April 2010

Out On a Limb: Up from the wreckage

by Jordana Bieze Foster, Editor

Have a bad day at the office?  At least you didn’t have to worry about not having any electricity. Or clean water.

Most of us take these things for granted. But for some practitioners, in places devastated by war or by natural disaster, they are very real concerns that go hand in hand with lower extremity care.

Just ask Vjolca Kola. She fled her native Kosovo and sought refuge in the Netherlands, grateful to find work as a housekeeper despite her training as a nurse. But as fate would have it, Kola’s new career path led her to the home of Margreet Van Putten, MD, MSc, whose reason for falling behind on her housework just happened to stem from the demands of her position in the school of podiatry at Fontys University of Applied Sciences.

As much as she wanted a clean house, Van Putten told attendees at the Diabetic Foot Global Conference last month, she couldn’t allow Kola’s medical skills to go untapped. Soon the refugee was a nurse once again, with a newfound interest in Van Putten’s specialty of diabetic foot care, and in 2004 she returned to Gjackova to open a foot clinic.

Easier said than done. There was no question of need, not in a place where good footwear is scarce and smoking is one of the only ways to cope with the poverty and desperation the war left behind. But public awareness of foot health was essentially nonexistent, and Kola’s resources were few.

Still, with the help of her husband, Van Putten, and others, Kola has made a difference. In 2008-09, she treated 40 ulcers, and 29 healed – a result Van Putten called “tremendous.”

William Ennis, DO, MBA, a wound care specialist at the University of Illinois Medical Center in Chicago, also knows something about such challenges. His DFCon lecture on “My Bag of Tricks” was already in the works when life in Haiti was shattered by a 7.0 magnitude earthquake on Jan. 12. And on Feb. 8, when Ennis left for Haiti as a medical volunteer, the lecture became reality; he would be treating patients only with what he could literally carry in his travel bag.

Ennis and his fellow volunteers treated 160 adults and 120 children under a single hospital tent, with no relief from the 100 temperatures or the ever-present flies and maggots. But they made a difference.

Without the customary buffet of diagnostic technologies and treatment options at their disposal, the volunteers called on diagnostic skills they’d forgotten they had. They listened to their patients. They listened to each other. They collaborated. They made do.

And at the end of every day, they marveled as all of the patients in the hospital tent broke into song.

“They prayed in a three-part harmony that was mind boggling,” Ennis said. “I would bet that that was the most powerful part of their wound healing. And it didn’t cost anything.”

Something to keep in mind the next time you’re having a bad day.

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