Driving through the Mississippi Delta, where he was considering set up a practice, a cardiologist named Foluso Fakorede saw sure signs of trouble, sure signs of need. As he drove through the Delta’s villages and past rural areas he saw too many people on crutches, or in wheelchairs showing missing limbs, and too many home-made plywood ramps and metal banisters made to help a wheelchair-bound person get from the ground level up to their own front door.
Dr. Fakorede, a 38 year-old physician born in Nigeria but raised in New Jersey, took that need personally because in addition to heart diseases, he specialized in vascular disease and the medical signals he was reading from his car window told of vascular disease treated too late or not all, vascular disease that had ruined lives and was on its way to killing people with diabetes.
An estimated 30 million Americans suffer from diabetes, and the State of Mississippi has among the highest rates in the country. Treating its consequences, especially the consequences of amputation of a diseased toe, foot or leg, makes diabetes America’s most expensive chronic disease, as well one of its most debilitating.
Too many amputations, Dr. Fakorede has found, are the result of improper or no treatment for vascular disease. Too many amputations, he believes, are completely preventable.
There are a bunch of “too manys” associated with diabetes, disproportionate numbers of cases among poor people and minorities. Among Native Americans and African-Americans diabetes is a deadly threat and amputation a historically-misapplied treatment.
Want proof of that? Dr. Fakorede found a copy of an old map in a plantation gift shop, a map of the areas of the United States where the most slaves were held. It’s geography, he immediately noted, was a near-perfect overlay of a map of places with America’s highest rates of amputation.
His prescription? You can find it on signs along Highway 61, the legendary “blues highway” through the Delta, advertising his “Amputation Prevention Institute.”
Lizzie Presser covers health, inequality and how policy is experienced for ProPublica. She previously worked as a contributing writer for The California Sunday Magazine, where she wrote about labor, immigration and how social policy is experienced. Her work has also appeared in The New Yorker, The Guardian and This American Life, among others. She has twice been a finalist for the National Magazine Award and the Livingston Award.