Concern over podiatrist shortage

GROWING CONCERN is being raised about a shortage of podiatrists in Barbados, particularly within the public health care system, amid warnings that the lack of specialist foot care is contributing to high amputation rates linked to diabetes.

The issue was highlighted by podiatrist Adrian Mullah of Comfeet Footcare Clinic in Belleville, St Michael, who pointed to limited access to podiatric services in public facilities despite what he described as an overwhelming need.

Citing a 2024 study, Mullah said “89 per cent of hospital admissions were related to foot conditions,” with “approximately 80 per cent linked to diabetesrelated foot ulcers.” He added that “one in five of those cases could result in amputation,” and warned that patients who lose one limb are more likely to require amputation on the other, with an associated risk of mortality.

Infrastructure

Despite these figures, Mullah said there was only one podiatrist serving the public system across nine polyclinics.

“What’s concerning us is that dealing with a foot issue, why don’t you have foot specialists situated in most of the polyclinics on the island, or almost all polyclinics on the island,” he said.

“There’s only one podiatrist out of the nine polyclinics on the island and he is serving about 282 000 people in Barbados, according to the last census. That’s one podiatrist, in terms of just public, for them. The rest are all in private.”

He said the absence of infrastructure in the public sector was a major barrier.

“There’s no infrastructure for podiatrists. You don’t have people who are there, situated within the polyclinics, the public sector, to screen people on time, notice a problem and prevent amputation rates,” Mullah said.

He stressed the importance of multidisciplinary teams (MDTs), made up of professionals from various disciplines working together, noting that such teams would improve patient outcomes.

Service delivery

“With multidisciplinary teams in place, you get faster patient assessment, better service delivery and fewer missed complications,” he said.

Mullah, who studied podiatry in the United Kingdom and worked in the National Health Service alongside his wife, podiatrist Stephanie Beute, said they returned to Barbados to help meet the demand. However, he noted that others were also willing to assist but did not know how to enter the public system.

“There are people who want to help, but they don’t know where to go because there is no structure,” he said.

There are about 11 practising podiatrists on the island, most of whom work in private care because there is no accommodation for them in the public sector.

Referencing World Health Organisation guidelines, Mullah said, “It is recommended that there be one podiatrist for every 25 000 people, but for diabetic patients, it’s one for every 1 000 or 1 500.

“Right now we have 11 on the island. We definitely need to increase the amount of podiatrists we have for the diabetic population,” he said.

“Ours is about 19 per cent for the population and the UK is about seven per cent. That’s almost coming up to three times as much. That’s why Barbados has been called the amputation capital of the world because of the high prevalence of diabetes.”

He added that many patients only discover they have diabetes after testing. Pointing to Singapore’s approach, Mullah said the government there sends students overseas to study podiatry and places them in the public sector on their return.

“I don’t know what the government’s budget is right now but if they could do that, I can guarantee you they would be able to reduce a lot of the foot issues just because you’re seeing those people and also preventing some of the amputation rates,” he said.

(AJ)

PODIATRIST ADRIAN MULLAH and his wife Stephanie, who is also a podiatrist, returned to Barbados from

the United Kingdom to help meet the demand for podiatric services. (Picture by Shanice King.)