Podiatrist Anna Stybowski shares a typical day in the life of her working at the Danila Dilba Health Service. This report describes just one day working at one of Danila Dilba’s clinics. All names have been changed.
I want to respectfully acknowledge at the outset, that I am a privileged white person. As such, this article is written through a colonial lens.
This report describes just one day working as a Podiatrist at one of Danila Dilba’s clinics. At this time, I did not have the support from the Allied Health Assistant. This person is now a valuable part of the team at Danila Dilba, and has made a big difference.
The Danila Dilba Health Service is an Aboriginal Community Controlled Organisation based on Larrakia Country. The full name; Danila Dilba Biluru Butji Binnilutlum was given by the Larrakia people, who are the traditional owners of the area now known as Darwin, and surrounding lands. In the Larrakia language Danila Dilba means dilly bag used to collect bush medicines and Biluru Butji Binnilutlum means Aboriginal people getting better from sickness.
I have been working at Danila Dilba for almost two years now, and it has been an absolute privilege. I work alongside an amazing team of GPs, Allied Health Professionals, Aboriginal Health Practitioners, nurses and most importantly, an Aboriginal Allied Health Assistant. We work together to provide culturally appropriate care to our clients. Many of our clients face multiple barriers and challenges to good health. Despite this however, there are numerous positive stories and good outcomes – a demonstration of people’s resilience, and their strong engagement in health and social services when provided in a culturally safe and responsive manner.
This report describes just one day working as a Podiatrist at one of Danila Dilba’s clinics. All names have been changed.
It clearly shows the impact of podiatry on our clients’ lives and how the pathway to better health and wellbeing can be more complicated for many of our clients. As podiatrists, we are uniquely positioned to build strong relationships and rapport with our regular clients. We offer a service that is synonymous with comfort, care and a sense of wellbeing. It is a service that has proven to be very valuable and in high demand at Danila Dilba.
Providing podiatry at Danila Dilba has many advantages over mainstream care: the team are experienced and supported to deal with complex care; clients feel safe and place more trust in services; the social determinants of health are addressed as part of holistic care. At Danila Dilba we build relationships with our clients and they are more likely to come back, not only for podiatry but for other care. Embedding podiatry at Danila Dilba has increased the opportunity for improving health and wellbeing outcomes.
Amanda, a regular client, is 65 years old with Type 2 diabetes and a history of foot troubles. I have pulled glass out of her foot on two occasions. I recently gave her some Kmart runners which she loves and has been wearing. All is going well with her feet today. She is engaged and sees our Diabetes Educator and Dietitian regularly.
Terry is a 56-year-old with Type 2 Diabetes who comes in every four weeks – any longer, and a high-pressure area on his foot breaks down. He straight away tells me he is worried as his foot has been sore.
A bit of debridement reveals a large, infected wound. Terry’s mood shifts when I tell him. Terry likes to stay active and he’s trying hard to manage his diabetes well. Terry says lately he has been walking a lot more as a way of managing his worries. He is dealing with stress about his son who just got released from juvenile detention. He has been in trouble with police a lot and now Terry is worried he is using ice or other drugs.
I realise the extra walking is why his foot is so bad today. I don’t want to tell him not to walk – this is his stress relief. I get the GP and she prescribes some antibiotics and arranges blood tests. I pad his foot up heavily and plan to see him again in a week. He needs new shoes and better orthotics – we have been waiting for a Prosthetics & Orthotics appointment for months.
UPDATE – seen two weeks later. As usual Terry arrives early for his appointment. He is eager to find out how his foot is going. Has been dressing it himself, walking less and stayed away from the pool. He tells me he never took the antibiotics as the pharmacy said they never received the script. He didn’t have time to call the clinic – too much going on as his son had needed admission to the mental health ward with drug-induced psychosis. He apologises for missing last week’s appointment.
Terry opens up a bit more and tells me how his other son committed suicide a couple of years ago. It was the same thing – drugs. We talk about this for a while. I offer him a GP review; tell him we have services that can support him. He declines everything – he says he is doing ok and knows he can call the mental health team if needed. Back to his foot – it has healed, and Terry is rapt! We plan to review every two weeks and follow up new shoes and orthotics to keep his foot wound-free.
John doesn’t show up for his appointment. I’m not surprised. John has been sleeping rough for years. He has Type 2 Diabetes and though only 50 years old, has a history of necrotising fasciitis and a trans metatarsal amputation on one foot.
It is difficult for him to engage with the health service. The Mobile team (outreach) have tried hard to get him to appointments, but he has only shown up when things are really bad. I have only seen him twice and both times he had to be transferred straight to hospital due to cellulitis. He has been discharged again recently.
I rebook him in four weeks and hope to get in touch with him before the appointment. I’ll ask our Indigenous Outreach Workers (IOW) to see if they can find him to tell him to come to the clinic to see me and the GP. Our IOWs are a valuable resource in helping clients like John engage with our service.
My 11:30 client has shown up two hours early. He wants to be seen. I find him outside arguing with his ex-partner. It becomes verbally quite violent – our security is on standby. He comes back in the clinic. He presents as mentally and emotionally unstable, aggressive and unwell. He is paranoid and tells me he is hearing voices. He does not have a mental health condition listed in his medical history.
I perform his footcare, debriding some painful pressure areas. He is grateful and says having sore feet makes him feel even worse and it helps him so much to have them done. I see him regularly because he is socially vulnerable and unable to walk with the pain from his feet. Afterwards I speak to the GP about my concerns about his mental health and we agree she will follow it up.
Jo is a new client who was referred for assessment of an infected dog bite wound. Jo is a heavy smoker and has Type 2 Diabetes with an HbA1c of 10. The wound isn’t too bad as it is not on a weightbearing surface so it should heal with good dressings. She doesn’t want these at the clinic, so I give her dressings to take home and rebook to see her in two weeks.
UPDATE – Two weeks later, Jo presents for review of her foot wound. It is clean but has not shown any signs of healing. It’s very unusual. I check her blood supply again and perform toe pressures, as this tells us more about whether she has adequate blood supply for healing. Her toe pressures are reduced, but sufficient for healing. I get the GP in to check and she has a chat to the client about smoking, explaining how it is delaying the healing. Jo says she has too much family stress now to think about quitting. We change the dressing plan and book in to review again in two weeks. I suspect the wound is just going to be slow to heal.
While I am with my 10am client, our acute nurse and GP politely interrupt the consult. They want me to “come and see something”. They introduce me to a 38-year-old woman from a remote community, visiting Darwin. Her feet are a mess. She has significant wounds, amputations and infections of both feet. They are really bad – even for a Podiatrist who has seen a lot of bad wounds!
She has been scared to see anyone about her feet as the hospital told her she needs a leg amputation. She is refusing to go there and has been trying to do her own dressings. The nurse soaks her feet and dresses them. There is nothing we can do in the clinic – she needs immediate hospitalisation for antibiotics and treatment.
Together, the GP, nurse and I explain why she needs hospital care, and that surgery is her choice – she can say no. She agrees to go to ED but by the time the GP has finished writing the letter, the client has left. We think she was scared and will not go to hospital. We try to call her – no answer.
UPDATE – One week later. I am working at another clinic. The GP tells me about a client coming in today that I might want to see. It’s this client. She has started coming to Malak clinic twice a week for dressings. They maintain she needs care in a hospital but are not being pushy about it. They know she is scared. They also know the leg does need to be amputated. They are supporting her with her diabetes medication and the foot dressings. She does not attend the clinic on this day, but I note she did come the following day. I check in with the Royal Darwin Hospital (RDH) Podiatry team – she has not yet presented to the ED.
Jane, a regular client, is a 67-year-old woman with Type 2 Diabetes and a history of foot ulceration. She is brought in by a support worker. Her feet are fine today and she just needs basic footcare and a foot check.
I am relieved when this client cancels as I have a lot to catch up on.
A no show. I am worried about this one. Charlie is a 60-year-old who lives in one of the urban communities in Palmerston with his large family. He has a history of diabetic foot ulcer and amputation and needs to come to podiatry regularly for debridement to prevent ulceration. Charlie has missed multiple appointments. Transport goes out to pick him up and he always says there is some business in the community he needs to attend to. He is a leader in his community and often tells me of his involvement in trying to sort out troubles.
I call him again today – no answer. I leave a voice mail and send an SMS encouraging him to contact for an appointment. He’s on my high-risk foot list so I plan to review his file in a month to see if he has made any contact and will see then if we need to involve an IOW to do a welfare check and encourage him to come in for review.
Another one of my very regular clients does not attend. Judy is a 40-year-old with Type 2 Diabetes who is on home dialysis and has a history of repeated foot ulceration. She needs regular sharp debridement of a high-pressure area to prevent ulceration.
I am surprised she is not here. I call her. Her mum answers and tells me she’s in hospital for kidney related reasons. She has been worried about her foot, but no one has been to see her about it. I call the RDH Podiatry team – they are swamped but can squeeze her in at 8:30am tomorrow morning. I call my client back to tell her and she is so relieved she will get her foot done tomorrow.
While I am catching up on admin, I receive an email from our RDH Podiatry team. One of our clients passed away in hospital. He was only 60 years old. He was a long-term homeless man, someone I was always chasing to see as he had a history of diabetic foot ulcers and amputations. He had only just presented to clinic a couple weeks earlier, to speak to a GP about finding accommodation. He was finding living in the longgrass difficult now – he was feeling old. I let the Danila Dilba team know of his passing.
A new client – a young woman, with an infected ingrown toenail. I see a lot of these. It’s an acute issue so needs to be seen promptly, particularly if it is someone with diabetes. This client is not very happy that she had to wait a month to be seen. I explain about the waiting list and that some people are waiting six to eight months to be seen. It’s difficult to explain to clients that we just do not have the resources to meet the demands of our community.
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This work is part of the Aboriginal and Torres Strait Islander Diabetes-Related Foot Complications Program, which receives grant funding from the Australian Government. |
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