- written by Dr Jemell Geraghty, Tissue Viability Nurse and King's College Lecturer, @woundnurseUK

“…The ulcers were very smelly and painful, but sometimes you feel like you deserve the suffering. You want to punish yourself for being weak, a liar and a junkie…” - Client. 

I have been working as a nurse for nearly 20 years and I still remember the first person I met who had experienced homelessness living with multiple wound. It was about 13 years ago, and he was about to change my life, my career and eventually be the inspiration for my PhD. 

Donal, was in his 50s and from Dublin, a nice guy who had incredible manners and great banter; we hit it off straight away. Donal had experienced a long relationship with heroin and had injected heroin intravenously and subcutaneously over most parts of his body. He was covered in scars and “skin popping” marks and had two large ulcers on both his legs. I remember thinking these must have been agony for him and, although I was used to the smell of open sores and it didn’t bother me, I know it must have been hard for him in the first instance to share his story with me and allow me to look at his wounds. He hadn’t injected in years and was on a Methadone programme. He was in a good place and wanted desperately for his ulcers to heal; he had been living with leg ulcers for about 5 years, on and off. 

Donals was so embarrassed when he removed his dressings and kept apologising. He had been changing them himself over many years and had disengaged with various clinicians whom he had met; he said he was tired of feeling judged and having to go back over his story of addiction again and again. He felt that some clinicians lacked the expertise and skills to manage his wounds properly and decided he was better off changing them himself. 

I remember thinking how brave Donal was and I was inspired by his resilience. I also felt sad that for that length of time no one had managed to engage with Donal’s wound care. It was clear, in my experience, that these ulcers were of “venous” aetiology (cause of condition), therefore not only were they treatable, they were healable and preventable! 

Donal is one of many people, men and women of various age groups with a history of injecting in the lower limbs and living with leg ulcerations that I have treated, healed and prevented recurrences. Contrary to popular belief, not all ulcers in the homeless population are related to injecting. I have worked with people who have experienced homelessness and never injected, who are susceptible to very similar wounds and venous disease, as are you and me alike.  

“I’ve been in a place where I just about I wanted just cut off (gestures to the leg) …. Just get it over with…you know what I mean…Cause it feels like it is spiralling out of control and you can’t do anything about it…like it would scare me just to look at it…do you know what I mean…” - Colin. 

For the last eight years or so, I have been campaigning, along with many other people to demand that the importance of wound and lower limb, vascular care physical health care is recognised. Currently, wound care in the homeless population is carried out by a range of clinicians from district nursing teams to outreach and homeless health teams. They do an amazing job; however, services are very inconsistent across the country. To avoid people like Donal living for decades in pain and with shame we urgently need to streamline wound care services. We need to ensure speedy referral to wound care, tissue viability and vascular experts who can identify problems quickly, diagnose and treat effectively and prevent where possible. 

It's our fear that specialist wound care for homeless people is seen as an optional extra, when it is in fact an essential component of inclusive and accessible health care. We need to highlight that wound care, like dentistry and specialist care for TB, sexual health and many more, should have its own place within homeless and inclusion health services and should be commissioned and recognised as so. It has been my greatest privilege to care for people’s wounds. 

Find out about our wound clinic pilot in Camden and discover how specialist nurse wound care has made a huge difference to people experiencing homelessness.  

"I mean I have seen people on the bus going (demonstrates sniffing) and I know it’s coming from me and I’ve had to get off buses sometimes I felt that embarrassed and go on the next one…” 

Watch our webinar with Dr Jemell, where we shared learnings from our wound care pilot.