Philippines: saving feet, one patient at a time

Rommel Barro visiting his doctor at the Jacinto Health Center in Davao City, Philippines. © Handicap International

Rommel Barro visiting his doctor at the Jacinto Health Center in Davao City, Philippines. © Handicap International

(Note from the editor: Reposted with permission from the World Diabetes Foundation. For the original article, click here.)

Dr. Isagani Braganza gives a quick, welcoming smile as Rommel Barro enters his consulting room at the Jacinto Health Center, and then turns his full attention to the man’s feet.

He leans in as Rommel removes his tennis shoe and sock, revealing a swollen ankle and a foot with a missing second toe. “Good!” the doctor says. “Very, very good.”

Months ago, the doctor explains, Rommel went to the local hospital – one of the Philippines’ largest – with an infected toe. But when the hospital recommended amputation, Rommel returned home, and refused to see any other healthcare providers. As the wound worsened, neighbours complained of the foul smell, and the barangay (village) captain approached Dr. Braganza for help.

“I promised there would be no amputation – but I did need to see him,” the doctor explains. “He came – luckily, he came.”

Focus on efficiency

Dr. Braganza is seeing diabetes patients this September 4, Friday, thanks to an innovative project initiated by the NGO Handicap International (HI), implemented in collaboration with local health authorities and supported by the World Diabetes Foundation.

The Philippines, which is ranked in the top 15 in the world for diabetes prevalence, is one of the world’s emerging diabetes hotspots. Yet most Filipinos must go to large hospitals, often travelling long distances, to receive diabetes education or care. HI proposed a multidisciplinary approach to bringing diabetes care to community health centres and began rolling it out in Davao City in 2007.

“The multidisciplinary approach involves everyone at a health center – doctors, nurses, nutritionists, health workers, midwives, dentists – defining each task for each of them, and distributing responsibilities,” explains Richard Erick Caballero, Project Manager for Handicap International. “The objective is to make the health center more efficient.”

By 2013, the project was a success that other local government units were eager to replicate it. HI proposed adding foot and wound care to the project, and – in close collaboration with local health authorities – expanding it to four cities and three municipalities within Southern Philippines. The result was WDF13-843, ‘Increasing access to quality, multidisciplinary diabetes care.’

Today, residents of 252 barangays across Davao region (182 in Davao City) have access to professional diabetes prevention and care services at their local health centers. Erick notes that Davao City has designated Friday ‘Diabetes and Heart Day’, and that the project’s monitoring parameters are integrated into the regional health system – both indicators of long-term sustainability.

“This is the only project in the Philippines of this scale and this quality, and I’m proud to be part of the team that’s created it,” he says.

Of big help

The advantages of the multidisciplinary approach are clear on this busy Friday at the Jacinto Health Center. Health workers take blood glucose, blood pressure, height and waist measurements; diabetes educators and nutritionists explain how to take care of diabetic feet and control portion sizes of food; nurses check feet and clean wounds.

Inside the consulting room, Dr. Braganza continues with Rommel’s story. The infected toe was a result of uncontrolled diabetes, he says, as he expected. So he cleaned the wound and soaked Rommel’s foot in Betadine, an iodine solution, which removed the dead tissue in Rommel’s second toe (a procedure called autolytic amputation), and saved the foot. Rommel was then given nutritional and foot care counselling, a prescription for metformin, and a request to return for a check-up.

Rommel sits impassively while Dr. Braganza explains his case. But when the doctor asks him how he feels about Jacinto Health Center, his face lights up.

“Dako jud ning tabang sa akoa,” he says. It has been of big help to me.