Treatment of leg ulcers
by Dr Sherri Kirkpatrick.
Children in many Third World countries suffer from painful leg ulcers. One group of school-age children in Chiba, in the Democratic Republic of the Congo, decided to take action and asked for help. Some of the children had legs covered with scars from previous ulcers – sometimes their legs were either deformed or crippled from the effects. All suffered pain from current weeping leg ulcers. The children knew that the Community Health Workers (CHWs) ran regular clinics for babies and asked if they could consider running regular clinics to treat their ulcers.
With a combination of traditional and Western medicine, the CHWs in Chiba have now successfully treated over 1,000 cases of tropical leg ulcers. These ulcers are the result of poor nutrition and poor personal hygiene. Improving nutrition is very important, but significant success has also been achieved by improving sanitation. A major goal was to provide a low cost project which was sustainable because local resources could be used.
The treatment they used is described opposite. Step-by-step pictures of the treatment were posted in central areas of the villages to remind people of the treatment and to raise awareness. They were laminated to make them last longer. Explanations were provided in the local language.
A dramatic improvement was noted in many of the ulcers after just one week. When records were reviewed after the first six months, the CHWs noted that out of 600 children with leg ulcers, all but a handful (6–8) had been treated successfully. They believed that the unsuccessful cases would also have healed if the treatment had been correctly followed.
As news of the successful treatment spread throughout the region, the health workers expanded their role from that of local care-givers to that of consultants for the development of similar projects in surrounding areas. As a result, they have become much more self-confident and aware of their own abilities. They are now providing leadership in other community efforts.
Dr Kirkpatrick has worked for many years providing training for health workers in Africa and the Caribbean. Her address is: Graceland College, 1401 West Truman Road, Independence, MO 64050, USA. E-mail: email@example.com
Treatment steps for leg ulcers…
1. A traditional antiseptic solution using guava leaves was chosen as the first line of defence. Guava leaves were picked from the tree, washed, placed in a pan of fresh water, and boiled for 10 minutes. The solution was then drained from the leaves, covered and allowed to cool.
2. Mothers were taught to wash their hands and the wound with soap and water. The washcloth was rinsed and wrung dry. It was then soaked in the antiseptic solution from the guava leaves and used to wash the leg ulcer. If soap was not available, the guava leaf solution was used on its own. The washcloth was stored in a plastic bag. The leg ulcer was allowed to dry in the air for an hour before covering with a dressing.
3. Bandages and dressings were made from old sheets. A good source proved to be hotels that were replacing used sheets. These were washed and torn into strips a metre long and 10cm wide which were then folded into squares. One strip was used for a dressing, while another was unfolded and tied over the dressing to keep it in place. Each child was given a total of four strips. The used dressings were washed with soap and water every day, dried in the sun to sterilise them and then kept clean in plastic bags. Each child always used their own strips.
4. Each leg ulcer was measured with a plastic see-through ruler and the size recorded on a treatment card. This helped show if the ulcer was decreasing in size because of the treatment. Each card was given a number which matched that on the child’s bag. The child was required to bring the bag each time they came for treatment. New measurements were taken and recorded weekly until the leg ulcer healed.
5. Each new bag contained a small bar of soap (donated by a motel), a thin washcloth and the extra bandages. As the project grew, however, it became clear that the treatment would be successful even without the soap and washcloth brought from the outside.
6. In severe cases, the CHWs placed a small amount of triple antibiotic ointment on the dressing before placing it on the wound.