Stakeholders from Visale, within Guadalcanal Province, during consultations for the National Diabetic Foot Disease Strategic Plan.
The Luk Afterem Legi project is a multi-year program that addresses the urgent and growing burden of diabetic foot wounds on the Solomon Island’s health system. Together with the Ministry of Health and Medical Services (MHMS) and other stakeholders, Interplast have been delivered a range of activities to strengthen diabetic foot services and community education.
Diabetic foot disease is a growing threat
Diabetic foot disease is a common complication of diabetes. For a person with diabetes, a sore area on the foot can quickly develop into an open wound. Without early intervention, these wounds can become infected and require hospital admission and may even result in amputation or death.
Unfortunately, the prevalence of diabetic foot disease in the Solomon Islands has been rising at an alarming rate. Local surgeons estimate that at any one time, 60-70% of beds on the surgical ward at the National Referral Hospital (NRH) are occupied by patients with diabetic foot wounds. The impact of this on the Solomon Island’s health system is devastating.
Action for better outcomes
With the right support and early action, many diabetic foot wounds and complications can be prevented.
Person-centred diabetic foot disease services play a key role in preventing complications of diabetic foot wounds. By strengthening services in the Solomon Islands, we can improve outcomes for individuals, their families, communities, and the nation.
The Luk Afterem Legi project aims to achieve three main outcomes:
- Outcome 1: Multidisciplinary diabetic foot disease services strengthened throughout the Solomon Islands health system.
- Outcome 2: Strategic approach to diabetic foot disease developed and implemented.
- Outcome 3: Strong pipeline of future health personnel skilled in diabetic foot disease service delivery. In the past two years, Interplast have supported a number of activities that have progressed these outcomes.
Roselyn Mataki Solowara and Jordanna Laejama demonstrate
a diabetic foot assessment during training in Alotau, Papua New Guinea.
Year one: Setting up for success
During 2023, the first year of the Luk Afterem Legi project, four key activities were completed.
Procurement of office and filing equipment
Capturing comprehensive client data is a vital step in strengthening service provision. When services can see trends in their communities, they can develop more effective and efficient strategies and put their resources to best use. Having office equipment is a simple but often overlooked necessity.
With support of our funders, Interplast were able to purchase filing cabinets and essential stationary for the National Diabetes Centre, allowing clinicians to record and store client data.
Solomon Islands nurse Roselyn Mataki Solowara with stationery funded through the Luk Afterem Legi project.
Training of trainers
Interplast supported two nurses from the Solomon Islands to travel to Papua New Guinea to deliver training to local health workers and graduate as diabetic foot care trainers in the Keep Moving training program.
“I was very happy, because this training program was very essential… to other people to develop their skills and knowledge they need. I [also had] the opportunity to learn more to increase my knowledge and skills in this field of DFC,” said Roselyn Mataki Solowara, one of two nurses from the National Referral Hospital (NRH) to graduate the program.
Having nurses equipped and able to train other personnel also ensures that local capacity and knowledge can grow sustainably within the country.
Left to right: Head Surgeon of the NRH Dr Rooney Jagilly, Roselyn Mataki Solowara, Jordanna Laejama and Interplast volunteer podiatrist Tom Fitzpatrick.
Supporting professional development of surgeons
Dr Scott Siota is a General Surgeon based at the NRH and has been a close partner to Interplast for 13 years.
Through Luk Afterem Legi, Interplast enabled Dr Siota to attend the 9th International Symposium on the Diabetic Foot (ISDF) and participate in important training and professional networking. There he was able to learn more about the latest research in diabetic foot disease and create new connections that may assist in the management of complex diabetic foot cases in the Solomon Islands.
One of Dr Siota’s biggest takeaways from the symposium was the huge emphasis on a multi-disciplinary team approach to management of diabetic foot cases.
“Surgeries on diabetic foot disease combine(s) vascular surgeons, plastic surgeons, radiologists, physicians, nurses, podiatrists, physiotherapists, dieticians and more — from day one, to discharge and follow ups. It’s becoming a huge division of its own. We all have to work together as a team,” he told us of the experience.
Since returning home, Dr Siota has shared his knowledge with peers, to help shape diabetic foot disease service delivery throughout the Solomon Islands.
Dr Scott Siota works alongside Interplast volunteer surgeon Dr Zac Moaveni during a surgical program in 2023.
Creating a strategic plan
To guide the strengthening of diabetic foot disease services beyond this program, Interplast collaborated with the MHMS and other stakeholders to develop the National Diabetic Foot Care Strategic Plan 2024-2028.
Over 70 people, across 9 provinces, including service users and their families, community members, service providers and other key stakeholders were consulted during the development of the strategic plan.
The National Diabetic Foot Disease Strategic Plan aligns with the current National Health Strategic Plan and outlines strategic objectives and targets to ‘ensure that all Solomon Islanders have access to equitable and high-quality multidisciplinary preventative, curative and rehabilitative diabetic foot disease services, irrespective of where they live, their personal, social or economic circumstances.’
The strategic plan will also be integrated into the National Non-communicable Disease Action Plan, due to be launched in 2025.
Stakeholders from Visale, within the Guadalcanal Province, during consultations for the National Diabetic Foot Disease Strategic Plan.
Year two: Prevention and treatment
Following on from the success of the first year, Interplast took information and direction from the new strategic plan and supported two key activities that strengthened treatment and prevention of diabetic foot wounds.
Procurement of clinical equipment and materials
Much needed clinical equipment and consumable supplies valued at $6,000 AUD was procured and sent to the Solomon Islands from Australia.
This equipment can be used for two key elements of diabetic foot wound treatment: wound dressing and offloading. When accessed in a timely manner, these two elements can prevent amputation and avoidable complications including sepsis and death.
Through our existing programs and partnerships, Interplast was able to get many of these supplies at a discounted rate and access heavily discounted shipping to get the procurement to Honiara.
A nurse provides wound dressings and offloading to a man with a diabetic foot wound.
Public health education on diabetic foot disease
To capture the attention of the Solomon Islands public, Interplast worked with Honiara-based production company Dreamcast Theatre to deliver a suite of education resources; such as posters, short films, and a live theatre production.
Together, we ran a three-day community-based workshop for 25 diabetic foot disease service workers, clients and other community members to design the messaging and concept of these resources. This ensured that the outcome would be culturally relevant and engaging.
The live production travelled to 5 communities in Central Province, informing 650 audience members of the importance of diabetic foot care and healthy living through storytelling and dramatisation. It sparked a lot of conversation, highlighting the impact of reaching communities in this way.
“I’ve seen [the] performances and I feel the same symptoms that you explained in [the] play. How can I access services and who should I see in our small village clinics?” One woman asked the team after watching the production.
To reach audiences beyond this scope, Dreamcast Theatre produced three short films that explored the prevention, treatment options and responsibility of all people to assist each other in minimising the impact of diabetic foot wounds. These videos are all available on YouTube and will be shared on various social media channels, as well as in waiting rooms of outpatient clinics.
Year three: Next step of the journey
Interplast is currently working with the MHMS and our funders to continue the Luk Afterem Legi project.
Next year we hope to continue working in collaboration with the MHMS, the National Referral Hospital and the communities they serve. We anticipate the opportunity to review progress towards our shared goals and encourage even greater outcomes.
After the seeing public education material resonate strongly with its audience, we also hope to see Dreamcast Theatre reach more people and grow awareness of diabetic foot disease.
However the journey continues, Interplast are committed to working with partners to reduce diabetic foot disease and its challenges for the people of the Solomon Islands.
View from the stage of a theatre production.
Acknowledgements
Interplast extends our gratitude to our generous funders, the MHMS and clinical staff, and all those who have supported project activities.
