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Diabetic Foot Care: Going Global

Nurses take their foot care tools and expertise to Zanzibar in East Africa.

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For nearly 20 years, Laura Roehrick RN, CFCN, has dedicated her life to reducing diabetes-related amputations through proper foot care.

She began her career as a diabetic foot nurse in 1993 with Kaiser Permanente, but quickly realized not only that she needed a lot more training, but that few, if any nurses knew foot care was within their scope of practice.

"This is a huge misconception that needs to be rectified. Nurses can cut toenails. They just need to be properly trained," Roehrick stated.

"Nurses need to know that there should be a foot nurse in every skilled nursing facility, in every hospital. If a patient needs toenail trimming and they are in the hospital, it should be done there."

Taking on the cause, she sought out any and all education and training opportunities, and studied under Teresa J. Kelechi, PhD, GCNS-BC, CWCN, FAAN, a pioneer in the field of foot care for patients with diabetes.

"I am immensely grateful to Teresa Kelechi, my mentor and the 'mother of foot care nursing' in the U.S.," Roehrick said. "Without her support, none of this would have been possible. She started the entire foot care nurse movement in the U.S."

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Equipped with proper training and with a few tricks of her own, she began educating others and attending foot care training opportunities, from small local programs to large, multi-national workshops and conferences.

Connecting Globally

It was at one of these conferences, namely the Diabetic Foot Global Conference (DFCon), when Roehrick starting connecting with international proponents of diabetic foot care and realized the lack of knowledge spanned the globe.

"Basically, Canada and the U.S. are the only countries that really utilize nurses, LVNs and RNs, in foot care," she said. "At these conferences, I started networking with people from overseas and especially in developing countries - India, Malaysia and Africa - and realized nurses were not being used as a resource anywhere [else] in the world."

In 2007, Roehrick saw an opportunity to finally make a lasting difference internationally. While teaching a training course in Tanzania, she met Fadhil Abdalla, MD, then a family practice doctor with his own diabetic foot clinic in Zanzibar.

"I went over there, to Zanzibar, [and] I met with him for a couple of days. I said I would come back. I would come back with equipment - and bring back nurses!" Roehrick declared.

Once back in the U.S., Roehrick began a nonprofit organization, the Preventive Diabetics Foot Care Alliance, to promote preventive foot care nursing throughout the world.

Into Zanzibar

Roehrick now has the support and resources to move ahead with her vision, and this March, she is helping Abdalla travel to the U.S. to train and to attend DFCon 2013 in Los Angeles.

The conference and training will be a huge step in the right direction, and he will return to Zanzibar - laden with much-needed equipment - ready to tackle the growing foot care problem for people with diabetes.

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Diabetic Foot Care: On the Road to Zanzibar

Laura Roehrick RN, CFCN, travela to East Africa determined to improve care.

Although there is some foot care in Zanzibar, clinics lack the vacuum drill that has become essential for optimum foot care, and Roehrick's first concern is to help Abdalla introduce his staff to the benefits of the new equipment.

Remembering her own promise to return, Roehrick is still planning a trip for this coming June.

She and at least four other nurses, forming what she calls her "Drill Team," are paying their own way to Zanzibar, bringing with them more equipment and expertise for local doctors, nurses and even laypeople.

"Part of my overall plan, or the vision that I have to help prevent amputations, is getting more laypeople involved for people who cannot get to clinics," Roehrick explained.

"If we can get some laypeople in the area of Zanzibar who are interested, then we can teach them and potentially they can have their own businesses where they focus more on the medical aspects with good tools."

Stemming from this idea, she and Abdalla have also collaborated on another initiative to disseminate important foot care information to those that need it most by getting the families of person with diabetes involved in their loved one's care.

"We are going to take a sampling of some relatives, train them to do medical foot care and give them home-kits," Roehrick said. "It's just one more thing we are trying to do to teach a man to fish and give him the fishing pole."

Half Moon Bay

In conjunction with Abdalla's visit and her own travel plans to Zanzibar, Roehrick is finalizing her plan for a sister clinic in her area of Half Moon Bay, CA.

A local low-income clinic there treats many patients with diabetes, but it lacks a diabetic foot clinic. Roehrick hopes to alleviate that need with, to start, 4 hours a month of free foot care.

"The need is huge for foot care here in Half Moon Bay," she said. "The idea will be for me to train a local nurse to take over what I start; I need to start training other nurses so that they can continue the work. But I need to start this little clinic first."

Roehrick hopes the new clinic in Half Moon Bay will not only serve the needs of the population, but also help raise awareness for its sister clinic in Zanzibar.

"We are not just going to go over there to start something and then leave," she said. "Through Skype and the internet, I can continue teaching them and giving support. If we set up a really good relationship between Zanzibar and Half Moon Bay, then, potentially, I can even fly over some people from Africa and have them train with me here."

Education Gone Global

Training in the U.S. has come a long way since Roehrick first became involved, and there is now a relatively new certification to become a Certified Foot Care Nurse (CFCN).

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But even with the new certification, there are still obstacles to Roehrick's dream of internationally accepted nursing foot care.

"The problem is there are no regulated courses of curriculum to prepare nurses for this CFCN exam," she explained. "There are random nurses and podiatrists teaching nurses, and that's a problem, I think."

She is hoping the nurses who attend her courses will be inspired to take up this cause for future generations and help push for regulated training for nursing foot care.

"If nurses can get to it sooner, then they can prevent that first wound that can lead to amputation. That's the whole message," Roehrick concluded.

"Eighty-five percent of amputations are preventable with nursing foot care, basically, and wearing proper shoes. That's why it is so important for nurses to do this. If we can just cut the toenails correctly and help with the calluses and corns, we are going to save feet - and save lives."

Roehrick wants to make sure everyone gets the message, from Half Moon Bay to Zanzibar.

Rebecca Hepp is an assistant editor at ADVANCE.

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