Dr John Clark: When medical problems need to be treated as social problems

A podiatrist attends to the wounds of an amputee at Middlemore Hospital. Photo / Jason Oxenham

COMMENT:

I am encouraged by your recent efforts to highlight the problems many members of our population are having with diabetes and its complications. I was particularly interested in Friday's report on the study done by Jason Gurney (NZ Herald, May 3) outlining the high incidence of amputations in the Māori population.

He has pointed out that our current model of medical care delivery is failing Māori in a spectacular manner and advances a few thoughts as why this may be.

As a GP who has spent my last 30 years in one of the poorest areas of Auckland with a special interest in the delivery of quality care to the most needy, I would like to make some comments.

Many Māori (and Pacific Islanders) are afraid to go out of their suburbs and attend specialist clinics. When they are surrounded by people of another colour/ethnicity and in the sterile (Western style) environment, they feel like "fish out of water". This, along with the issues of problematic transportation as well as getting time off work or the pressure of the current family crisis makes up many of the causes of clinic DNAs ("Did not attend").

Medical delivery in the poorest suburbs often consist of cheap clinics with a turn-up-and-wait-your-turn policy. Then you are assigned a doctor you probably haven't seen before and will probably never see again. This is no way to feel truly understood or to build trust and confidence.

Similarly, it is important to have competent, trained and sensitive staff who are able to respond to people's needs and queries when they arrive unexpectedly, that is opportunistic teaching, encouragement and advice.

Although podiatry services are all well and good, we have never had an adequately funded, local podiatry service, yet the number of our patients who have needed an amputation are very low. This is because we examine, assess and treat foot problems ourselves and the patient doesn't have to find another health professional in another location to have their needs met. One of the biggest problems in avoiding foot damage is education in the wearing of appropriate footwear – many have been brought up either in barefeet or jandals and it's hard to change. And when they do, they go for the cheapest which are often poorly fitting and so create their own problems.

Jason Gurney, Department of Public Health, University of Otago. Photo / Supplied

I am glad Gurney mentioned the Mana Tū programme as there have been some great advances made for some people through this programme but it has also highlighted many of the hurdles that need to be addressed to get to the bottom of many people's poor diabetes management.

One of the issues is poverty causing family food shortages. Fortunately, we are able to supply emergency food parcels. This is sadly not an uncommon occurrence.

Another issue is unrelenting stress with people staggering from one crisis to another – financial, then housing, then family or legal issues. When their diabetes is not causing any immediate symptoms, it tends to be shifted to back or their priorities to be picked either when "things settle down" or when an emergency (like the need for an amputation) presents itself.

The Mana Tū has seen some real progress in the 15 months it has been operating but as the funding is coming to an end, there seems little chance of it being extended through the district health boards. So unless this good work is picked up, my prediction is that the majority of advances will be lost within the next 12 months and we'll go back to where we were – making the best of a difficult and frustrating situation and helping people when they are ready to change.

I believe it is time we stopped treating diabetes as a medical problem and started treating it as a social problem. We need properly funded and properly motivated staff providing wrap-around services that address emotional, financial, drug/alcohol, housing issues because it's only when people feel that these issues have been dealt with can them then feel they can work on their diabetes and so prevent those complications of amputations and renal failure that is vexing our health system.

Dr John Clark. Photo / Supplied

• Dr John Clark is a general practitioner working in Panmure.