LAHORE: Haji Yaqoob of Pattoki was bowled over by shock and disbelief when not one but four doctors declared that his foot had to be amputated.

Suffering from diabetes, an extreme case of which causes nerve damage or sensory diabetic neuropathy as it is called medically, Yaqoob’s feet slowly began to lose all sensation. Usually in such a case the patient does not feel any cut or sore on the feet and gradually it becomes worse.

One look at the state of Yaqoob’s feet would have made anyone believe that amputation may have been the only answer. His diabetic foot ulcer had caused not just the skin to deteriorate but partly the muscles too, leaving some of the foot bones exposed. It was a horrific sight.

“I was a driver and without my feet, I was useless,” he says grimly. Today Yaqoob lies down on an examination table so that his foot is examined.

Diabetologist and podiatric Dr Arshad Siddiqui carefully unwraps the bandage off Yaqoob’s foot. Compared to the earlier picture where Yaqoob was suffering from grade four ulcer and his bones and joints were exposed, this new sight of the foot is remarkable. New skin – darker in colour – has now formed healing almost the entire foot, except a large crescent shaped area where reddish granulation tissue has now formed.

“It is the formation of the granulation tissue that shows he is out of danger,” says Dr Siddiqui.

It took Dr Siddiqui years to come to this stage but today he has set up a small corner inside the Diabetic Consultation Room at the Mayo Hospital where those with diabetic foot ulcers can come to get themselves examined and treated by him. The mini office where he works with just an assistant and has two examination tables only, one outside, and one inside where dead tissue is removed to avoid necrosis.

The place was inaugurated formally on World Diabetics Day on Nov 14 2017 and Yaqoob’s was his first case.

“Every 30 seconds, somewhere in the world, someone undergoes amputation because of diabetes,” Dr Siddiqui informs. “It is important to know that this amputation is one hundred percent preventable.”

However, he adds, two things are important for a preliminary assessment. “One is to rule out that there is no bone infection or osteomatitis and the other is to determine the vascular status and ensure that the blood vessels are not constricted.”

The case of another patient, Jamil, was similar to Yaqoob’s.

A fruit vendor, Jamil developed diabetic foot ulcers but since his job was mostly standing around, his feet became badly affected. This time, the abscesses developed on the soles of his feet.

“I became completely dependent on my family to even take me to the washroom,” he said, remembering the lowest point in his life. “There was no other source of income either.”

“An amputation means an entire family is affected because the bread winner is gone,” says Dr Siddiqui.

Convinced since his exit fellowship in Medicine in 2016 that a comprehensive foot care clinic could help save amputations, Dr Siddiqui went to Karachi first for training because of the better facilities. He began practice at Mayo on his return.

Just in three months, three cases of major amputations have been successfully cured while a total of seven to 10 cases of great toe amputations have been a success. With severe ulcers, the doctor’s qualified assistant visits the patients’ homes. The outcome is that there is now a rise in the number of patients who come to see Dr Arshad in his clinic which is open only every Wednesday.

“We get about 20 to 25 cases every week,” says Farhan Ahmed, the medical assistant.

“If cases keep increasing like this, the clinic then may be also held twice a week. Usually everyone closes down consultancy at 1:30pm but our clinic remains open later than that. Last week, it went on till 6pm,” he added.

King Edward University and Professor of Medicine dean Prof Dr Irshad Hussain says the project is the third of its kind in Punjab, one being in Multan and the other in Lahore General Hospital.

“There is a definite rise in the incidence of not just diabetes in Pakistan, and also globally but also foot ulcers,” he says.

“The main problem is awareness and people do not understand that their wounds can become ulcers and get worse because of diabetes. Having said this though, I fully support this programme in Mayo Hospital and praise the initiative by Dr Arshad Siddiqui.”

The hospital’s budget did not allow a separate room nor much else. But Dr Siddiqui kept pursuing the matter finally a small area inside the Diabetic Consultant Room along with two exam tables were allowed by Mayo MS Dr Tahir Khalil.

“The fact is that a lot of times I had to spend money from my own pocket, and my assistant is being paid by a batch mate of mine…This is how we managed to arrange expenditures. Now we are vying for the expensive machinery and equipment to be donated to us,” says Dr Arshad Siddiqui. Even the computer for data entry, with still wrapped keyboard has been donated recently. But a lot more will be needed in the near future, he predicts.

Paramedical staff and other personnel – especially dressers and technicians, logistics, infrastructure and space and a machine called a ‘Pedograph’ the cost of which is in millions is badly needed if more and more patients are expected to come. There is also a need to give specialised footwear to patients who are currently buying from private sellers which is more expensive.

For Yaqoob and Jamil, the clinic has proved to be a blessing.

“If I had delayed even a little bit and I had gotten news of this place, I would have lost my leg from below knee,” says Jamil and adds, “But my recovery has been miraculous and I live my life with dignity now instead of being dependent upon others.”

Published in Dawn, March 5th, 2018