International Diabetes and Endocrinology Conference (IDEC 2016) organized by Baqai Institute of Diabetes and Endocrinology (BIDE) at Karachi from August 19-21st attracted a large number of delegates from all over the world. Apart from the plenary sessions, there were four to five concurrent sessions, workshops being run at the same time, hence it was not possible to listen to every distinguished speaker but looking at the presentations one was able to listen, there certainly were some Star Performers who deserve to be identified, commended and appreciated.
Without undermining the importance of presentations by Dr. Zulfikar Abbas from Tanzania on Diabetic Foot, Prof. Morsi Arab’s talk on Community constraints in National Diabetes Programme, Presentation by Prof.Abdul Jabbar on Diabetes and Ramadan, Talks by Prof. Akhtar Hussain from Oslo and Prof Wasif Hanif from Birmingham, UK, deliberations in Mother and Child Health session, presentations by Prof.Azad Khan from Bangladesh on Diabetic Care in Resource Poor Countries and Footwear for Diabetics in low resource countries by Prof. Nielsen from Denmark, were brilliant and extremely important. Both these speakers (Prof.Azad and Mr. Nielsen) clearly demonstrated that specialized care for the poor is possible even with limited resources but the essential pre-requisite was sincere devoted leadership.
Diabetes is a very faithful disease which requires a life- long treatment. Failure to manage it, leads to dreadful micro and macro vascular complications which are extremely expensive to treat. Hence, curative and treatment approach is not the option for such countries but preventive strategies is the only answer. To set up such a programme, run and manage it successfully is an uphill task. If one looks at the Ibrahim Model being practiced in Bangladesh, its secret of success is Democratic, Transparent, Ethical functioning of the Diabetic Association of Bangladesh. It has now one central and sixty two affiliated associations which are all independent in their functioning, generate their own funds, run by local leadership. This decentralized approach has worked wonders. If this system can work in Bangladesh, why it could not be replicated so far in other countries including Pakistan, needs a detailed critical analysis.
Prof. Ibrahim established the Diabetic Association of Pakistan on February 28th 1956. Once he left for Bangladesh after the 1971 crisis, Diabetic Association of Pakistan has remained in doldrums and eventually turned out to be a one man show. It lacks democratic, decentralized set up which is the greatest strength of Diabetic Association of Bangladesh. The problem with these poor resource countries in the region in particular is the lack of sincere leadership. These countries have failed to produce people like Prof. M. Ibrahim. Every time one visits BIRDEM, they have introduced some new programme, service, established some more medical institutions, set up state of the art centers of excellence in different disciplines. Efficient running of these institutions is also a tribute to late Prof. Ibrahim because he was able to make a team which makes all the difference.
Late recognition of foot ulcers in people with diabetes coupled with improper care leads to amputations. These patients with diabetic foot ulcers need special footwear and the branded one available are too expensive. Mr. Nielsen demonstrated how these cost effective Footwear to suit individual patients with diabetic foot ulcer can be made and quite easily. He is also assisting BIDE, guiding them in making available these cost effective foot wear. He is extremely enthusiastic in promoting these footwear which is indeed commendable. I have specially mentioned about these two presentations because in this region, most of the countries have limited resources. Hence with proper planning under the advice of professional leadership which believes and practices ethical medicine, a lot can be achieved instead of complaining all the time and criticizing the governments. Medical profession needs to do some soul searching and come up with answers to our healthcare needs. It may not be too late to learn something from the Bangladesh experience in the management of diabetes in particular.
BIDE ever since its inception is doing a good job, training graduate doctors for Diploma in Diabetes, training of foot care assistants, diabetes educators, striving to make available cost effective footwear for patients with diabetic foot ulcers. Aga Khan University and a few other centers in Pakistan are also contributing their share in providing care to the people with diabetes as well as training manpower with Fellowship programmes. Hopefully in the days to come, situation will improve for the better but it is also important to take care of the phony characters who talk a lot but do nothing, enjoy creating hurdles to satisfy their personal ego. Such characters are found in almost every country and we are not the only one to be blessed with such individuals.