John Hopkins University student, Brandon Sumpio speaking at the Diabetic Foot and Amputee Symposium at the QEH(A.Miller/BGIS)

Although total lower extremity amputation rates have remained relatively constant over the period 1999-2009, the number of major amputation surgeries done in Barbados over the last 10 years has increased.

This information was revealed at a Diabetic Foot and Amputee Symposium held yesterday at the Queen Elizabeth Hospital (QEH) by John Hopkins University student, Brandon Sumpio, the son of Professor of Surgery (Vascular) and Diagnostic Radiology, Bauer Sumpio.?? Prof. Sumpio is the creator of the Let Them Walk programme, a collaborative effort between Yale University, the QEH and the University of the West Indies to donate prostheses to Barbadians in need.??

Mr. Sumpio pointed out that one would have expected that as a result of primary care public health awareness and increased government spending on diabetes over the period, there would have been a resultant reduction in the prevalence rate of diabetes and hypothetically less diabetic amputations.?? However, this was not the case.

"We did a 10-year retrospective study here at the QEH and at the Bayview Hospital and we looked at their medical records from January 1, 1999 – December 31, 2009… We looked at major and minor surgeries, above knee and below knee and we also looked at what was the cause of the disease – infection, trauma, gangrene… We also looked at what point they were being amputated.?? Were they coming in a month before or were they coming in and on the same day having their amputation performed?" Mr. Sumpio stated.??

The study showed that in 1999, of the 225 amputations performed, 123 were minor amputations (below the ankle) – 47 were below knee amputations and 35 were above knee amputations.???? Seventy five per cent of the amputees were diabetic.??

"In 2009 there were 226 amputations… In terms of the number of people with diabetes that rose to 85 per cent.?? So, there are more patients with diabetes getting amputations than before…?? When we break it down, of the 226, 80 were minor amputations, a huge decrease… This means that less people are getting, so to speak, easier amputations and more people are getting below and above knee amputations.?? ?? "So, the trend is going from 1999 when there was a high number of minor amputations and less major amputations. Now we see it’s pretty even across the board.?? The scary part of this trend is that they are actually more major amputations being performed here at the QEH and Bayview," he revealed.

The researcher emphasised that in addition to there not being a decline in amputee statistics, the number of patients with diabetes had increased and with more major amputations being carried out, more people would need prostheses or would be less mobile and dependent.?? Other than the "huge economic burden" caused by the disease, Mr. Sumpio explained that diabetes also contributed to a higher death rate.

To turn the situation around, he suggested the first thing that could be done was to stop labelling the country as the amputation capital of the world.??

"Patients hear that 225 people are getting amputations every year so they are worried that if they see their doctor due to a small cut on their foot, they are going to lose their whole leg.?? Then… get the public awareness going to tell people that if you go see a doctor it does not have to end in amputation…," he outlined.

The Medical Student noted that the Ministry of Health’s Step by Step programme, which is targeted at health care professionals to establish sustainable, integrated and low-cost health care capacity for attending to the diabetic foot, could result in a reduction in lower limb complications and prevent unnecessary amputations in people with diabetes.??

The programme has been made possible through the support of Rotary of Ledbury UK, The World Diabetes Foundation, the international working group on the diabetic foot affiliated with the International Diabetes Federation and The Chronic Research Disease Center of Barbados. ????????????

Chairman of the Barbados Diabetes Foundation, Dr. Oscar Jordan, who also spoke at the symposium, put on record his regret that in the past there had been no comprehensive programmes of prosthetic management geared towards limb replacement as this would have been beyond the capacity of local resources.??

Part of the audience at the symposium which was held in the QEH’s auditorum. (A. Miller/BGIS)

He, therefore, thanked Prof. Sumpio who, he noted had been coming to Barbados to carry out examinations for the past couple of years and had since developed a long-term relationship with the Queen Elizabeth Hospital and the Universtity of the West Indies.??

Apart from the academic exchange, the Let Them Walk project has so far provided prostheses for 30 patients and the team is committed to continuing the programme.

The World Health Organisation has predicted that between 2000 and 2030, it is estimated that diabetic rates would move from 171 million to 366 million and in the Caribbean, from 33 million to 67 million.?? Currently, Barbados has the highest prevalence rate of diabetes in the Caribbean at 16.4 per cent, with Trinidad and Tobago, Jamaica and Belize following around 12 per cent.?? The Barbados Eye study however, has shown that the diabetes rate is perhaps closer to the range of 19.4 – 21.6 per cent.?? Mr. Sumpio blamed the local figures partially on the fact that Barbados was now mainly a service industry with less of a focus on agriculture.


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