Improving Wound and Lymphedema Treatment Outcomes in Limited-Resource Environments: An Integrated Approach
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Medical professionals are increasingly compelled to do more with less and wound care is no exception. This special focus issue of WOUNDS will share the experiences of a dedicated global multidisciplinary team of wound and lymphedema clinicians, academic institutions, public health experts, industry partners, and non-governmental development organizations (NGDOs) participating in the World Alliance for Wound and Lymphedema Care (WAWLC). Their mission is to develop an integrated approach to improve wound and lymphedema patient outcomes in low-resource environments.
The WAWLC builds on strategies initiated by the Association for the Advancement of Wound Care (AAWC) Global Alliance, Handicap International, and other NGDOs in cooperation with the WHO Global Programme to Eliminate Lymphatic Filariasis (GPELF). GPELF developed and implemented an effective, low-resource set of evidence-based, home-care activities including hygiene, wound care, exercise, and raising the affected limb. During the first 19 months of testing this protocol in pilot projects and operational studies, the project’s primary measure, incidence of acute lymphedema attacks, declined from more than 12% to 5%.1
The WHO disseminated technical and training tools to make the GPELF sustainable. There are discussions about how to adapt these tools for other disabling chronic diseases including Buruli ulcer, diabetes, and leprosy. The International Consensus Conference on Disability Prevention Related to Leprosy held in Cebu, Philippines in September 2006, officially recognized benefits of integrating a unified approach to leprosy and lymphatic filariasis by adopting the same protocol of community home-based care, so that the NGDOs became partners in improving outcomes for these diseases. In 2007, representatives of the AAWC, Handicap International, Health Volunteers Overseas, and WHO held a meeting in Geneva, Switzerland to develop a system of relevant clinical and public health activities to manage all chronic wounds and lymphedema in an integrated manner in limited-resource settings. During this meeting, Dr. John Macdonald and Dr. Mary Jo Geyer were commissioned to edit a white paper2 that would collate the basic principles of both wound and lymphedema care. This document is intended to serve as the foundation for developing integrated training and educational materials adapted for different levels of the healthcare system within limited-resource settings worldwide. 
A second meeting that was held March 5–7, 2008 in Geneva, Switzerland, was convened to further define the white paper and to establish the “Global Initiative for Wound and Lymphedema Care” (GIWLC). As a result of this meeting, pilot site evaluations were conducted in Cameroon, Ghana, Sierra Leone, and Uganda. A June 2008 Footwear Workshop in Mali supported by several NGDOs and led by Dr. Geyer added the potential for off-loading the insensate foot to this uniquely integrated agenda. In March 2009, the first GIWLC teaching seminars were conducted in Ghana in the cities of Accra and Kumasi.
In October 2009, representatives from multiple international associations, NGDOs, and industry met in Geneva, Switzerland. The official name of the organization was changed from the Global Initiative for Wound and Lymphedema Care to the World Alliance for Wound and Lymphedema Care (WAWLC). The WAWLC is truly the first global organization devoted to advocating and coordinating the work of different associations involved in wound and lymphedema activities.
As you read the WAWLC story by Dr.
1. Brantus P. Ten years of managing the clinical manifestations and disabilities of lymphatic filariasis. Ann Trop Med Parasitol. 2009;103(Suppl 1):S5–S10.
2. Macdonald JM, Geyer MJ, eds. Wound and Lymphedema Management. Geneva, Switzerland: World Health Organization. In press.
3. Kurd SK, Hoffstad OJ, Bilker WB, Margolis DJ. Evaluation of the use of prognostic information for the care of individuals with venous leg ulcers or diabetic neuropathic foot ulcers. Wound Repair Regen. 2009;17(3):318–325.
4. Bolton L, Corbett L, Bernato L, et al. Development of a content-validated venous ulcer guideline. Ostomy Wound Manage. 2006;52(11):32–48.
5. World health Organization. Innovative care for chronic conditions: building blocks for action. http://www.who.int/diabetesactiononline/about/icccreport/en/index.html. Published 2002. Accessed December 8, 2009.
6. Geyer MJ. Perspectives from the first AAWC Global Alliance Project. WOUNDS. 2008;20(10):A21–A25.
