The Tribune

By DR KENNETH D KEMP

GROWING up and living on a remote family island offers a wealth of peace and tranquility few outsiders can comprehend. With a small population, everyone on the island is either a family member or neighbour and there’s a genuine sense of community throughout the entire land.

Crime, if existent, is minimal with any occurring infringement considered relatively banal in nature. Moms tend to work most of the day in their vegetable gardens and deliver those goods to friends and family throughout the week, exchanging for a crop they themselves don’t grow. Fathers are out fishing that morning and the catch of the day is prepared fresh that evening, never once having been frozen.

My patient, hereafter referred to as Vin, was born the eldest of five children and he and his siblings were raised on one of these smaller islands. Vin’s father was a fisherman and when he went out to sea, Vin often felt the responsibility of helping his mother, who worked in a small grocery store, taking care of the home and garden. They were short on material possessions and Vin was often teased about his family’s financial circumstance but he never complained and appreciated any gift his mother could afford on her modest salary.

After graduation from high school, Vin approached his father about coming to work for him and they’ve now worked together for 30 years. Today, he loves his job and couldn’t imagine doing anything else. On a typical day out to sea, he sets out with his father and brother and there’s a crisp saltiness to the air. With callused hands that have been roughened extensively over the years, he steers the boat and heads to the first of many fishing stops. There is no land in sight for miles and the water, so clear that you can see down to the sea floor, is full of wondrous sea creatures hidden among the abundant and colourful reefs. With a rhythmic sway that echoes the breeze, the net is cast and underneath the open sun-drenched sky, they wait.

Today, seafarers can depend on radar technology and GPS to help them navigate the ocean terrain but hundreds of years ago, world explorers navigated the seas using the stars. As evening approached, the North Star was their guide among a vast and moving constellation and all these years later, should their modern navigation tools fail them, Vin, like the voyagers in our history books, can follow the same North Star that they gazed upon and find his way safely to the shore.

Many years ago, following a fishing trip, Vin participated in a basketball event and was abruptly hit with bullish strength and speed by a teammate. His right knee was visibly knocked out of its joint socket and the pain was excruciating. While he was waiting for medical attention at the hospital, his knee popped back into place on its own. He was placed in a knee immobiliser and prescribed an oral anti-inflammatory and a narcotic for pain relief. On several routine follow-up evaluations in the clinic, his blood sugar was notably elevated. What initially started as treatment for a sports injury evolved into the diagnosis and decades-long treatment of diabetes. Vin began to develop foot issues within less than a year of his diagnosis.

The first incident occurred after he developed a blister on his left foot from wearing tight shoes and ambulating for a prolonged period of time. Fortunately, it was minor and healed within a week using an over-the-counter tropical antibiotic cream. A year later, he developed another blister on his contralateral, right, foot walking along the beach.

This time, the blister became infected. It was the start of more serious issues. His arch collapsed and his foot appeared more deformed. Within hours, his right foot was red, hot, swollen and he felt cold, nauseous and had a high fever. He was diagnosed with sepsis. The infection had spread throughout his bloodstream and he was quickly going into shock. An air ambulance was arranged and Vin was airlifted to the public hospital in Nassau and rushed into the operating theatre. The wound was incised, flushed with saline and drained and he was given intravenous antibiotics for the following two weeks. In time, he healed but the bones in his right midfoot and ankle had become weakened and caved in so he was now, without proper attention, much more susceptible to further diabetic foot ailments.

Despite this, several years passed without major incident. Then early last year, in the safe space of his own home, he stepped on a shell his grandson had collected from the beach. Without sensation in his foot, it was the trail of blood that followed his footsteps that alerted him to the fact that he’d cut himself.

Recognising the devastating effects from an untreated wound, he immediately went to the local clinic and was prescribed oral antibiotics but his wound deepened and his infection progressed quickly.

It was weeks before he was seen in Nassau and by that time the infection had not only spread into his blood stream, but also throughout the bones in his foot. To save his life, he underwent a partial amputation of his foot and spent eight months recovering, during which time he couldn’t work.

To make matters worse, diabetes had not only damaged the nerves in his feet and caused his weakened bones to collapse, but it also caused his eyesight to deteriorate. Prolonged high blood sugar levels had damaged his retina and the blood vessels had partially ruptured causing significant bleeding within both of his eyes.

The news was earth shattering and the chance of ever going back out onto the open ocean and doing what he loved no longer seemed attainable. What makes his story so compelling is that it lays bare the price extolled when your livelihood and lifestyle depend on a human body that’s no longer functional in that capacity. Men and women living on a remote Family Island wouldn’t dream of trading their peace and tranquility for the city life for anything in this world but the cost of that peace is the limited access to healthcare. But Vin remained positive solely because he had a strong support team in his corner, pushing him to never lose hope.

When his health was down, family and community lifted him up. His parents, now married for almost 50 years were at the helm of his dream team and they, along with his siblings, helped to take care of him and his financial responsibilities. He also extends his gratitude to his kids and gives special thanks to his girlfriend who stood by his side with unfailing loyalty. She prepared all of his meals, called to check on him every day during her breaks at work and gave him hope that everything would be okay.

After undergoing multiple and bilateral corrective eye surgeries, Vin’s eyesight is now 70 percent improved on the right and 50 percent on the left. He also walks with a custom Diabetic shoe and insole. What he wanted to specifically emphasise is how important it is to follow the advice of doctors and to take your medication as prescribed. He also iterated the importance of seeking medical attention as soon as something occurs, especially if you’re diabetic.

On the outer Family Islands, children go to school and then play outside before washing up for dinner. On Saturday evening, parents drink beer and dance but get home early enough to put their children to sleep. The entire family goes to church on Sunday. Men and women work, without issue, well into their 80s and 90s and walk almost daily. On the Family Island, Vin enjoys a happy, quiet life and he remains positive that someday, somehow, he’ll be back on his boat with his brother and father, providing food for his family and showing them that even when you’re down, if you can look up, you can get up and the race is never over until it’s over.

This is the KDK report.

• Nicknamed ‘The Prince of Podiatry’, Dr Kenneth D Kemp is the founder and medical director of Bahamas Foot and Ankle located in Caves Village, Western New Providence. He served as the deputy chairman for the Health Council for five years and he currently sits on the board of directors for the Princess Margaret Hospital Foundation in his role as co-vice-chairman.