Travel sickness

Many Western clinicians visit developing nations to gain valuable healthcare experience, but what they find there can often be a shocking litany of trauma wounds and services blighted by poverty.

We’ve all been there. Your friends say you have to visit a place as it is really beautiful, but when you get there it is actually a little bit disappointing. It’s the travel version of seeing a poor Hollywood remake of your favourite childhood book. It happened to me in Venice. ‘Arrive by the canal,’ I was told, ‘it’s the most romantic sight in the world.’ In reality the water smelled of drains and I was ripped off by a distinctly non-Italian gondolier. Lesson learnt.

This weekend I was in another city fabled for it’s beauty, this time the dreaming spires of Oxford, England, but rather than taking in the sights, I was attending a wound care symposium that soon disabused me of the notion that everybody travels for pleasure. It turns out that in fact, some people actually seek out danger, poverty and trauma in an effort to take their expertise to those who do not have access to adequate healthcare services.

St Anne’s College was hosting a one-day symposium entitled ‘Managing acute and chronic wounds following major catastrophes in Haiti and Africa’, which focused on the response to the disastrous earthquake that struck Haiti in January 2010 and the ongoing difficulties of providing wound care in parts of Africa.  Many of the experiences I listened to were not only genuinely shocking and insightful, but also provided a stark contrast with my own expectations of foreign travel.

The Gift of Pain
One of the speakers, Professor Andrew Boulton, gave a talk on the practical approaches to prevention and treatment of diabetic foot ulcers in developing countries, where he described type 2 diabetes mellitus as a 21^st century epidemic, with perhaps 100 million sufferers in China and a similar number in India alone. I had read about the dangers of neuropathy and injuries due to lack of sensation in people with diabetic foot or leprosy, but Professor Boulton gave a graphic presentation of the problems faced by these people in India. I must confess I had never regarded pain as a gift, but as Professor Boulton explained, it is only pain that alerts us to tissue damage — unlike the people he saw in an Indian clinic whose living conditions were so harsh that there feet were regularly gnawed upon by rats at night, leaving them with terrible wounds.

Acid test
In one of the afternoon sessions, Marc Swan, a reconstructive plastic surgeon, discussed his experiences in East Africa, where poor healthcare resources mean that certain conditions such as cleft palate, that are eminently treatable with the right equipment, can have devastating consequences for infants’ chances of survival and can cause them to be shunned by their community. There were also examples of how poverty can have a devastating effect on people’s lives, such as the women who had been horribly disfigured by having battery acid hurled into their faces by jilted or jealous partners, accidents from crude farming incidents and extensive trauma wounds due to the prevalence of drink driving and the lack of seatbelts in cars. All of these wounds presented unique challenges to a Western surgeon used to having access to the best equipment and supplies.

On a more positive note, Mr Swan did highlight that the lack of basic equipment often drives people to improvise in surprising ways, for example, negative pressure dressings made from furniture foam and cling film and skin grafts being attached with superglue.

He also noted that in East Africa, the lack of healthcare staff means that each patient is accompanied by a family member or friend who caters for all their physical needs, such as washing, dressing changes and feeding, while they are in hospital.

Even though I didn’t manage to hop onto one of the ubiquitous open-top busses that circle the city, the speakers made sure that my day out in Oxford was still a worthwhile trip. I may have missed a lot of the sights, but I gained a unique insight into how difficult in can be to apply wound care in countries blighted by poverty and disease. I also, to my shame, learnt that there are more pressing concerns around the world than the price of a gondolier trip.

Launch of virtual conference
For further insights into how clinicians manage different healthcare situations in their own practice, log on to Wounds International on 13 April. We will be launching our online conference with free access to much of the content from our successful international event in Cape Town in February. This will provide access to clinical presentations, made easy workshops, posters and free papers, as well as a virtual exhibition.

This is a fantastic opportunity to take part in the conference and to share the resources online with your colleagues.

Other resources:

The diabetic foot in sub-Saharan Africa: A new management paradigm

Improving outcomes in patients with diabetic foot complications in Tanzania: a model for the developing world:

The challenge of managing burn wounds in Uganda

Jason Beckford-Ball from the Wounds International HQ in London.

Join us on 13 April for our virtual conference.