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The photo below is an example of the all too common problem of the Diabetic Foot in Guyana - infection associated with gangrene requiring at least local amputation for limb salvage. This is what the Phase-1 Project was designed to prevent and treat. And we have been successful! In the first 2 years of the Project the diabetes related major amputation rate at the Georgetown Public Hospital Corporation, the national referral hospital in Guyana, has been reduced by 42%.
Please stay tuned as we prepare to tell you the story of Phase 1 and to discuss how we will expand these benefits in Phase 2

Guyana Diabetic Foot Project Team
The Guyana Diabetic Foot Project in collaboration between Canadian and Guyanese health professionals, aimed at creating a comprehensive diabetic foot care clinic at Georgetown Public Hospital Corporation (GPHC), the national referral and training hospital in Guyana, South America. The Project developed out of the Canadian Association of General Surgeons (CAGS) supported University of Guyana Postgraduate Diploma Course in Surgery, the first postgraduate medical training program in Guyanese history.
At the 2006 Bethune Roundtable, Dr. M. Rambaran, Director of Medical and Professional Services at GPHC reported that diabetic foot complications were the single (10%) most common reason to be admitted to a surgical ward at GPHC, most a result of severe infection. Forty-two percent of these patients went on to have an amputation, ½ of which were major amputations. This is part of the world pandemic of type II diabetes.
As part of CAGS’ mentorship program, Dr. Brian Ostrow visited GPHC and carried out a needs assessment on diabetic foot care in January 2007. He interested Dr. Gary Sibbald, (Director of the Wound Healing Clinic, Women’s College Hospital, Professor at the Dalla Lana School of Public Health in Toronto),  a world authority in wound care. After a year of planning, in February 2008, GPHC was awarded a $97,460 grant from the Canadian Caribbean Cooperation Fund (CIDA), as the Canadian government’s contribution to a $150,000 18 month project.
The Project, which completes its second year of activity in May 2010, uses multi-level, longitudinal, primary and secondary education strategies to create an evidence-informed, interprofessional, patient-centered diabetic foot clinic at GPHC. Three Canadian expert visits, modeling interprofessional care, have taken place. Eight Guyanese key opinion leaders, chosen to lead the local work, have completed or are completing the International Interprofessional Wound Care Course from the University of Toronto. The project has trained over 65 Guyanese health professionals in applying the Best Practice Recommendations of the Canadian Association of Wound Care to their local setting.
The Diabetic Foot Centre (DFC) opened in July 2008. Both prevention and treatment components of comprehensive care are promoted. A specific 60 second screening tool, created to identify high risk status, has been adopted by the Ministry of Health. In the first 18 months over 1200 persons with diabetes have been screened. Over 1400 high risk and ulcer patients have been seen in the centre. Preliminary data show a dramatic outcome.
In the first 21 months of DFC operation, the number of patients having diabetes-related major amputations was reduced by 42% compared to the three previous years!
The Project works closely with the Ministry of Health to create sustainable new capacity inside the public health system. It declared the DFC, a Centre of Excellence in diabetic foot care, in November 2009. The next step was to create a national program.
CAGS has recently received funding from the Partnership Fund of Canadian International Development Agency (CIDA) for a 3 year $840,000 (CIDA contribution $500,000) project to regionalize diabetic foot care. This Phase 2 project will target ½ of the country’s 37,000 people with diabetes and train 353 local doctors, nurses, medexs, rehab specialists and community health workers to provide comprehensive care, including glycemic and anti-hypertensive therapy along with foot care – recognized high priorities for diabetes control.
This Project may serve as a model for other collaborations between Canadian and International health professionals.


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