Thus spoke Swami Sampoojya Poornamritanandapuri, at the inaugural function of Amrita Diabetic Foot Conference (ADFC 2011), organized by Amrita Institute of Medical Sciences and Research Centre (AIMS), Kochi, India (6-7 May 2011). In the words of Swamiji, 'we can reach a supreme state of bliss if we respect our body, as the human body is a temple in which God resides.' So we must refrain from insulting anybody and must respect everybody. It is important for all of us to keep our bodies healthy and pure as they are too precious to be neglected. This can be done by eating proper and pure food so that we remain fit to perform our duties towards society. Out of this respect arises the need to control diseases like diabetes.
Dr Prem Nair, Medical Director, AIMS, spelled out that the goal of this multi-disciplinary conference was saving the diabetic foot and preventing amputations, by deliberating on the entire gamut of diabetic foot problems - from the cellular level to the patient's bedside. This will not be possible without involving the general medical practitioner at the primary health level, in this noble endeavour.
Professor (Dr) Rama Kant, President-elect of the Association of Surgeons of India (ASI) 2012, and the Chief Guest at ADFC 2011, stressed upon the need to innovate and modify in surgery - be it the diabetic foot or any other part of the body - as and when the situation demanded. This is particularly relevant in the Indian context where surgeons and doctors have to often work in far from perfect settings. In order to succeed, one needs to change ones mindset, as very many times our perceptions can be wrong. He said that human beings would do well to emulate the example of geese that travel long distances, flying together in a 'V' formation. Scientifically, this organised togetherness increases the power of the flock by 71%. So team work and love for fellow beings goes a long way in achieving the impossible. Citing the story of Lord Krishna washing the feet of his poor friend Sudama from the epic Mahabharat, he said that it was an example of doing foot care with humility.
On the first day of the conference (6th May), there were excellent presentations on diabetic foot infections/complications and advanced management of the high risk diabetic foot. The importance of microbial gene analysis, bone debridement, anti fungal treatment, proper nutrition, endovascular therapy, diabetic arthropathy, and surgical offloading of diabetic foot ulcers were discussed at length.
Amputation is a marker of quality of diabetic foot care. Dr Sarnarendra Miranpuri from Detroit Medical Centre, rightly remarked that, "It would always cost less to manage diabetic foot complications, and prevent them from happening, rather than to treat them." There are many new modalities which are being developed and used for this purpose. Bioengineered alternative tissues contribute to wound healing, but are yet to be available in India. Negative pressure wound therapy also results in faster healing and fewer amputations. Anodyne Infrared therapy is the most modern technique which has been recently introduced in India for wound healing. It emits MIRE (monochromatic infra red energy) which has a wavelength of 890nm and energy of 6240 mW. MIRE therapy is known to have amazing success rates and has worked in situations where even hyperbaric oxygen therapy failed.
However, in our country, many of these useful, but expensive, methods may be nonexistent in poor rural settings which form a vast majority. So, cost effective methods, coupled with doctor’s ability to diagnose correctly and timely, is the need of the hour. In many cases, as pointed out by Prof (Dr) Rama Kant, doctors do not even do routine examination of the foot, in a proper way. There is also a need for patients and general public to know about the importance of correct footwear. Faulty footwear and/or walking bare foot, which is so very common in India, are an invitation to infected ulcers and eventually amputation.
As Prof (Dr) Rama Kant rightly remarked, "the mantra is to have faith in one self, treat obstacles like friends and not foes, and never feel too big to be nimble. Tough times do not last, tough people do. The key to success and efficiency is to work together in cooperation as a team and to think out of the box." (CNS)
(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Diabetes Media Initiative (CNS-DMI). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP. Email: email@example.com, website: http://www.citizen-news.org)