You Are Using What to Treat What?

International wound care in underresourced countries can be challenging, rewarding, and fun. When I was invited with 2 others to visit Ghana, Africa, in 2008 to teach health care providers how to treat wounds, I was excited about the opportunity but concerned as to what I could teach them. I knew how I treated wounds, but I realized I had no idea how they did or with what! There was no point in my teaching how to use advanced therapy dressings to treat wounds if they would never see the dressings. We all decided that this visit would require that we learn from them about their approach to wounds and how they treated them. We did lecture on the basics of wound care, but the specifics we learned from them. We also went to pharmacies to see what dressings, bandages, solutions, and topicals were available for use in the treatment of wounds. We probably learned more from them on that trip than they learned from us; however, the information we obtained was invaluable and a challenge as we developed wound courses teaching them how to maximize what was locally available. 

I went on a search to find out if there was some evidence of effectiveness of the traditional therapies and to find others that might be available for use locally. Some guidelines had to be established for us to recommend any treatment—the treatment/product had to be safe for use on wounds and it had to be effective in helping wounds to heal. There were a couple of interesting products that we had to suggest the locals discontinue using because of toxicity. One product was called “Wund Solution” (sic), and the label recommended it for the treatment of diabetic ulcers and all wounds. Reading the fine print revealed it was a cleaning solution for counters, floors, and furniture in hospitals. It was hardly something you would want to use on a wound.

I was amazed to find published solutions to many problems the providers were having. Finding affordable normal saline was very difficult. Interestingly, Linda Benskin, PhD, RN, SRN (Ghana), CWCN, CWS, DAPWCA, a nurse in the United States and a member of the Association for the Advancement of Wound Care, had already solved that problem. She used a common beer bottle, filling it with clean water and adding 2 beer bottle caps full of table salt. When the salt dissolved, the solution was normal saline!¹ This provided a simple solution to a difficult problem utilizing common things.

Another issue was the lack of a nonadherent dressing. I thought the answer to that one was simple—put a thin layer of petrolatum, which is available most anywhere, on gauze and use it as the contact layer in most any wound dressing. We even made a video showing how to do it! After 1 teaching session which included this information, an African nurse asked me if I had any experience using banana leaves as a nonadherent primary dressing! I learned from her that the waxy banana leaves prepared in the appropriate manner can be used very effectively as a nonadherent dressing, especially in the treatment of burns. After doing some research, I am pleased to report that it does work and works well.^2-5 I have now added that information to that presentation.

One of the most common problems in Africa and other underresourced countries is the presence of large inguinal hernias in both men and women. These can be very debilitating and occasionally life-threatening problems.⁶ In the United States and developed countries, treatment includes operative repair with some type of mesh. Getting expensive mesh in underresourced  countries is not an option in most cases. Dr. Andrew Kingsnorth of Plymouth, UK, working in a small town in Ghana, Africa, in 2005 found that sterilized mosquito netting cut to the appropriate size worked very well in the repair of even the largest inguinal hernia.^7,8

These are just some of the examples of techniques and procedures that can be used effectively in the treatment of wounds in underresourced countries. There are many others we discuss in our programs, all of which are safe and effective. This search has proved fascinating and continues to bring good, usable information all around the world. If you have a treatment you would like to add to the database, please let me know at TATread@aol.com.