Minister of Health, Donville Inniss (Right) in conversation??with member of the Rotary Club of Barbados South, Jennifer Randall during a break at theThe Step by Step Diabetic Foot Programme at PAHO headquarters.??

With over 200 major and minor amputations done annually in Barbados, this island’s Health Minister, Donville Inniss is urging Barbadians to "start acting responsibly when it comes to their health care" in an effort to reduce this figure.

The Minister made the plea today, as he addressed the start of a two-day workshop on the Step By Step Diabetic Foot Programme, at the headquarters of the Pan-American Health Organisation, Dayrells Road.??

Noting that the Ministry "continues to grapple with limited human resources" Mr. Inniss said: "Prevention is about you, John Public and therefore, requires your full involvement. I am too often appalled at the apathetic attitude of [some]Barbadians towards their own health situation. There is too often the attitude that one can do as one likes and the hospital will step in and take over when things go wrong.

He warned, however, that Barbados could not continue to attempt to provide all medical interventions at all times and added: "It is a recipe for financial disaster resulting in mediocre service throughout the system. I am deeply concerned that too many Barbadians actually believe that health care is free. But with a wages bill of approximately $9 million per month at the QEH, and an average electricity bill of $465,000 per month, coupled with all other expenses in the entire public health care system – we really cannot be talking about a free system. ??Somebody is footing the bill."??

The Health Minister further pointed out that in Barbados amputations were a major predictor of mortality in the diabetic population, with an estimated 60 per cent of individuals, with a major amputation, dying within five years.?? Citing costs associated with surgical anesthesia, recovery and rehabilitation as astronomical, he told participants that a working document of the landmark???????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????? ????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????????2007 Heads of Government Summit on CNCDs, had revealed that direct and indirect costs of diabetes for Barbados, in 2001, was 1.83 per cent of the Gross Domestic Product or US $37,801,138 million.

Mr. Inniss outlined: "When this figure is broken down, it shows that the direct care cost amounted to US $35 million and included medical care, prevention, diagnosis and treatment."?? He also noted that other immeasurable costs included loss of functionality,

loss of contribution to the community and changes in the family structure of an individual due to premature death or disability of a loved one.

Lauding the Rotary Club of Barbados South, the International Diabetes Federation and the Diabetes Foundation of Barbados for partnering with the Ministry, he said the objectives of the Step By Step programme were "in keeping with the principles of health care, which have their foundation in primary health care strategy."

Meanwhile, Podiatrist and Representative for the International Working Group on the Diabetic Foot (B’dos), Simone McConnie, said the idea of the Step By Step Programme was to build a network of primary health care givers, able to identify and recognise diabetic foot challenges from early on, and to early detection of problems that could actually be managed to prevent amputations.??

Mrs. McConnie, who is also the Chief Operations Officer at the Diabetes Foundation, lamented the fact that there were only six podiatrists in the country and said the programme could assist in this area.??

"We are not asking individuals to be podiatrists, we are just asking them to have the skills of early detection… and [it is about] motivating the patients as well, so that they are educated… [it is also] with the aim of having diabetic clinics across the island

and taking away the pressure from the hospital…, she said

The Step By Step foot project was implemented first in Tanzania by Dr. Zulfiqarali Abbas, in 2004. Funded by the World Diabetes Foundation, its key aim is to help developing countries reduce the level of amputation to about 50 per cent.

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