinical practice of wound treatment.”


Simone McConnie, Coordinator of the Step-by- Step programme

The podiatrist, proposed low cost, yet effective wound treatments such as saline therapy and off-loading wound pressure as important to preventing amputation.

She said that “through training and education of primary healthcare providers and the transference of this knowledge from the participants here to other providers, the Step-by-Step programme will certainly achieve its ultimate goal of – Reducing amputations in Barbados by 50%, over time. “

McConnie added that “following the completion of the programme participants were provided with a proper set of instruments as well as educational materials and patient assessment forms. These will be critical in assisting participants in executing what they have learned here.

We want to make sure that participans are fully equipped, so that in a year’s time in the advanced session of the Step-by-Step programme, they will be able to give accounts of the positive results. This advanced session will include an evaluation of the activities of the past year and training on more advanced aspects of diabetic foot care.”

About the Step-by-Step programme

The Step-by-Step programme is a joint initiative of the Rotary club of Barbados South, Rotary of Ledbury, UK; The World Diabetes Foundation, Barbados Diabetes Foundation, the International Working Group on the Diabetic Foot affiliated with the International diabetes Federation and the Barbados Ministry of Health. It is a global project which is aimed at educating both patients and medical practitioners in diabetic foot care. The programme was highly successful in both Tanzania and Africa and was launched in Barbados in 2009.