Here, There, and Everywhere

I bring you greetings from Saudi Arabia where I have been teaching at a diabetic foot ulcer conference. It is a long way to Jeddah, Saudi Arabia from Montgomery, Alabama! The meeting is 3 days long and is designed for physicians. I was asked to speak on the evaluation and management of diabetic foot ulcers which seemed to be a topic that interested them. During this trip, I came to realize wound care education is not only needed but also desired by health care providers around the world. To attempt to meet the needs of physicians treating diabetic foot ulcers in Saudi Arabia, Dr. Nashat Ghandoura, a physician consultant at the King Fahd Hospital, Jeddah, Saudi Arabia, started this educational program. This was the tenth diabetic foot ulcer conference held at the hospital. 

During my time at the course, there were lectures on diabetic foot infections, etiology and nonoperative management of the Charcot foot, diabetic foot complications from the orthopedic viewpoint, and types of foot amputations for diabetic foot ulcer problems. The presentations were designed to introduce primary care physicians and many surgeons to the topics and the treatments available for diabetic foot issues without reflexively resorting to a below-the-knee amputation. My presentation on the overall approach to diabetic foot management included the importance of screening for foot problems in patients with diabetes, diagnosis and management of peripheral neuropathy, an overview of both large and small blood vessel diseases in the patient with diabetes, the importance of basic wound care in diabetic ulcer treatment, and techniques of limb salvage. There were many good questions following each presentation, implying the interest of those in attendance. 

Throughout Saudi Arabia, I learned diabetic foot ulcers are treated by primary care physicians and referred to surgeons (general, orthopedic, or plastic depending on the situation) when the need arises. The King Fahd Hospital is unique in that it has a special clinic for these patients called the Surgical Diabetic Foot Unit and Wound Care Unit, the only one in all of Saudi Arabia. I was honored to be invited to tour their unit. Their clinic is in a small office but is doing great work to provide specialized, evidence-based care for patients with diabetic foot ulcers and to reduce the amputation rate. There were also patients there with venous ulcers and lymphedema being treated with compression therapy. I was interested to see that our wound center in Montgomery, Alabama, is not the only wound center in the world with “large” patients! It is an honor and privilege to help support these efforts to improve care no matter where in the world they may be taking place. 

It is easy for us to talk about wounds and the problems of treating them. It is even easier when we consider these problems might only occur in places far away from us. Yet it is another thing to see them first hand. We are not surprised when people talk about health-related problems in under-resourced continents such as Africa. It is another to realize these problems exist in places where resources are not considered to be an issue, such as a country like Saudi Arabia. But then again, how many times do we see poor wound treatment decisions being made in our hospitals, clinics, and even wound centers here in the United States? Obviously, education is the answer to improve care for patients here and around the world, but unfortunately practitioners here and abroad must realize that education is needed and then be willing to use that information to change old, established treatment patterns. It is rather easy to support telling others around the world how to fix their problems, but are you willing to do what it takes to improve the care you provide patients with diabetic foot ulcers and other types of wounds in your local wound center?