Published online Jul 30, 2019. doi: 10.5412/wjsp.v9.i2.12
Peer-review started: February 28, 2018
First decision: May 13, 2019
Revised: June 15, 2019
Accepted: July 17, 2019
Article in press: July 17, 2019
Published online: July 30, 2019
Processing time: 154 Days and 5.2 Hours
Diabetes-related amputation rates are high in the Caribbean. Many authorities have identified independent risk factors for diabetes-related amputations, but cultural factors remain underappreciated. We coined the term “Caribbean substitution culture” to describe the attitude of patients with diabetic foot infections in which they refuse to access medical care, instead voluntarily choosing to substitute “bush medicines” or other alternative therapies in the place of conventional treatment. Recognizing that the Caribbean substitution culture is a barrier to effective treatment of diabetic foot infections is the first step in curbing these practices. In this paper, we discuss the issues related to the Caribbean substitution culture, including the demographics of the population at risk, the alternative therapeutic practices and potential public health strategies to combat this practice.
Core tip: Many authorities have identified independent risk factors for diabetes-related amputations, but cultural factors remain underappreciated. We coined the term “Caribbean Substitution Culture” to describe the attitude of patients with diabetic foot infections in which they refuse to access medical care, instead voluntarily choosing to substitute “bush medicines” or other alternative therapies in the place of conventional treatment. We discuss the issues related to the Caribbean Substitution Culture, including the demographics of the population at risk, the alternative therapeutic practices and potential public health strategies to combat this practice.