Dear Editor,
I recently learnt from a medical practitioner that the underlying cause of most foot ulcers/wounds, is chronic venous insufficiency (CVI) from a damaged blood valve.
This letter is for the attention of: The honourable Dr. Frank Anthony, Minister of Health. I heard on the TV news last week of one aspect of foot care concern in Guyana, that of filariasis and the Ministry’s door to door pill distribution drive soon to begin country wide, to eliminate this disease.
Please Mr. Minister also put the spotlight on CVI which, as a medical doctor, you would know that this condition manifests outwardly in a leg ulcer or wound.
The current system at foot clinics at the government hospitals is inadequate and devoid of the relevant treatment. Great numbers of our people are in everyday, non-stop, chronic pain from peripheral neuropathy. Many Guyanese are suffering in silence while these foot clinics continue with daily dressing of these chronic wounds, chronic ulcers (some living with it for years). A known close up case to me is the dressing of bacteria infected wounds, all because the public system does not carry out on each patient, a culture laboratory sensitivity test to determine the specific bacteria to be isolated and treated.
Guyanese are losing their limbs to amputation as though Guyana had a war that bombs blew off their limbs. Another contributory factor to amputation is accidents. I know, because my interest is high and many times I inquire of these persons, young and old, why the loss of limb, and it is either, bad circulation, diabetes or after a road accident. Please Mr. Minister, it is time for close up attention to be paid to this chronic situation plaguing our people.
The foot care services in the public system are behind in proper foot care treatment – one treatment does not fit all. We are in the twenty-first century and our public health system is lagging behind in improved patient care services. Imagine Guyana does not have a podiatrist for persons in need of this service, particularly diabetics.
The cost of this care is phenomenal and beyond the reach of most Guyanese. Those mostly affected are the seniors at pensionable age with little or no financial resources to carry the cost of this sudden unexpected financial burden, many with no health insurance to cushion the costs.
Persons are travelling from as far as Leguan to Georgetown and are forced to bypass the public health service to access private foot clinics in Georgetown to get the “better treatment” with the hope and expectation that these wounds would close and bring an end to this tortuous ordeal of twice or thrice weekly dressings at a daily cost of five thousand dollars and more, and at times, as necessary, medication, laboratory and diagnostic tests which can escalate the costs. Day to day quality of life for these persons is greatly diminished.
Can the government look into the recruitment and placement of a vascular surgeon at the Georgetown Public Hospital Corporation (GPHC) to be accessible to all Guyanese? Currently there are no vascular surgeons in Guyana. I am told there was once a Cuban Vascular Surgeon at Dr. Balwant Singh’s hospital but this service is no longer available. Some of these persons aren’t even aware they should be seeing a vascular surgeon for this condition. Again, I am reiterating that Guyanese without the affordability are suffering in silence with no end in sight to this chronic condition.
To avoid this “disease burden” as explained by one doctor and to combat the constant daily pain associated for some, with this condition, families and the patients, with no other choice, are forced to amputate the limb to bring an end to daily dressing costs and pain management costs and suffering.
I understand medically, there are two options: 1. Micro surgery to reroute the blood vessels and/or 2. Amputation: which is the end of the road, with the option to fit a prosthetic leg. I further understand that Guyana needs to upgrade from a plastic prosthesis to a bio-arm or bio-leg, making these choices available to the patient.
Again Mr. Minister, please help the electorate who elected your government for the people and by the people, to examine the services currently offered countrywide in Guyana in the public system thereby offering hope to the doctor and to the patient in their quest to save or heal these limbs. We need our human resource to have all their limbs intact to enable them to function at their optimum best.
Your intervention Mr. Minister can bring relief to this chronic situation by revamping what is now systemic in the system where the patients are left mainly to nurses with little or no assessment of their condition at a higher level of a vascular specialist. It is as if this need does not exist. Amputations for bad circulation problems are systemic; there is limited public education at these clinics; the patients and their families are left to the mercies of an outpatient clinic.
It is a circuitous route. Patients start out at the private clinic, financial resources are exhausted and they return to the government foot clinics only to re-infect the wound and then families are forced to return to the private system again to bring relief to the family member. Meanwhile the financial burden of private medical costs takes its toll on the family eventually forcing them to consider amputation.
I conclude by saying and repeat many times over that there is a great need for the services of a vascular specialist since it is evident that the need exists for the many causes of this condition of which: hereditary, varicose veins and injury to lower legs are listed as the reasons for venous statis ulcers. Medical literature informs that venous ulcers are caused by severe or long term swelling from poor blood flow in the veins. This causes weakening in the tissue of the leg. The skin then breaks down manifesting in an ulcer. Meanwhile the underlying condition remains as the chronic venous insufficiency.
I thank you Mr. Minister for your earliest attention to this dire need existing in our society.
Yours faithfully
Maria Rodrigues
