Steve York (Ngāpuhi, Ngāti Raukawa, Ngāti Tūwharetoa) was a community podiatrist for a Māori health provider in Te Tai Tokerau, Northland, where he provided preventative foot care for those with lower limb complications related to diabetes. However, many Māori in his region couldn’t access this service, and he had a burning desire to know if he was actually making a difference in preventing diabetic foot complications. To find out, Steve embarked on a research career, providing the first detailed account of the state of diabetes-related lower limb amputations in Northland.
In 2010, after commencing a postgraduate certificate in Māori health at AUT University, Steve began working as a diabetes podiatrist for the Northland District Health Board, based at Whangarei Hospital. Here he became focused on investigating the number of diabetes-related lower limb amputations in Northland as someone now directly managing the end stage of diabetic foot complications – “at the bottom of the cliff”.
“New Zealand’s diabetes population is increasing at an alarming rate, and the prevalence rate for Māori is higher than non-Māori – 7.8 per cent versus 5.3 per cent. The risk of irreversible long-term complications is considerable – increasing lower-limb ulcerations, amputations and subsequent mortality. This causes significant health, social and economic consequences for the individual and their whānau,” says Steve.
In 2011, Steve was awarded a HRC Māori Health Research Summer Studentship to research trends of diabetes-related lower limb amputations in Northland from 2000 to 2010. His findings highlighted that of 708 amputations performed over this period, 400 were diabetes-related (212 individuals); in-patients costs were $5.7 million; and Māori had more amputations than non-Māori. Also, about half of the individuals had multiple amputations and 50 per cent did not survive more than four years post-amputation.
“One of the reasons I focused on amputations is because there was a deliberate inequity of community podiatry services in Northland. Over half of the diabetes population have never had access to community podiatry services and this was well documented since 2006.
“I knew this amputation data would be important, not only for my quest to reduce the inequity of service delivery, but also for the patients. It would help them to become more aware that diabetes is a serious issue and that amputation is a life-changing and life-ending consequence of these complications.”
Steve says he wanted to show the number of amputations and what they were costing in terms of surgical procedures, hospital bed stays, human and social costs, and mortality.
“I wanted to demonstrate to the decision-makers, planners and funders that this is what it’s costing us by doing nothing.”
Steve presented his findings in reports and at a variety of workshops, conferences and meetings to highlight the devastating effects that amputations were having on Northland’s community. Last year, the Ministry of Health directed that extra funding for diabetes care was to be used towards providing additional community podiatry services in the region. Steve says he’s pleased that every person at risk of diabetes foot complications in Northland now has access to funded community podiatry services, which has made these services more equitable.
After completing his postgraduate certificate and diploma in Māori health and keen to continue his research, Steve was this year awarded a HRC Māori Health Research Master’s Scholarship to undertake a nationally focused observational study on mortality outcomes for Māori following diabetes-related amputations. His supervisors are Dr Nick Garrett (Ngāti Maniapoto) from AUT University and his long-time mentor Associate Professor Te Kani Kingi (Ngāti Pukeko) from Massey University, Wellington.
“I’m really interested in finding out what’s happened over the past 20 years in regards to diabetes-related amputations in New Zealand. I want to provide a good knowledge base in this area of health and to be able to make comparisons with other countries and ethnicities, particularly relating to mortality outcomes. It would also be important to know, as a clinician, if the varied levels of investment towards podiatry services have had any influence to reduce the complications of diabetes, such as amputations.”
Steve, who is still a full-time clinician – and the only hospital-based diabetes podiatrist in Northland – says his journey into research has been deliberately planned and developed over the past four years towards his current Master’s research.