Foot note Dominican Republic

Aimee is cheerful, 42 years old, lawyer. She is suffering of diabetes type 2 since 2005. She likes to play with her children in the refreshing rains of November. She puts on her children’s rain shoes, but that day she took the decision not to use them on herself. Two days after that  afternoon she felt weak and realized that her left foot was hot, red and very swollen.
Because of her foot problem Aimee was admitted at Plaza de la Salud General Hospital
( HGPS), in Santo Domingo, Dominican  Republic, with a plasma glucose 400 mg /dl and a serious foot problem (Texas score 3B).

Walking barefoot in the rain or in beaches, are the favorite choices of Dominicans, because of the high temperatures of this tropical island.

The diabetic  foot clinic of the hospital, has two areas, one for prevention and another for ambulatory wound care,  but both areas have the same common waiting room. During the time patients are waiting to be treated in the waiting room, a patient-educator who had been healed foot ulcers is the teacher for the others. We asked him and other patients like him, to talk about their experiences to healthy people or not injured  patients to prevent ulcers in their feet. They have become our :’Teachers for prevention’.
Before  the daily and free education  from our Prevention teachers to diabetic patients at the waiting room ,we hand to them a short and simple questionnaire about  proper footwear, foot hygiene, nail clipping, based on ‘IWGDF Guidance documents on prevention and management of foot problems in diabetes’.

Walking without footwear is the main causal factor of wounds in patients who come to our hospital.

Aimee is an example of this. But it is noteworthy that she still is a responsible patient,  she is controlling her diabetes well and she knows that walking barefoot is not an option.
I was interested to know and asked her, why has she put on shoes to her children, to protect their feet from scrap metal, cans, wood or glass hiding under puddles and why she decided in the mean while not to put them on herself?
She replied: “Because that afternoon I wanted to have fun, I wanted to feel the offloading of my work’s loading …I was trying to feel more free from the pressures of my job and I decided not to use shoes.  Being a mother makes me care for my children, protect them from everything, but I forgot to take care of myself. My mistake Doctor, I just thought that nothing could happen to me …only my wrong  decision was  enough to end up in this jail …but, believe me, I’ve learned my lesson”.

‘Taking care of preventive measures is an important decision, please accept them and don’t neglect its lessons’.

Dr Nalini Campillo
Dominican Republic

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