ANYONE else would have at least bandaged the tiny gash, but when Nadeem Khan, who suffers from severe diabetes, wounded his foot he could not even feel the pain. Slowly an infection developed and soon became so critical that when he finally went to a well-known state hospital, doctors said the affected toe would have to be amputated.

Not ready for such a dire step, Nadeem visited other places — all renowned public hospitals — but all the doctors said the same.

“They did not even examine me properly, just took one look at my foot and said that I would have to lose the toe,” says the 48-year-old man, who has also suffered acute kidney and stomach problems in the past.

Extreme diabetes often results in nerve damage. Medically, the condition is known as sensory diabetic neuropathy. But the problem is not that it cannot be addressed, it is that globally the decision is made to amputate the affected limbs or digits in order to control the infection.

But Dr Arshad Siddiqui from Mayo Hospital has been working in the opposite direction — by helping to save feet rather than lose them.

“The seriousness of this problem is such that until a few years back statistics showed that globally, every 30 seconds a limb would be amputated,” he says. “This year it is seen that amputations occur every 20 seconds.”

One of his patients is Muhammad Yaqoob, whose case is similar to that of Nadeem. Yaqoob, a cab driver, began slowly losing all sensation in his feet. An infection he developed became so severe that soon the abscess ate away his skin and muscles, exposing the bone. One look at the case and most doctors would definitely have had reason to amputate.

But the Diabetes Foot Care Clinic (DFC) at Mayo Hospital thought differently.

Originally a two-bed space (one for examination, the other for dressing) in the hospital’s diabetic consultant room, this began as a test project. Today, the hospital administration stands convinced by its success and it is now a proper programme.

“In purely economic terms, an amputation means that an entire family has been affected because the breadwinner is gone,” says Dr Siddiqui. “Besides losing a part of the body, the pain, this perhaps the most pressing concern of the patient.”

Once at the DFC, the patient’s foot is thoroughly examined, and if need be, it is operated upon in order to drain the abscess. Then treatment follows on a daily basis for at least a couple of months.

“Within two months, my foot was much better,” says Nadeem, who is still advised bed rest. “Instead of amputation, now I have a foot that is slowly regaining feeling. My diabetes is under control now, too.”

The prevalence of diabetes in Pakistan has escalated to 26.3 per cent from 22pc, worrying statistics provided by the National Diabetes Survey of Pakistan (NDSP). Speaking at a recent conference on foot ulcers, Prof Dr Abdul Basit, president of PWGDF (Pakistan Working Group on Diabetic Feet), said that 36 million Pakistanis were suffering from diabetes, and the disease burden could be reduced by proper diet, regular exercise and weight loss. But, he said, there was need to open up more such foot clinics.

Most cities in Pakistan are still deprived of foot care clinics to educate and treat patients. In Lahore, the DFC is the only one. Dr Basit says that his organisation has established 115 foot care clinics nationwide so far, and are planning to increase this number to 600.

Meanwhile Yaqoob recounts his shame in depending entirely on his family for the smallest of things, and at the same time, not being able to earn daily wages. “Home life was badly affected, and we were living hand to mouth,” he says. Today the affected area on his foot shows only a patch of darkened skin. The development is astonishing considering how deep the abscess had been.

Nadeem’s toe also is now black and crooked. The abscess had gone down to a cracked bone, but since the draining, treatment and proper dressing of the wound, the bone is now clean while his toe is slowly regaining feeling.

“My only problem is my wages,” says Nadeem, who is still on bed rest but is not being paid anything by the private company he works in, nor being helped medically. Like many others he is under crushing financial depression. “Just one tablet of my medication costs Rs130,” he says, “while insulin costs Rs850 which lasts 22 days.”

Dr Siddiqui, who has been working alone on this project apart from an assistant, says that from holding sessions only once a week, now they have increased to twice a week.

“We have 50-plus patients just for follow-ups — our regular patients, and otherwise we get about 35 new patients every week. This is all-day work, not just for a few hours,” he says.

Published in Dawn, September 16th, 2018