Meet Alfiah's team at NUH

Now, as a podiatrist who specialises in the treatment of acute wounds at Singapore's National University Hospital (NUH), Alfiah provides treatment for patients with a variety of conditions.

“We have a few podiatry clinics in NUH and our timetable changes every week. At rehab clinics we treat skin/nail pathologies such as calluses, ingrown toenails, and musculoskeletal issues such as plantar fasciitis," says Alfiah.

Treating these conditions requires a varied approach. For example, calluses are caused by the build-up of thickened skin because of injury, pressure, or friction. This condition is treated by carefully removing the thickened skin around the area and educating patients on the importance of proper footwear to alleviate pressure points.

On the other hand, musculoskeletal issues, such as plantar fasciitis, calls for a more holistic treatment plan. Treatment includes prescribing rest, applying ice to reduce inflammation, and helping the patient reduce tension in the affected area.

As part of her role at NUH, Alfiah also treats patients at the vascular and endocrine clinics. In the vascular clinic, she works alongside another podiatrist and vascular consultants to treat patients with post-surgical wounds, venous ulcers, and arterial wounds.

This posting presents a variety of challenges for Alfiah who enjoys the work.

She recalls, “There was this one case where I was treating a patient with a venous ulcer. Venous ulcers are chronic sores that occur due to poor blood flow within the veins, leading to persistent venous hypertension and, eventually, breakdown of the skin."

Alfiah kept a close eye on the patient's wound, but after some time, it was clear that there was not much progress on the healing. Understanding that every patient's response to treatment can differ, she thought it was time to try something new.

She decided to switch to a different type of dressing that was better suited for the patient's condition. This patient responded well to the new dressing and eventually the wound began to show signs of improvement.

For Alfiah, it is interactions like these that give her the most satisfaction when it comes to her work.

With a gleam in her eyes, she shared, “Having the opportunity to give back to society and seeing the joy on my patients' faces is what gives me the most satisfaction"

 Alfiah applying Negative Pressure Wound Therapy on a patient's feet

Given the diverse range of foot conditions that podiatrists treat, it is not surprising to see that they have unique ways to treat patients.

Negative pressure wound therapy or NPWT is one of such method which is prescribed to certain patients. This method works by fitting a special dressing or bandage is sealed over the wound and a gentle vacuum pump is attached.

From here, the pump will draw out fluid from the wound bed to reduce the risk of infection. At the same time, the suction applied brings the wounds edges together which speeds up the healing process.

Generally, NPWT is prescribed by medical professionals for diabetic patients with chronic ulcers or wounds.

Another example comes in the form of Maggot Debridement Therapy or MDT. This treatment is typically offered to patients with wounds which are sloughy.

For context, a sloughy wound is one which has dead tissue that often appears as a white or yellowish film over the wound. This dead tissue can prevent the wound from healing properly because it may harbour bacteria and stops new, healthy tissue from growing.

Maggots used in MDT are specially bred in a sterile environment and when applied to the wound, they consume the dead tissue without harming the living tissue. This cleans the wound and helps the healing process.

Alfiah explains, “There are many reasons why we use maggots. It could be because patients find sharp debridement with a blade painful, or the team wants to preserve as much of the healthy tissue as possible because maggots only consume unhealthy tissue leaving behind the healthy ones."

When patients are first introduced to MDT, many naturally react with fear, whereas others feel squeamish. Thankfully, they have Alfiah to reassure them, and once the initial surprise passes, most go along with the treatment.

For MDT, about 200 live maggots are applied, and special dressings are applied to keep the maggots in place and to absorb any excess exudate (fluid that leaks out of blood vessels) from the wound.

Alfiah recalled, “I had a 75-year-old gentleman that was admitted with a severe infection. He underwent wound debridement twice in the operating theatre. And despite that, the wound was still unhealthy and sloughy."

“We trialled three cycles of maggot debridement therapy for the patient, and the wound was cleaner with no sign of infection. After that, we moved on to other treatments, and the patient's wound appeared much cleaner with no sign of slough."

 Alfiah at a feet screening exercise for the public

Besides her love of biology and an innate desire to care for others, Alfiah's passion for the profession comes from the simple joy of helping patients get on the road to recovery.

As she explains it, “I love how my job lets me give back to society. The delight and happiness expressed by my patients when they make a full recovery is more than enough for me."

Alfiah's experience treating chronic wounds has also revealed to her the importance of foot health in Singapore especially for patients with diabetes.

She said, “Diabetes is a serious problem if left unchecked. Some patients are unaware of the consequences, while others are afraid of getting bad news, so they choose to avoid seeing doctors and going to the hospital."

Left untreated, foot ulcers will worsen with time which leads to infections and other health complications down the line.

Alfiah believes that many of these issues could have been avoided with proper care and education about the disease. This is one of the reasons why she takes extra time to advise and educate patients on how they can manage their conditions.

She also shared real-life examples of diabetic patients and the complications that they face.

“I remember this one patient who persistently refused to wear the insoles I recommended. Despite my constant reminders, he just wouldn't comply. So, I shifted my approach. One day, I asked him gently whether he understood the reason he needed to wear the insoles. To my surprise, he confessed that he didn't really understand the reason."

Alfiah saw this as a teachable moment.

“I took him aside and explained, 'The insoles are designed to protect your feet. Without them, the ulcers you have could get worse. And because you have diabetes, these ulcers won't heal easily. This could lead to even more serious health issues later.'"

Listening to her detailed explanation, the patient was shocked, and agreed to take her advice.

It's moments like this that spur Alfiah on in her career as a podiatrist and she intends to use both education and clinical work to better the lives of her patients.

Looking to pursue a rewarding career in Podiatry, just like Alfiah? Watch our TikTok feature of her here!

MOH Holdings (MOHH) is offering local and overseas scholarships to nurture the next generation of nursing, pharmacy and allied health professionals. These scholarships are in partnership with public healthcare institutions and allow you to study in local and overseas universities. For more details on the health science disciplines (including Podiatry) offered, check out this page.​