Elephant In The Room | Wound Awareness Week 2008

Val Voight, 74, from Tanunda, near Adelaide in South Australia, suffered in excruciating pain for 13 years before she finally received the proper treatment her wounds required to heal.

The married mother of two, now living in Tanunda Lutheran Nursing Home, suffered from chronic Venous ulcers on both her legs, which were further complicated by cellulitis or infection. In practice this meant that the wounds would temporarily get better whenever treated, before the infection returned over subsequent weeks. This caused the ulcers to spread from her feet to her knees.

“The difficulty with Venous ulcers and cellulitis is that once they are there, they stay there without proper treatment” explains Adelaide based wound management nurse Tal Ellis, who was responsible for Val’s limb saving treatment. “Chronic Venous ulcers can be treated with special bandaging but if the infection remains the wounds simply flare up again”

With Tal’s help, Val now has a chance to walk again.

The pain from her wounds was so great that it was keeping Val awake at nights, and was only controllable with Morphine. She was often bedridden and has been unable to walk for the last 3 years. Unsurprisingly Val also suffered from depression for many years. It wasn’t until Tal Ellis was called to attend to Val by the vigilant staff at Tanunda Lutheran Nursing Home that she finally received the treatment she so badly needed.

Tal treated the condition in partnership with the nursing home staff and Val’s General Practitioner. The treatment regime involved long term antibiotics and high compression therapy which is a special type of bandaging. The treatment also involved foam dressings containing silver underneath the compression bandages, which helped to control the infection and leakage from the wound. The bandage and dressings were initially changed three times a week, which soon reduced to twice a week. Most importantly of all, Tal and the staff provided psychological reassurance to Val that, despite the initial discomfort, she would get better. In conjunction with his regular visits he also provided support and direction to the nursing home staff.

The treatment began in May of last year and Val’s wounds have now healed more or less completely. With Tal’s help, Val now has a chance to walk again.

In a way Val was lucky. Proactive support by the staff at Tanunda Lutheran nursing home meant that Val eventually received the treatment she needed. However failure to properly diagnose and treat the problem 13 years ago meant that years were wasted before she received the appropriate treatment. Critical to the problem are a general lack of awareness of the problem of chronic wounds not healing, a lack of knowledge of modern and appropriate treatment being available and insufficient capacity among many healthcare professionals to make the right diagnosis.

There is also a tragic cost barrier to this treatment, which can initially be very expensive. In the first 6 weeks of Val’s treatment, over $5500 was spent on dressings alone. The total cost of Val recovering was approximately $15,000, all of which she, her family and Tanunda Lutheran homes had to pay for simply because she was in residential care rather than a public hospital.

In the first 6 weeks of Val’s treatment, over $5500 was spent on dressings alone.

Tens of thousands of Australia’s elderly community, just like Val, are living with wounds for years - many of them in very poor health and pain. This terrible problem is being caused by a lack of awareness of the health problem wounds represent, insufficient Medicare funding for non-hospital treatment of a condition which affects the oldest and sometimes poorest members of the community, plus inadequate understanding of the issue and appropriate treatment methods by many healthcare workers.

That’s why the Australian Wound Management Association (www.awma.com.au) has organised Wound Awareness Week - a campaign running from Monday 26-Friday 30 March 2007 dedicated to raising awareness of the enormous human cost imposed by wounds throughout Australia. The week draws together the community and experts from across the entire healthcare profession to compel the government to make a change. Groundbreaking surgeon and Australian of the Year Dr Fiona Wood is supporting the efforts of the Australian Wound Management Association as they try to raise public and professional awareness of wounds as significant health problem.

Val with celebrate her 76th birthday in April 2008. Thankfully it will be far happier than ones she has experienced in previous years.

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Dulcie Billing, 82, has suffered from chronic wounds for over 4 decades and is fighting the battles of proper wound care treatment till this day.

The Thornbury resident suffers from venous leg ulcers, a painful condition she’s been battling since the 60s. It’s been an ongoing battle for Dulcie, who admits that while treating her ulcers on a daily basis may be cumbersome, she is lucky to be living in an age where wound care management has made significant advancements.

Much of her gratuity lies with the Australian Wound Management Association (AWMA). AWMA are a non-profit organisation dedicated to the developing and improving the best practice in wound management for all Australians.

President of the AWMA committee, Professor Michael Woodward who has been treating Dulcie since May 2005, admits that while Dulcie is receiving treatment that makes for a more comfortable living, her quality of life could improve significantly should she receive the proper treatment required.

Suffering from leg ulcers since the 60s, Dulcie had been with St.Vincent’s wound clinic sporadically since 1998, with her ulcers healed by the end of 1999. However, in May 2005, her ulcers returned, placing her under the treatment of Professor Michael Woodward ever since.

…a staggering 270,000 Australians suffer from recurring chronic wounds due to the inability to afford proper treatment.

“Dulcie suffered deterioration in her ulcer because she couldn’t afford the proper treatment required,” Professor Michael Woodward claims. According to him, her fluctuating condition is preventable.

“If she used the recommended dressing required for the prevention and management of her infection, her wound would heal quickly and remain healed.”

“An outbreak in wound infection leads to increased nursing time, extended hospital stays, high healthcare costs and consequently affects the patient’s quality of life.”

Yet, a staggering 270,000 Australians suffer from recurring chronic wounds due to the inability to afford proper treatment. In serious cases, the pain is so excruciating it debilitates the patient to the extent that administration of morphine to subdue the pain proves futile.

As all expenses are paid out of pocket, for patients such as Dulcie, getting the right treatment is unaffordable.

“All this does is prolong the patient’s condition and suffering, (which is unnecessary and unacceptable),” Professor Michael Woodward says.

That’s why the Australian Wound Management Association (www.awma.com.au) has organised Wound Awareness Week 2008 - a campaign running from 31 March - 4 April, dedicated to raising awareness of the enormous human cost imposed by wounds throughout Australia. The week draws together the community and experts from across the entire healthcare profession to compel the government to make a change. Best-selling author Bryce Courtenay is supporting the efforts of the Australian Wound Management Association as they try to raise public and professional awareness of wounds as a significant health problem.

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SC spoke with Doris on 25 October

Leg ulcer, not sure how long she has had it – a while. Started as a small infection, and became larger “very quickly” – about 2 inches (5 cm) square.

Didn’t heal through April May and June, - about 6 weeks until Doris decided to go to the Austin. She has been having treatment for 4 months since.

Used lots of different sort of dressings, none helped it heal. A silver dressing has, however, made a difference and is aiding healing really well.

This is dressed twice a week by the local doctors nurse

…the cost of dressings needs to be covered or at least subsidised.

A few years back she had another ulcer and a nurse who dressed it was training at the Austin, and suggested Doris go there.

She and her husband are retired pensioners, and they are just managing to get by… its tough though, and very stressful.

Assistance is needed to pay for these dressings – many people, especially the elderly, cant really afford them, but they work, so it is an awful catch 22 situation

They also have to pay to go to Melbourne, and the travelling and accommodation expenses associated with this, every 4 weeks to see Michael Woodward. Once again, catch 22 because the pain, suffering etc that the wound causes and the fact the treatment alleviates this means they have no choice. Having the ulcer slows Doris down and means that her and her husband cant enjoy their retirement.

Doris’s message is this: the cost of dressings needs to be covered or at least subsidised. The dressings are expensive, but they work and they’re effective and it stops suffering.

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