Gwen Fernandes, a student at the Wales Centre for Podiatric Studies, was awarded the 2007 Cosyfeet Study Award. The £1000 grant reward helped to fund her final year research project comparing diabetes pathologies in the developing world with those in the UK. Gwen volunteered at Korle-Bu Teaching Hospital and at the Ridges Hospital in the Greater Accra Region of Ghana. Her subsequent report is featured here.

The International Diabetes Federation (IDF) reports that 245 million people worldwide are living with diabetes and about two-thirds of these people live in developing countries, such as Ghana, in sub-Saharan Africa (IDF, 2006a–c). Diabetes is a major and fast increasing cause of morbidity, premature mortality and disability, and as such is a costly disease bearing individual, psychosocial and economic implications.
   In developed countries, such as the UK, the keys to management of people with diabetes are well-organized foot care, good diabetes control and patient education (American Diabetes Association, 2003). Diabetes awareness programmes, leaflets, the Internet, as well as written and verbal advice from healthcare providers facilitate in solidifying a patient’s knowledge about the condition. Patient empowerment is also fundamental to successful self-management and improving health.

The Korle-Bu Teaching Hospital experience
The United Nations Educational, Scientific and Cultural Organization (UNESCO) estimated that 25% of Ghanaian adults are illiterate, a statistic that significantly hinders the possibility of patient empowerment (Adjah, 2005; UNESCO, 2002). At Korle-Bu Teaching Hospital, the diabetes clinic holds over 80000 patient records; and, each day, approximately 160 patients attend the clinic from in and around the catchment area. They assemble before their appointment times for a health education talk which details basic foot care, blood pressure regulation, diet and physical activity. Their blood glucose levels and blood pressures are also assessed. However, a large majority of these patients have returned for more medication simply because they could not afford the initial 3-month oral anti-diabetes medication. This further contributes to the burden on health resources.
   Alternative methods of communication are essential to the diabetes awareness campaign. The medium of television has proved a useful tool not only for highlighting the signs and symptoms of diabetes, but also for explaining to the public that the nature of the condition is not shameful or spiritual, but rather a manageable condition where severe complications such as amputations can be avoided. Using the media to spread the news of diabetes and raise its profile is also common practice.
   The Traffic Signal Book is an excellent example of improvised health care provision in Ghana. This booklet is a sort of diabetes diary containing a record of a patient’s blood glucose levels from each previous visit and if a patient is unable to comprehend numerical values, the traffic-light colours are given as an alternative measurement tool. Green represents the normal spectrum of blood glucose (between 3mmol/L and 6mmol/L), yellow indicates a glucose level of between 6mmol/L and 9mmol/L, and red indicates any value above 10mmol/L. Patients were clearly capable of understanding this monitoring method. HbA1c testing is not routine in Ghana, so this book provides a valuable insight into the patient’s history of self-management.