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The consequences of poor access to healthcare

I saw a 25 year old man recently in an Urgent Care Centre where I work; he was in an awful state with an infected wound to his hand.

Just over two weeks earlier he had a nasty accident which involved white spirit and a lit cigarette. He sustained terrible, full thickness burns to his dominant right hand – the areas affected worst were his 2nd, 3rd, and 4th fingers and the palm of his hand. Following an initial assessment at a local emergency department he had been transferred to a burns unit some 25+ miles away for definitive care. There his wounds were treated and dressed. He was discharged and expected to return every other day to have his wounds redressed.

And therein lay the problem; this particular young man is homeless and penniless. He had no means to get himself the 25+ miles to the burns unit. But, each time he presented himself to a local emergency department he was turned away and instead advised to go back to the burns unit. Days passed, the dressing remained unchanged and the young man slept rough – perhaps predictably his wounds became infected and painful.

He came to our unit and we didn’t turn him away. Once I called him in he was given some strong painkillers. The filthy blood- and pus-contaminated dressings were by now, firmly adhered to his flesh. I soaked his hand in water to soften them up and eventually I was able to begin to gently remove them from his hand and fingers – the smell was absolutely dreadful and I feared the worst.

Unfortunately, I found that the top of one of his fingers was necrotic (blackened, dead tissue) and another two were practically falling apart as the dressings were lifted off. I put on some temporary dressings and referred him back to the burns unit, where he was taken by hospital transport for surgery. I hope they can save the rest of his fingers – life is already difficult enough for him – but of course I’ll probably never know…

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