The AAWC Global Alliance

   During the opening session of the 2006 SAWC in San Antonio, Texas, the AAWC launched the World Wound Care Alliance, now called the AAWC-Global Alliance. This is a volunteer program designed to provide underserved countries of the world with wound care education concerning management of a number of frequently encountered wounds, including edema and lymphedema. Teams now have traveled to Cambodia, India, and Peru. The reports from the Cambodian and Indian teams are in this issue of WOUNDS. Other volunteer teams are scheduled to return to Peru and India during the fall of 2008.    As this program was getting started, something extraordinary happened. In September 2007, John Macdonald, MD, then President of the AAWC, was asked by Handicap International (HI) (https:// www.handicap-international.org.uk ) to come to Geneva, Switzerland to explore the potential for integration of wound management (including edema/lymphedema management) across the wide scope of treatment of neglected tropical diseases in resource-poor settings with representatives of the World Health Organization (WHO). The African Region of WHO is leading the drive for integration because duplicating services would be a waste of precious resources. Handicap International chairs the Lymphatic Filariasis (LF) Partnership, a group of Non-Governmental Development Organizations (NGDOs) that have a long history of working with the national health systems in developing countries. This partnership has led the way in providing nonsurgical morbidity management programs for LF and other neglected tropical diseases. The HI partnership through their contacts, and in cooperation with the WHO, will be able to assist the AAWC-Global Alliance in making wound management services operational within the existing healthcare structures of specific countries and settings. They will also be able to assist the AAWC-Global Alliance in identifying appropriate sites for the volunteer programs. Health Volunteers Overseas (HVO) has also collaborated with AAWC to facilitate volunteers for the AAWC-Global Alliance programs. Health Volunteers Overseas provides the logistics and the structure for processing and organizing volunteer visits. This includes on-site accommodations, professional support, and pre-visit organization. Volunteers must pay for travel expenses and personal necessities, such as insurance and immunization.    The alliance of HVO and AAWC Global Alliance will allow the provision of on-the-ground, long-term clinical interventions and the clinical expertise to prepare the training materials and to develop the best methods for integrating wound care across disease states—it’s a potentially significant collaboration!    Handicap International first heard about AAWC from Mary Jo Geyer, PT, PhD, (Chatham University, Pittsburgh, Pennsylvania) during a Lymphatic Filiariasis meeting in Ghana in early 2007. Their interest derives from patients in developing countries with chronic wounds/lymphedema who fit the criteria of the severely handicapped. They recognize this as a “hidden epidemic.” As a result of the Ghana meeting, HI asked the AAWC to join them in forming The Working Group on Integration of Wound Management (WG-IWM) Across Diseases in Resource-Poor Settings, and to present this program to the WHO. The initial meeting took place in September 2007 in Geneva, Switzerland. The American attendees were Mary Jo Geyer, Nancy Kelley (CEO of HVO), and John Macdonald, MD, representing AAWC.    Nancy Kelly, Dr. Geyer, and Dr. Macdonald met with physicians from WHO and HI who represented Lymphatic Filariasis, Buruli Ulcer, and Diabetes. Each group gave a presentation on their mission. We presented the importance of a wound care component to their programs, but more importantly, stressed the critical importance of wound care integration into many established WHO initiatives within multiple fields.    During that meeting, the WHO asked AAWC, with the support of HI, to write guidelines for the first WHO wound care initiative. The WHO wants the initial announcement of their involvement and guidelines to take the form of a WHO policy, a “white paper.”    It was then agreed that the plan was for Dr. Macdonald, representing the AAWC, to lead the consortium in creating the white paper that would present the rationale for wound care intervention in resource poor countries. The white paper is intended to review the epidemiology and socio-economic realities of these diseases in the underserved countries; present clinical, holistic, patient evaluation methods required of the wound care professional; outline the essentials of modern wound care principles accompanied by evidence based documentation; and provide an overview of specific disease treatment guidelines that can serve as a platform for future education programs in countries with minimal resources, specifically venous ulcers, diabetic ulcers, pressure ulcers, infected ulcers, and atypical ulcers.    The white paper would be developed with the assistance of Dr. Mary Jo Geyer and Pierre Brantus, MD, a physician with HI, and global wound care leaders of my choosing. Drs. Terrence Ryan, Rob Kirsner, Gary Sibbald, David Keast, Heather Orsted, Bill Ennis, Laura Bolton, and Terry Treadwell, were chosen to participate in the creation of the document. Dr. Kingsley Asiedu, Director of the WHO Buruli Ulcer program, leads the WHO participation for this initiative.    The initial draft of the white paper has been completed and accepted by the WHO. The final draft will be reviewed in Geneva, Switzerland, October 13, 2008. The white paper, Best Practice Recommendations for Wound and Lymphedema Management, consists of 11 chapters authored by 9 contributors representing Canada, United States, and United Kingdom; it will be published in 6 languages. The completion of this white paper is the first stage of a 3-stage WHO effort into the wound care arena. The second stage will be to implement the education module in developing countries. Stage 3 will evaluate the outcomes of the initiative and revise the wound care policies as needed. A 10-day visit to Ghana by the AAWC team (Dr. Terry Treadwell, Dr. Mary Jo Gyer, and Dr. John Macdonald) was completed in July 2008 to evaluate the needs of the healthcare professionals and determine the needs for providing quality wound care in the local environment. The stage 2 implementation visit that will provide a formal teaching symposium for all of West Africa, is planned for early 2009. We believe this initiative will provide AAWC with a continuing leadership position in the establishment of global wound care intervention.    Until now, WHO has never had any policy for wound care. Buruli ulcer, diabetes, tropical ulcers, and leprosy were all isolated units. There is an established WHO department specifically for lymphatic filariasis and lymphedema. However, WHO has not previously realized the connection between lymphatic pathology and modern wound care. It is also significant that WHO has never incorporated the modern principles of wound care into the established programs that deal with diabetes, tropical ulcer, leprosy, and Buruli ulcer. The opportunity for dramatically improving diagnosis, documentation, and treatment for these difficult problems is humbling.    Once WHO establishes a policy and initiative to promote wound care, this will educate and legitimize the efforts of governments and medical professionals to actively seek wound care support and will open doors for wound care globally. Wound care will now have official WHO backing. The result will be a proliferation of NGDOs attaching wound care to their established programs. As an example, “Doctors without Borders” recently asked WHO if they had established any wound care guidelines. The answer, NO! The emphasis on wound care by the WHO should make governments aware that wound care and lymphedema are specific problems that have been ignored.    I had always believed that lymphedema should attach its anchor to wound care. How ironic that in this case it appears that lymphedema has suddenly driven wound care awareness!    It should not go unnoticed that as of this time, the AAWC-Global Alliance program is the only volunteer program in the world positioned to specifically provide multidisciplinary professional education teams to teach wound and lymphedema care to underserved countries. It should also be noted that AAWC is the first and only wound care society to be invited by the WHO to partner in the promotion of wound care. This strong cooperative effort of the AAWC-Global Alliance and the WHO is of enormous significance for both organizations.    The WHO now has recognized the AAWC as the global leader in wound and lymphedema education. The AAWC recognizes that teaming with the WHO dramatically enhances the mission of the AAWC. Together, the AAWC and the WHO now offer the promise of modern medical care for millions of wound and lymphedema patients throughout the world.    And, yes, this IS a big deal!