Introduction

Benjamin Franklin famously stated, “An ounce of prevention is worth a pound of cure.” This statement was made in reference to the importance of fire prevention in 18th century Philadelphia,¹ but it aptly applies to modern diabetic limb salvage. The multidisciplinary model for amputation prevention has been in place now for almost two decades, but how far have we really come?

Recent literature suggests that there has not been a significant decline in reamputation rates for diabetic patients despite the team approach to care.² Diabetes is a complex and aggressive disease that affects multiple organ systems and robs patients of sight, sensation, limb, and quality of life. Treating such an aggressive disease is challenging, to say the least, and often the desired outcome is not achieved.

Issues With Screening and Patient Education

Focusing on prevention has taken center stage on the war against amputations. The concept is to screen and educate diabetic patients while providing early intervention for foot issues, including callus formation, vascular compromise, and peripheral neuropathy. Seems easy, right? Well, at times it may not be so black and white.

Our health care institution, like many others, has sought to reach out to the surrounding community with free classes and seminars. These programs have been sparsely attended, which was surprising because we are the safety net hospital in the region. The low attendance rate was largely attributed to the “noncompliant” nature of the patients in regard to their own health by the administration. However, as a clinician caring day in and out for this same patient demographic, the apathetic explanation was simply untrue.

It is obvious that our patients care deeply about their own health as well as that of their entire community, so why were hospital-initiated screenings and classes not successful?

Impact of COVID-19 Pandemic

Many lessons have been learned during the COVID-19 pandemic, and one of the biggest for our health system is the power of representation. UF Health Jacksonville (Florida) was one of the first hospital systems to receive the COVID-19 vaccine in the region, and a majority of the faculty and clinical team embraced the opportunity.

Hospital staff members, however, generally showed hesitancy to receive the vaccine despite all the educational material provided. The root cause of the hesitancy was explored by upper level leadership, and the answer, quite frankly, highlighted a history of distrust for the medical community.

The push for vaccination brought back terrible reminders of the not too distant past surrounding the Tuskegee experiment and its victims (marginalized members of society from the rural South). It also underlined the racial disparity between clinicians and the patients they care for in relation to the larger community. This awareness surrounding diversity and inclusion led to meaningful reflection and an opportunity to learn from the past.

The IDEA Council and Addressing Health Care Disparities

UF Health took on a new approach to bridge this divide by forming a new IDEA (Inclusion, Diversity, Equity, and Access) Council with a mission to instill a culture of inclusiveness as a foundation to approaching medical care, education, and research.³ Forming more extensive partnerships with community groups to build trust for a better future became a priority. Fostering inclusiveness through representation has yielded positive results.

The diversity and inclusion approach will also be applied to amputation prevention screenings for the diabetic population in the Jacksonville area. The Lower Extremity Amputation Program (LEAP) Alliance is a 501©3, not-for-profit organization with a mission to save limbs and lives through the “Bare Your Soles” diabetic foot screening program in collaboration with community-based groups such as the Lions Club.⁴ It is with great excitement that we are partnering with the LEAP Alliance to better serve our diabetic community.

Truly meeting people where they live, backed by those in their own community, will likely have a greater impact. Being mindful of representation is necessary to address health care disparities by building bonds of trust. This quote by Dr. Martin Luther King keeps us inspired to move forward for a brighter and healthier tomorrow: “Of all forms of inequality, injustice in health care is the most shocking and inhumane.” 

References

1. Founders Online. On protection of towns from fire, 4 February 1735. National Archives and Records Administration. Accessed April 8, 2022. https://founders.archives.gov/documents/Franklin/01-02-02-0002.
2. Liu R, Petersen BJ, Rothenberg GM, Armstrong DG. Lower extremity reamputation in people with diabetes: a systematic review and meta-analysis. BMJ Open Diabetes Res Care. 2021;9(1):e002325. doi:/10.1136/bmjdrc-2021-002325
3. Idea Advisory Council, Inclusion, Diversity, Equity and Access (IDEA), College of Medicine, Jacksonville University of Florida. UF Health. Accessed April 8, 2022. https://idea.med.jax.ufl.edu/our-team/leadership/
4. LEAP Alliance Las Vegas. Accessed April 8, 2022. http://www.leapalliance.org/

About the Author

Christine Miller DPM, PhD is a certified wound specialist by the American Board of Wound Management and a Fellow of the American College of Clinical Wound Specialists. She currently serves as the Co-Director of the Limb Salvage Program at the University of Florida, College of Medicine-Jacksonville.