Editorial
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Surg Proced. Jul 30, 2019; 9(2): 12-18
Published online Jul 30, 2019. doi: 10.5412/wjsp.v9.i2.12
Caribbean “substitution culture” is a barrier to effective treatment of persons with diabetic foot infections
Shamir O Cawich, Vijay Naraynsingh, Ramesh Jonallagadda, Cameron Wilkinson
Shamir O Cawich, Vijay Naraynsingh, Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, Trinidad & Tobago, West Indies
Ramesh Jonallagadda, Department of Surgery, University of the West Indies, Cave Hill, Barbados, West Indies
Cameron Wilkinson, Department of Surgery, Windsor University, St. Kitts, West Indies
Author contributions: Cawich SO designed the study; Cawich SO, Naraynsingh V, Jonallagadda R and Wilkinson C performed the research; Cawich SO, Naraynsingh V, Jonallagadda R and Wilkinson C wrote the paper; Cawich SO, Naraynsingh V, Jonallagadda R and Wilkinson C revised the manuscript for final submission.
Conflict-of-interest statement: The authors declare that there are no financial relationships, personal relationships or other scenarios that may represent potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Shamir O Cawich, Professor, Department of Clinical Surgical Sciences, University of the West Indies, St Augustine, Trinidad & Tobago, West Indies. socawich@hotmail.com
Telephone: +1-868-6229909
Received: February 27, 2018
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
Core Tip

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.