COLLABORATION. Ulla Hellstrand Tang, who presented her theses at the Clinical Sciences Institution in spring, has undertaken a 90-day cycle trip to draw attention to the major regional differences in prevention and treatment of foot complications in diabetes. The project was called Hoj17. The project was implemented in cooperation with the Gothenburg Diabetes Association, in order to encourage politicians and the health-care profession, in partnership with patient organisations, to develop a common strategy. In Akademiliv, Ulla shares her experiences of taking on this challenge in order to raise the profile of research results in society.
“Help – police 112!”
At 23:19 on Tuesday, May 16, I sent an SMS to my husband Janne. He woke in horror and called the police.
My second SMS, at 23:23 was “Check my GPS-position…Someone’s taking my bike”.
Terrified, I lay silently in my tent, my heart pounding, as I heard the sound of someone trying to take my bike and bike-trailer. The sound of the two would-be thieves, just a couple of metres from my tent, woke me up with a start. In contact with the police via my mobile, I finally crept out of the tent in the dark. A quick check with my flashlight revealed that nothing had been stolen.
Time to put our feet down
The idea for Hoj17, a 2500 kilometre bike ride to improve foot health in diabetics, came on 16th April 2016, when Monica Ullbrandt and Birgitta Kihlberg, active players in the diabetes movement, and I chatted; reaching the conclusion that it was time to make a stand in respect of foot care in diabetes. The appeal for Hoj17 read as follows: “Check my foot!”.
Meetings and debates
The preparations commenced during summer 2016. The bike, bike trailer, panniers, tent, sleeping bag and gas cooker were purchased and a toolkit put together. A cycle-friendly route was planned, with meetings along the way. In eight regions, local diabetic associations organised 13 debate-focused meetings.
The first meeting, in Norrköping on 12 May was a big success. Director of the Diabetic Association, Cecilia Gomez, the Östergötland Diabetic Association and foot therapists have booked meetings with politicians. The aim, this autumn, is to discuss strategies to improve prevention and care of diabetes-related foot complications in Östergötland.
Three weeks after starting, I cycled to the Stockholm meeting. Politicians, patient representatives and healthcare professionals decided to meet in autumn 2017 in order to discuss which regional foot problems Stockholm needs to resolve. The long-term goals were fewer foot ulcers, fewer amputations and improved quality of life for people with diabetes.
After nine weeks of cycling, I arrive at the meeting in Piteå. There, the representative of the diabetic association, foot therapists and the local association are working collectively to ensure that all persons with diabetes will undergo an annual foot examination, according to a uniform, predetermined system. Feet in the “at-risk” zone should be referred on for further intervention (orthopaedic technician and specialist care).
After 2000 kilometres I reached the northernmost part of Hoj17, Jokkmokk. At the meeting, foot therapists, representatives from the Diabetes Association, Jokkmokk District and the Swedish Diabetes Society attended together with politicians in order to work towards improved prevention and care of foot complications in diabetes in Norrbotten.
Southbound train
For thirty-nine out of ninety nights, I slept and woke up in my tent to the sounds of nature. Cranes, grouse, snipes and bellowing roebucks added to the wonder of life in the wilds. There were sunny breakfasts by sparkling lakes and other amazing lunch stops. The sight of a pair of bears in a spruce forest made my heart race. I crossed into the arctic circle in glorious sunlight.
My bike, bike trailer and ten panniers seemed exotic on the inland route south to Värmland. At the meeting in Kil, the Värmland-model was presented by diabetic foot coordinator, Marie Bejmo. Her presentation, covering a 17-year career, during which the number of amputations in the County has halved, fascinated the audience. Biomedical engineer, Dr Stefan Hellstrand, demonstrated the benefits of a sustainable health-care initiative, to reduce the number of diabetic foot ulcers and amputations.
After 2500 kilometres on my bike, I finally reached my home county. At the final meeting, the Gothenburg Diabetic Association put the issue of diabetic foot care firmly on the agenda. They presented cold, hard facts about the disparity in foot care for sufferers of diabetes in the Västra Götaland region. During the panel discussion, precise proposals were given on how VGR can halve the number of foot ulcers and amputations. Patient representative, Leif Sundberg, told us of the benefits of having a foot free from foot ulcers. Positive key figures – ecological, economic and social – were presented, on the benefits of halving the number of instances of foot ulcers and amputations.
Mission completed
Through a unique, climate-smart public-health project, Hoj17 has well and truly raised the profile of foot care in diabetes. The need for all sufferers of diabetes to undergo foot examinations, and interventions for individuals with at-risk feet, gained significant attention in the media. This included slots on TV news, four broadcasts on local radio, 15 newspaper articles and thousands of followers on social media. Multidisciplinary networks have been established to facilitate collaboration in improved prevention and care of foot complications in diabetes. Värmland and Sörmland, which have already successfully halved the number of amputations, are waiting with open arms to receive delegations from other parts of Sweden. Hoj17 has achieved its goal.
TEXT: ULLA HELLSTRAND TANG
Ulla Hellstrand Tang presented her thesis on 30 March with the dissertation: The Diabetic Foot – assessment and assistive devices on the department of orthopaedics, Clinical Sciences Institution. She is a prosthetist and orthotist, Area 3, Department of Orthotics, Sahlgrenska University Hospital.
