My Scope of Practice: Bringing Wound Care to the Forefront in South America

  A General Surgeon and opinion leader in wound care in Colombia, Cesar Jimenez, MD, presided over his country’s first Advanced Wound Care course in September 2006. The audience included general practitioners, nurses, vascular and general surgeons, the general community, and representatives from the government’s health department. The objectives of the conference reflected Dr. Jimenez’s vision and mission regarding the importance of proliferating knowledge on the microenvironment of wounds and wound care technology – ie, to encourage state-of-the-art wound care, to enhance understanding of the different types of chronic wounds, to share knowledge of basic diagnostic and treatment tools, and to facilitate a holistic approach to care. The 154 conference attendees and presenters came from Colombia, Mexico, and the US and included representatives from 12 medical companies. Known as “the wound doctor” in his hospital and among colleagues, Dr. Jimenez continues to be proactive about educating patients and providers on a variety of wound care considerations.   Dr. Jimenez has 4 years’ experience in vascular and general surgery and 2 years in wound care. He created and served as Chief of the first wound care department inside Clinica del Occidente, a general hospital in Colombia, training people from Colombia and Ecuador regarding the treatment of open abdomen, fistulas, diabetic foot and vascular ulcers, radiotherapy, and traumatic and postoperative wounds he sees in his clinic.

   “I established a wound clinic in my hospital after discovering no one was effectively taking responsibility for wound care,” says Dr. Jimenez. “In general, I have observed that people in the medical community tend to avoid managing wounds. Two years ago, while practicing general and vascular surgery, I began investigating and studying the field of wound care because few seemed willing to confront its demands. I enjoyed exploring the subject and gradually more and more wound patients came to me for help. I created and have maintained the wound clinic with just one nurse, who has experience in ostomy care. Hospital administration provided a large office for the clinic; later, an additional offsite facility was opened for my private wound patients. Although the clinic is called Clinica de Heridas y Terapia Enterostomal (Wound and Enterostomal Therapy), most of the people we see are wound patients. Our clinic currently offers general and vascular surgery consultation, surgical debridement, maggot therapy, and conventional and advanced dressings.”

  After establishing the clinic, Dr. Jimenez began giving educational presentations and lectures on wound care to the hospital’s general practitioners, anticipating not only an increased awareness of wound-related problems but also an increase in patient referrals from the hospital and emergency room. Within 6 months, he was the hospital’s recognized wound specialist among practitioners in many different specialties.

  Eager to implement new technology into wound management, Dr. Jimenez learned about negative pressure wound therapy. He brought the technique into his practice and an article that details his experiences with its use in 87 patients with refractory wounds is scheduled to be published in the November issue of the Journal of the Colombian General Surgical Association.

  As the clinic’s business grew, Dr. Jimenez was sought by Johnson & Johnson South America. The company learned he was treating wound patients and they had products useful in his practice. The company not only provided information about its wound care products, but also sponsored Dr. Jimenez for membership in the Association for the Advancement of Wound Care and enabled him to attend the Symposium on Advanced Wound Care in San Diego in 2005. In addition to membership in the AAWC, Dr. Jimenez also is a member of the Latin-American panel for wound care of Johnson & Johnson, along with colleagues from Mexico, Argentina, Chile, Puerto Rico, Venezuela, Brazil, and Costa Rica.

  Last year’s wound care course was academically sponsored by The Wound Care Integral Foundation (Fundacion para el Cuidado Integral de Heridas) and the Colombian Surgery Association (Asociacion Colombiana de Cirugia). The former is a non-profit organization Dr. Jimenez established to organize and administer the conference. He currently serves as its president. “The foundation’s purpose is to expand wound care culture and endovascular treatment for wound patients,” Dr. Jimenez says. “It also strives to ensure wound patients receive proper care. The majority of the funds raised by the foundation are allocated to reduce the bulk purchase cost of dressings. The savings are passed along to patients and in some cases dressings are provided free of charge.”

  For Dr. Jimenez, wound dressings are a particular challenge. “Neither government healthcare nor insurance companies cover wound care or wound dressings of any type,” he says. “In most cases, patients must purchase dressings themselves at considerable expense because such dressings must be imported from Europe or the US. When they see the results that can be achieved, patients are willing to bear the cost.”

  Dr. Jimenez continues to add to his knowledge and skills. Last year, he spent 2 months visiting Dr. Thomas Serena in his wound clinics in Pennsylvania. He also spent time in the Vascular Surgery departments of Shadyside Hospital and Presbyterian Hospital in Pittsburgh, where he observed the important role endovascular surgery can play in improving wound healing. Inspired by what he saw, he applied for and received a fellowship in endovascular surgery in the US; he is now studying at the Arizona Heart Hospital, Phoenix, Arizona. This past March, he attended the National Wound Healing Course on hyperbaric oxygen therapy in Columbus, Ohio with the intention of introducing this treatment in Colombia. HBO is not currently available in any Colombian facility, a fact that Dr. Jimenez believes denies patients access to valuable technology.

  Dr. Jimenez’s future plans include raising additional funds for his foundation. He hopes to procure financial, technological, and educational support to advance wound care in Colombia. He acknowledges that although completing his endovascular surgery training is a key step that will allow him to introduce endovascular techniques in Colombia, finance is a continuing, major concern because of the necessary expenditures for supplies, facilities, and so on.

   “Wound clinics are still very new to the Colombian medical community, existing in only a few hospitals,” says Dr. Jimenez. “Often they are under the charge of a nurse with limited knowledge and power to intervene in a patient’s care.” Undaunted, Dr. Jimenez is doing all he can to improve wound care in his scope of practice.

My Scope of Practice is made possible through the support of ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ. This article was not subject to the Ostomy Wound Management peer-review process.