Q: How long have you been in the profession?
A: 34 years.
Q: What made you decide to become a podiatrist?
A: I was a nurse, but my hearing was deteriorating, and I needed a more closed-in environment that would allow me greater engagement and face-to-face time with a patient, away from the hustle and bustle of a busy, noisy ward. Also, my grandmother was a chiropodist, so I had an introduction to the profession at an early age.
Q: If you had to do it all over again, would you still have chosen this career path?
A: Most certainly – every day is different and rewarding.
Q: What do you like most about being a podiatrist?
A: For me, I have the satisfaction of having people come in with a problem and go out with a solution.
Q: Describe an average day at work.
A: There is no such thing. I never know what’s coming through the door – even with long-standing clients.
Q: How many hours a week do you work?
A: Upwards of 60 hours per week. Running two clinics. Striking work/balance is a challenge. I have new associates who have also joined which means more management responsibility. I also do home visits, which are not always near each other geographically.
Q: Give an example of a unique situation or patient with which/whom you have dealt (anonymous of course!).
A: Well, I have a patient with 20-size feet!
Q: What has been the most difficult thing you have ever had to tell a patient?
A: I can’t really say. It’s more about health education and changing lifestyles; sometimes it’s as simple as changing footwear or going on a diet, which some are not willing to accept. NHS healthcare for feet is in decline except for the most at-risk, and this means having to budget and pay for private foot care.
Q: What advice would you give to those considering studying podiatry and those seeking to develop their careers post-graduation?
A: For those considering a career in podiatry, they should do some work shadowing, even for just a day. For those newly qualified, I would say they should find their niche. Too many recent podiatric graduates want to specialise in biomechanics. I would argue for specialising in diabetic foot care. Diabetes UK ( www.diabetes.org.uk ) has recently announced that the number of people living with diabetes in the UK has reached more than four million, and there is an urgent need to increase diabetes care and education.
Q: How much emphasis should podiatric education place on soft skills, for example, business management? Staffing? Financial planning? Work/life balance? Other?
A: Universities are increasingly incorporating this into the curriculum, but at the same time, I think they could focus further on the soft skills.
Q: You are one of few accredited UK podiatrists in the business (150 according to the Society for Chiropodists and Podiatrists). Do patients really care whether a podiatrist is accredited or not? Is accreditation worth the bureaucratic hassle?
A: Do clients really care about whether you are accredited? No. But accreditation is about ensuring that my practice works to a gold standard and that all practice procedures and protocols are being met. Accreditation is a good audit tool, not just internally, but for all of our clients.
Q: There has been a lot in the news lately regarding UK diabetes numbers on the rise and that diabetes is increasing the risk of dementia by 60 per cent. Now they are also saying statins can increase the risk of heart disease. Just who can I trust for fair and accurate information?
A: I know how difficult it is to digest the regular stream of scare mongering in the media. I try to stay up to date on the latest information both in the UK and abroad and advise my clients appropriately. If they have wider concerns, they should discuss these thoroughly with their GP.
Q: Come on, you really are just a glorified agony aunt, with a sharp pair of nippers in your hand. Refute.
A: I have many regular clients as well as new. It’s not just about the feet. Their overall health and wellbeing impacts on the quality of their lives, and if I am in a position to be a sounding board during treatment, then I feel that I have made a difference.
Rwanda is a small ambitious country known as the land of 1000 hills with a population around 12 million and a rapidly growing economy. It has rolling hills for as far as you can see, a rain forest, gorillas and volcanoes, making for quite the site to any visitor. However, it is also known for the 1994 genocide in which over 1 million people were killed in 100 days across the country.
This tragic event has led to some very big health issues, which the country still faces, but thanks to a range of donor funding and strong political leadership, the country is on its way to quickly becoming a middle-income country.
As countries shift from low incomes to middle income economies, health issues become complex, where the country can face a mix of communicable disease (ie. malaria, HIV, TB) and the introduction of non-communicable disease (ie. diabetes, high BP, cholesterol) with changes in lifestyles.
Now you are probably wondering what this has to do with podiatry?
Well, as clinicians we play a role in the overall wellbeing of every patient that walks through our door for treatment and we become advocates for a number public health issues. While our specialist area is focused on the foot and ankle, an understanding of the bodily systems is imperative for understanding the impacts on the lower limb. This allows us to transition from clinical practice to other work streams such as health policy, public health programmes, service management and research.
As a podiatrist with a public health background, the increase of diabetes and chronic conditions in developing nations has become of personal interest. In many of these countries, diabetes is poorly understood and without proper prevention and care, can lead to a large economic burdens on the healthcare system. In 2012, the UK alone spent a whopping £639 million on foot ulcers and £662 on lower limb amputations, so the prevention and monitoring of these conditions is of paramount importance in the developing world.
The quality of life for individuals with diabetes is also drastically affected if not controlled, impacting mobility, footwear and overall lifestyle. Additionally, chronic ulceration and limb amputation, creates an increases risk (approximately 80%) of mortality within the first 5 years post amputation.
How did all this lead me to Africa, I hear you say?
In April of 2016, I (sadly) departed from the Betafeet clinic to implement an mhealth project in Rwanda in partnership with the Ministry of Health. This project, allows patients across the country to speak with a doctor and receive a prescription via SMS through their mobile phone, reducing the travel time, wait time and expense of receiving care from one of the local physical hospitals. The system is also working on monitoring both communicable and non-communicable disease using artificial intelligence, engaging patients to take ownership of their health.
This could be a major milestone for a country with stretched resources. To put things into perspective, over 80% of the population lives in remote areas of the country and works in the ‘in-formal’ sector as subsistence farmers with an average income of 2-3 dollars per day, which is not very much. To receive care, a patient may travel over an hour to reach their nearest hospital where a doctor is present and then wait anywhere from a few hours to a few days to receive the care they need. However almost 80% of the population already has a mobile phone.
Appropriate access to clinical care is a large part of the prevention and management of many conditions and undertaking this project has been a great experience. As a clinician, I have had the opportunity to utilise my knowledge to develop operational pathways and input into the technology development to shape the way patients receive their care.
It is with
this experience I now look to move on to my next adventure focusing on Aboriginals
and the utilisation of technology in the prevention of major non communicable
disease such as diabetes.
Final comment from Reggie Simpson and Betafeet Podiatry
We wish Andre the very best in his future and thank him for this interesting blog account. We look forward to his next blog focused on his work with the Aboriginal population.