Isolated indigenous communities which had never seen a “foot doctor” have been visited by a podiatric medicine team that made a ground-breaking trip into the Western desert.
Heidi Chin, a final year Podiatric Medicine student, travelled with podiatrist Mr Burke Hugo to the desert communities of Punmu, Parnngurr, Kunawarritiji and Jigalong. It was the first trip of its kind.
Mr Hugo is a senior podiatrist at Royal Perth Hospital and a mentor to Podiatric Medicine students. Other team members taking part in the Indigenous Diabetic Foot Program were diabetes educator Maria Bastian and physiotherapist Anushka Bandaranaike.
“The Indigenous Diabetic Foot program is a podiatrist driven initiative that is culturally specific to Indigenous Australians,” Ms Chin said.
“Under difficult conditions, we were responsible for assessing, managing, treating and, most importantly, educating Aboriginal people about diabetes.”
Indigenous Australians are more than three times as likely as the non-Indigenous population to have diabetes. “This highlights the need for podiatric intervention in remote communities, to reduce the rate of foot problems and associated complications,” Ms Chin said.
The fact that the communities had never or rarely seen a podiatrist meant the team faced the challenge of how to make long standing contributions which would continue after their departure.
“Many acknowledged they were diabetic but did not understand that preventative measures for complications could be taken,” Ms Chin said. “I witnessed this sad reality as a lady was flown out of her community due to rapidly ascending infection resulting from a dog scratch. The foot appeared gangrenous and she was likely to become a bilateral amputee.”
Recognising that education was the first step in the prevention of serious foot problems, the team gathered community members, young and old, with and without diabetes, and held interactive educational sessions and practical demonstrations of foot care.
“It was rewarding to see the community being involved with our program - observing, touching, washing and scrubbing their feet while socialising and having fun,” Ms Chin said. “On meeting a teenage boy who was ashamed of his diabetes, missed medication and received no family or peer support, I realised the importance of involving youth in our diabetes foot care program. Empowerment through school education is a positive step which we hope to take in the future.”
The team also carried out podiatric assessments. “I treated a graceful, elderly lady Daisy, whose story was told through the 2002 film Rabbit Proof Fence,” Ms Chin said.
The team liaised with Home and Community Care workers, nurses, Aboriginal health workers and medical officers with the aim of encouraging them to continue foot care sessions on a regular basis.
They also trained general practitioners, Aboriginal health workers and nurses to perform simplified diabetic neurovascular screenings to determine if a patient required ongoing surveillance and follow up.
By working closely with GPs, the podiatrists gave valuable input to current health screening practice and reinforced the importance of multidisciplinary interaction in the progression of health services, Ms Chin said.
“This move from a reactive, acute care model to one in which early prevention is important has significant value in rural and remote settings where podiatric services are lacking or infrequent,” Ms Chin said.
Although it was the first trip of its kind in the Western Desert involving podiatric care, advantages of the project were already recognised by community members, Aboriginal health workers, GPs, nurses and CEOs of each community, she said.
“Future activities such as these must be adequately funded, supported and continued. Podiatric management of the high- risk foot can save limbs, reduce the costs to community and greatly improve the quality of life of many.”