“Another five toes lost”, I observe, as a forefoot is dropped into the plastic-lined steel bucket. It’s late afternoon as the surgeon tidies up the amputated stump of the man from East Kwaio. Several days earlier the man presented with diabetic foot sepsis, an infection in the bloodstream due to a gangrenous foot, the result of poorly controlled diabetes. Diabetic foot infections are a cause of an estimated 30,000 amputations per year in the South Pacific. The effects are devastating.

Now free of the offensive smelling, putrefying forefoot the man is transferred back to the ward and is managed on three different types of intravenous antibiotics to try and clear the residual infection. The next couple of days will be challenging. It is difficult to manage the insulin therapy for the man’s diabetes as blood sugar test strip supplies at the hospital have been exhausted, meaning there is no way to monitor the man’s blood sugar control. With limited resources, hospitals in the South Pacific struggle to cope with resource-demanding diseases such as diabetes.

The sound of sawing through bone

The following day a second man lies on the operating table with a malodorous foot. This time, the amputation will be just below the level of the knee. The rhythmic sound of sawing through bone can be heard as the surgeon proceeds to amputate the leg. Beads of sweat can be seen on his forehead as he delicately works to fashion a stump which six months later will hopefully be able to accommodate a prosthetic leg and give the man some degree of independence. “Another five toes lost”, I observe as I head back to my room for a late lunch.

On the afternoon of the second day, loud wailing can be heard, coming from the hospital ward. The first man, with the amputated forefoot, has just passed away. He had succumbed to the diabetic foot sepsis with which he originally presented. “Ten toes and one life lost in two days”, I observe as I walk back to my room, looking down at my ten toes.

When I was last at Atoifi 18 years ago as a final year medical student diabetes was present but uncommon. During my 2 month stint there I didn’t see any complications from diabetes –Oh how times have changed.”

10K Toes Lead Ambassador.