Northern Ontarians face many of the same health problems as Southern Ontarians. The shortage of family doctors in both regions leaves large parts of the population under serviced. Emergency rooms and walk-in-clinics are viable options for those in the more urban centres, but for those without a home address or access to transportation, it might not be quite so easy. For people in the far north, especially in remote communities, the only way to get access to medical treatment may be to travel a fair distance, which makes receiving medical attention a difficult proposition.
A large problem in all of Ontario is the ability to diagnose and treat those with diabetes. Even with early diagnosis and proper treatment, some people may not fully understand the severity of their disease. If proper foot care is neglected, any break in the skin from normal wear and tear or injury may lead to more serious bacterial infections and/or ulcerations. Diabetics can become susceptible to a condition called peripheral neuropathy – a loss of sensation in the feet due to nerve damage. A loss of sensation can make diabetics less aware of pain in their feet from ailments such as blisters or cuts that can eventually become problematic.
In Thunder Bay chiropodist Leigh Fairbridge works at Bay View Foot Clinic and the Anishnawbe-Mushkiki Aboriginal Community Health Centre and sees many diabetic patients. Fairbridge says the most common foot problem she sees is neuropathic foot ulcers, which if not treated properly can become infected and may lead to toe or limb loss. According to Fairbridge, many people, especially those without regular access to medical care, are not aware of the connection between foot care and diabetes. “Many of my patients aren’t aware their diabetes can have an adverse effect on their feet,” says Fairbridge. “Patients don’t see how foot care can be related to keeping themselves healthy in their daily fight against diabetes.”
Patients may delay a visit to a doctor because they hope the problem will go away on its own. When they finally do see a chiropodist, it might be too late. “Sometimes people get to me and there is nothing I can do, their condition may have deteriorated so much amputation is the only option,” Fairbridge explains. Unfortunately, with travel costs and lost wages to be taken into account, many people can’t afford to take the time off work to see a chiropodist, causing situations like this to happen more than Fairbridge would like.
Sometimes stories in the urban centres aren’t much different. For the many homeless people in Toronto, receiving medical care can be difficult. Hours could be wasted waiting in an ER when a trip to a family doctor is really what’s needed. That is why places like Sherbourne Health Centre have become valuable in their communities. Sherbourne Health Centre is able to serve those clients who live within the community and are registered on one of the family health teams. When family health team members at Sherbourne Health Centre see clients with diabetic foot problems, they have the opportunity to refer clients directly to the chiropody clinic within the centre. This allows clients to have fast and easy access to services, thus removing a potentially large barrier to care. The chiropody clinic is open weekly and is staffed by chiropody students from The Michener Institute, under the guidance of faculty.
To prepare students for such circumstances, the chiropody curriculum at Michener includes specific diabetic foot education. “Michener’s chiropody students rotate through several different diabetic wound clinics given by chiropodists and doctors who specialize in treating diabetic patients,” says Christine Burton, Michener chiropody professor. “Students learn the signs and symptoms of diabetic foot problems and how to treat possible complications including diabetic ulcerations.” After graduation, Michener chiropodists are well equipped to deal with all kinds of foot ailments, especially diabetic specific concerns, because of their academic and clinical education. An affiliation between Michener’s chiropody program and a place like Sherbourne Health Centre, allows students to obtain hands-on clinical training in a diverse environment and to enhance their skills outside the classroom.
For diabetics, foot care should be as important as daily insulin and diet control. Reminding diabetic patients to take care of their feet is a good practice all health-care practitioners should adopt.
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