17 May, 2016
You should not smoke
If you smoke, stopping smoking is often the single most effective thing that you can do to reduce your risk of future illness. The risk to health falls rapidly as soon as you stop smoking (but takes a few years before the increased risk reduces completely). If you find it hard to stop smoking, then please consult a smoking cessation clinic or service.
Undertake regular physical activity
Anything that gets you mildly out-of-breath and a little sweaty is fine, for example: jogging, heavy gardening, swimming, cycling, etc. A brisk walk each day is what many people do - and that is fine. However, it is thought that the more vigorous the activity, the better. To gain most benefit you should do at least 30 minutes of physical activity on most days. Two shorter bursts are thought to be just as good as for example two 15-minute bouts of activity at different times in a day.
Eat a healthy diet
Briefly, a healthy diet means:
• AT LEAST five portions, and ideally 7-9 portions, of a variety of fruit and vegetables per day.
• THE BULK OF MOST MEALS should be starch-based foods (such as cereals, wholegrain bread, potatoes, rice, pasta), plus fruit and vegetables.
• NOT MUCH fatty food such as fatty meats, cheeses, full-cream milk, fried food, butter, etc. Use low fat, mono- or poly-unsaturated spreads.
• INCLUDE 2-3 portions of fish per week, at least one of which should be 'oily' (such as herring, mackerel, sardines, kippers, pilchards, salmon, or fresh tuna).
• If you eat meat it is best to eat lean meat or poultry such as chicken.
• If you do fry, choose a vegetable oil such as sunflower, rapeseed or olive.
• Try not to add salt to food, and limit foods that are salty.
Don't have too many sugary foods and drinks
Sugary foods and drinks are high in calories, and too much may cause weight gain. It isn't just the amount of sugar that may be bad. Even eating small amounts of sugary foods (sweets, etc.) too often is bad for teeth. Tips include:
• Try not to add sugar to tea, coffee, and breakfast cereals. Your taste for sweetness often changes with time. Use artificial sweeteners only if necessary.
• Reduce sugar in any kind of recipe. Use fruit as an alternative to add sweetness to recipes.
• Try sugar-free drinks. Give children water as their main drink.
• If you eat chocolate or sweets, try to keep the quantity down. Eating them as part of a meal, and then brushing your teeth, is better than between meals as snacks.
Don't drink too much alcohol
A small amount of alcohol is usually fine, but too much can be harmful. Men should drink no more than 21 units per week (and no more than 4 units in any one day). Women should drink no more than 14 units per week (and no more than 3 units in any one day). One unit is in about half a pint of normal strength beer, or two thirds of a small glass of wine, or one small pub measure of spirits.
Further tips on healthy independent living can be obtained from your GP, Practice Nurse, Podiatrist other Healthcare Professional.
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.