Joe is a doctor currently working for MSF in Pakistan. He blogs about the challenges patients with diabetes face, and shares the story of an older man with a terrible wound who was finally able to access treatment...
Patients with chronic diseases need regular follow-up, ongoing education about their illnesses and access to a reliable supply of quality medication. Unfortunately here in North West Frontier Province, this ideal is seldom if ever achieved. Due to many factors, including poverty and difficulties in regularly accessing healthcare facilities, many patients who should have close monitoring and support instead suffer through a confusion of haphazard and sporadic treatment. As a result, they progress through an inevitable and tragic deterioration.
Type 2 Diabetes is very common here and so are its complications, including problems like gangrene, kidney failure, blindness and metabolic derangement leading to coma and death. Because of the devastating damage it causes throughout the body, it is an important example of a disease that needs well-regulated control. But, most of the diabetic patients who come to the MSF emergency room and in-patient department have been denied this in the past and consequently they are often in very bad shape.
He looks closer to 90 to me – the weathering of a life harder than it needed to be
Ziarat Gul, a man currently admitted in our ward is no exception. Blind in one eye and with a long white beard he is a hunched, frail old man who has become well known to us over the past few months. He guesses his age is somewhere between 60 and 80, but he looks closer to 90 to me – the weathering of a life harder than it needed to be.
When he first presented he had a carbuncle – a large area of infected skin similar to an abscess – on his back that had been festering for some time. He had been unable to get proper treatment for the wound or afford to purchase his vital medication, and his blood sugar was dangerously high. Infections are a real problem for patients like this: the uncontrolled diabetes (caused by the missed medication) weakens immunity, increasing the likelihood of infection and, once an infection takes hold, it pushes the diabetes further out of control – a vicious cycle in which this man was trapped.
Luckily, once identified, the problem was simple enough to treat: a special diet, daily doses of the right tablets and dedicated wound care. Though it has taken a lot of patience on the part of the MSF nurses and several debridements by the MSF surgeon to remove the infected tissue, this previously neglected wound is dramatically improved. From a painful crater in his back, it is now a healthy, neat surgical wound after a successful operative closure today.
This previously neglected wound is dramatically improved
A success story like this is very gratifying for us because this man is one of the lucky ones. He managed to get to the MSF hospital while there was still time for us to help him. Others are not as fortunate. Over the months that I have been here, we have admitted many diabetics with infections whose disease is out of control because of chronically poor management. For most this means an extended stay in our hospital until things improve, for others it ends with the amputation of a foot or leg with all the long-term impairment that can bring. And for a few, it is their last illness in this world.
It is not easy having to accept that a person has suffered or died from a preventable cause, from something that, had it been seen to earlier, would have been completely treatable. And so we hope that the story of this old man who is now on the mend will be told, and will spread in the community and that others in need of similar help will come sooner to the hospital. Soon enough for us to nurse them and their neglected wounds back to health. Inshah-Allah.