Improvised compression bandages
One of the biggest challenges in low-resource settings is finding something to substitute compression bandages with. Modern short-elastic compression bandages are usually expensive. There are cheaper versions from Chinese manufacturers available, and you have to take your time and research the market to find reasonably priced models. If the patient has a compression bandage, this should be washed and re-used as long as possible.
There are few good workarounds for compression bandages. You cannot simply wrap a cotton cloth around a leg and expect that to function well. That is incidentally something they used in the times of Hippocrates, but we doubt that it did much good. If the patient can afford compression stockings, these can also be used when there is an active leg ulcer. Stockings will probably last a few months and can be quite cost-effective. But in an off-the-grid setting in rural Botswana or Ethiopia, you will be searching in vain for a compression stocking.
We have been trawling the internet to find clever ways to substitute modern compression bandages with something cheaper. We found very little information on this topic. However, we came across the video below where Hiske Smart and Gary Sibbald discuss and demonstrate the "African Bandaging System" at the South African IIWCC meeting in Cape Town back in 2012. They demonstrate applying a compression bandage system by only using crepe bandages and a cotton roll as padding. We agree that this is a good workaround solution, and it is cheap.
Video 1 Hiske Smart and Gary Sibbald discuss and demonstrate the "African Bandaging System" at the South African IIWCC meeting in Cape Town back in 2012. They demonstrate applying a compression bandage system by only using 2 crepe bandages and a cotton roll as padding.
Figure 1 Hiske Smart published this article on the "African bandage system" in 2014. Click on the image above to get to a link to this article.
Image source: https://search.informit.org/doi/10.3316/INFORMIT.377718776980838
In theory, it should be possible to make re-usable compression bandages from elastic fabric that you can buy in a regular shop selling fabric materials. Ideally, this material should have a short stretch.
Please send us an email if you have any other ideas about improvised compression bandages. This is a topic that is really important for wound care in Africa.
A compression bandage need not be expensive - even in western countries ( where medical items usually are more expensive), the cheapest compression bandages cost around 2 US Dollars. This type of compression bandage can be washed several times before losing its elasticity, so the long-term costs are pretty low. Otherwise, you may have to be quite innovative - do some online research about who supplies cheap compression bandages - you will be surprised at the price differences. Also- remember that medical items for veterinary use are often more affordable - veterinarians also use compression bandages! We hope to have a chapter on medical suppliers on the continent available for you soon.
Another suggestion is to use several pantyhoses (kneehigh) on top of each other - for example, four layers. Pantyhose can be relatively cheaply bought, but obviously, this is a very improvised method. The patient will have to buy a size of pantyhose that fits well but is not too tight. After the third pantyhose is pulled onto the leg, the patient should feel some compression effect; possibly, a fourth layer must be applied. The advantage of pantyhose is that it is thin, and most patients will be able to use regular shoes even with four layers of pantyhose. The disadvantage of the pantyhose method is that this material easily tears- even fingernails can easily make a tear, and a walk through thorny bush will not be a good idea.
Another suggestion is to have the patient buy three pairs of regular long socks in the same size, which go up to the knee. These were in fashion for men about 50 years ago and may not be as readily available everywhere, but we are sure they are still around in many shops. Preferably they should have some elasticity, and they should have a good fit but not too tight. The idea then is that the patient takes on one sock at a time -the first one should fit comfortably, the second will give some tightening, while the third sock, as the outer layer, will provide the most pressure. Obviously, this is not necessarily a cheap solution depending on the price of the socks. Also, the socks will get worn out ( slack) after a few weeks of use. When the edema in the leg reduces, the socks will become too loose and no longer supply compression - at this stage, the patient has to buy a new set of socks in a smaller size. Another thing to remember- the patient may not fit into their shoes with three socks on and may have to use a bigger shoe size on the one foot. So this solution is not the most practical one, but it is a possible workaround.
Figure 2 If several knee-high socks are applied on a leg as multiple layers- for example, three socks- this may have an adequate compression effect. This can be a cheap short-term solution if other compression aids are not available. One downside of this method is that we do not know how much compression this will deliver. Also, the patient will have difficulty fitting into his regular shoes while wearing three socks.