Rose A., 20

Rose is an orphan living with her grandmother after losing both parents. Although she completed Class Eight in 2021, she was unable to continue with her secondary education because her family could not afford school fees. To survive, she worked as a house help, but her employer eventually let her go so that she could seek medical treatment due to the worsening state of her health. Her illness began in 2002 as a small wound on her lower leg, but over the years, it has progressively worsened, spreading to both lower limbs around the ankle joints. Because of extreme poverty, Rose has only been receiving basic cleaning and dressing at a local dispensary, with no access to proper medication, diagnostic tests, or specialist care. As a result, the wounds have become chronic, deep, and infected - characteristic of severe chronic leg ulcers. On presentation to the facility, she had long-standing ulcers that were septic, foul-smelling, and showed clear signs of advanced infection. Several areas of black, dead, soggy tissue were noted, which would need to be surgically removed before proper wound cleaning and management could begin. She has been admitted several times in the past, but due to inability to pay medical bills, she was repeatedly discharged against medical advice. This cycle has allowed the condition to worsen significantly, putting her at risk of life-threatening complications such as widespread infection, severe pain, immobility, and potential permanent disability.

Rose was diagnosed with chronic leg ulcers and spent twelve days in the ward being on antibiotics, and pain management and daily wound dressings. Rose now feels good and can now move about with the compound without feeling pain. They were scared that they will be asked to make some co payment because of all that happened before where they could request to be discharged home for inability to pay. After marked improvement was observed, she was discharged from the hospital to continue her medication treatment at home and scheduled for alternate day dressing at the facility.

Rose’s prognosis is guarded but potentially favorable with timely and comprehensive medical intervention. Given the long history of untreated and recurrently infected chronic leg ulcers, she is at risk of developing complications such as persistent infection, cellulitis, osteomyelitis (infection of the bone), severe scarring, and impaired mobility if treatment is delayed further. To establish the underlying cause of her chronic ulcers and guide proper treatment, Rose will require a skin biopsy. This will help determine whether the ulcers are due to infection, venous disease, autoimmune conditions, or other chronic skin disorders. She will also be referred to a dermatologist for specialized evaluation and long-term management.