Nurse traveled to Africa to treat foot wounds caused by diabetes

Laura Roehrick, RN, CFCN, takes a feet-first approach toward diabetes care.

Armed with a high-speed drill, burrs and bits and an unusual technique, Laura Roehrick, RN, CFCN, worked on the miguu of many patients in Dar es Salaam, Tanzania.

Roehrick traveled halfway across the world to teach proper foot care to African doctors as a faculty member of Step by Step, a program funded by the World Diabetes Foundation and International Diabetes Federation that aims to improve diabetic foot care in developing countries.

“My goal going into Africa was to see with my own eyes what is happening there,” Roehrick, a foot care nurse and owner of the The Foot Care Connection, told Endocrine Today.

Diabetes is an epidemic in Africa. On her first day there, a taxi driver told Roehrick that many people in Tanzania drink 10 or more sodas per day. Few people know about diabetes or related dietary concerns, she said.

Foot clinics are rare in developing countries. Step by Step’s team estimates it can reduce the number of amputations by 50%.

“My mission is based on a fact I discovered 13 years ago – 85% of amputations that occur because of diabetes are preventable,” she said. “Why are we not doing a better job at preventing it?”

Rustic clinic

In Dar es Salaam, Roehrick spent four days in an underfunded, rustic clinic where she trained four nonmedically-trained staff members. Infection control had been inadequate before her arrival. The staff would sterilize the basins and wear gloves, but they would not wash their hands in between patients.

Some of the foot conditions of the patients were appalling, according to Roehrick, and almost all were related to diabetes. Many people in Tanzania do not wear shoes, leading to dry, callused feet. No one was addressing the resulting skin care conditions.

“One woman had a wound for seven years that was not healing. People had parts of toes missing, rat bites on numb feet,” she said. “Before I came, [the staff] would just change the dressings on these wounds in very primitive conditions, and the wounds wouldn’t heal.”

Roehrick left the team with a high-speed drill and burrs and bits to sculpt the feet, as well as textbooks and hands-on training.

“I taught them a new way of doing things. I would sculpt the nails and calluses of each patient who came in, using the drill, and pretty soon the staff was doing it and I was observing it,” she said.

Roehrick started The Foot Care Connection, based in Santa Rosa, Calif., 13 years ago. She was the first nurse in California to open an independent foot care practice.

“Foot care is something that nurses in this country, to this day, are still told we cannot do,” she said. “But, it is within our scope of practice and nobody knows about it.”

Roehrick’s focus is on diabetes amputation prevention. Ninety percent of amputations begin with a callus, a callus fissure, an ingrown toenail or nail problem, she said.

“My specialty is the worst of the worst nails and calluses you have ever seen. I use a high-speed electric podiatrist drill and I sculpt them. I’ve developed a technique that I haven’t seen anyone else do quite like me. I take burrs and bits from different industries that aren’t traditional, and I sterilize them and sculpt the feet without a scalpel – sterile, painlessly, effectively,” Roehrick said.

Moving forward

While in Africa, Roehrick also traveled to Uganda and Zanzibar. In Zanzibar, she met with Fadhil M. Abdalla, a family practice doctor there with a special interest in diabetic foot care.

Her experiences and observations in Africa, coupled with her meeting with Abdalla, prompted her to begin the long process of starting her own nonprofit, hoping to improve foot care in Africa, specifically in Zanzibar.

“I want to try to prevent that first wound in developing countries and get education at that base level,” Roehrick said. – by Katie Kalvaitis