Editorial Message: Are You a Candle or a Mirror?

Dear Readers,

I was recently looking through my notes from all my trips to Ghana, Africa, with the World Health Organization beginning in 2008. After the numerous trips we have made to do wound care education, to help establish wound treatment centers, and to help with Buruli Ulcer research, it was quite eye opening to read my thoughts about our first trip. One of my first recollections was how the health care providers and politicians realized their need for modern wound care information and how enthusiastic they were to hear that we could provide some of that education. Dr. Akwasi Kyei-Faried, head of the  Disease Control and Prevention Program of the Ghana Health Service, told me, “Unless you throw a searchlight on an issue, you don’t see the problems.” For better or for worse we had helped them turn on the searchlight. I was overwhelmed with the thought of what could be done if there were only enough time and resources. 

During the 8 years since that first visit, I think much has been accomplished. With the help of physicians and health care workers from Ghana, the Netherlands, France, Switzerland, Canada, and, of course, the United States, numerous centers are now treating wounds with some of the basic, modern wound care techniques and achieving better outcomes. In many instances just convincing health care workers they should pay attention to wounds and care for them has been a major accomplishment. Several years ago we had an educational program about the care of wounds in one of the small hospitals. Part of the program encouraged the providers not to cause damage to wounds by using potentially caustic substances to clean or treat the wounds. One of the products we discouraged using was acetic acid. In this hospital, acetic acid was used to wash every wound on a regular basis whether it was infected or not. The head nurse very graciously smiled at this new information and assured us they would only use soap and water to clean the wounds unless they were infected. 

About a year later, we returned to the hospital to visit, to see how they were doing, and to do more teaching. The head nurse did not know we were coming until she saw me standing in the door of the treatment room. A look of panic crossed her face and she turned her back to me facing the dressing cart. After doing something on the cart, she turned around with a big smile on her face and welcomed me and the others to the hospital. As she walked away to greet the others of our team, I saw that she had removed the bottle of acetic acid from the dressing cart and tucked it in her pocket! (At least she remembered she should not be using it!) As one can imagine, follow-up visits and continued training are critical if we are to help change old habits. 

As some of us work around the world to help improve wound care, you can do the same wherever you work. You and I both know that every hospital in this country needs to practice better evidence-based wound care. Perhaps you could be the one to help “throw a searchlight” on the issue so the problem can be seen. I know it can be difficult to challenge the establishment, but we must consider our patients and what is best for them. If being a searchlight is too much, all of us can be a candle burning brightly to light the way to better care. If we can join together, others can be a mirror reflecting the light that is already there. With just one candle and many mirrors, we can make a lot of light. Will you help?