Amputation or Healing? The Untold Story of Wound Care on Philadelphia’s Streets
In part 1 and part 2 of this series, we delved deep into Kensington’s Opioid crisis and a silent contaminant that’s been circulating the drug supply there for five years. What we’ve learned through speaking with harm reduction and recovery professionals is that the poison is scientifically referred to as Xylazine, a horse tranquilizer, and is known on the street as tranq.
Homeless people suffering from substance use disorder might find the drug they are using to be laced with tranq, which presents very differently in humans than in horses, causing people to wander senselessly down the streets in a zombie-like fashion as their bodies begin to exhibit tiny lesions resembling pimples. Those lesions eventually turn purple, creating grotesque gaping wounds that can expose the bone and spread the infection to nearby tissue. According to Harm reductionist Kelsey León, formerly of Prevention Point Wound Care Clinic, the spots can be malodorous, and seeking treatment for them can be a daunting, humiliating, even life-altering task.
“When folks do come into the hospital, many surgical teams who have not been treating these wounds street-side or in the community look at a wound like that and immediately think that it’s necrotic,” León explained in an exclusive interview with Invisible People. “If there’s osteomyelitis, infection of the bone, or inhibited blood supply, their knee-jerk reaction has been ‘We need to amputate it.’”
León explains that many of these amputations are preventable, stating that “they do heal.”
While the wounds are undoubtedly complex and gruesome, regular dressing changes, regular cleanings, and barring the spread of infection, the wounds do heal without amputation. This raises one question, a big one:
Why Are Young People in Kensington Losing Limbs? A Healthcare Breakdown
When we talk about homelessness, we often say it’s not only the loss of housing but also the loss of choice. Homeless people get very little, if any, say about what they eat, where they sleep, things they are exposed to on a day-to-day basis, etc. This is equally true in medical settings.
Stigmas and stereotypes taint the medical system, causing unhoused patients, and especially unhoused patients with substance use disorder, to be discriminated against in myriad ways.
Sarah Laurel of Savage Sisters Recovery said we should call it what it is, “active discrimination.”
While there are still some doctors who are operating unaware of the fact that proper wound care could save the patient and the limb, advocates say some doctors are choosing to amputate these patients by drawing the assumption that they won’t perform proper wound care and will lose their lives instead of just their arms, hands, legs, and toes.
This biased belief has led to a series of preventable amputations in the Kensington area, many of which are happening to young people in their early 20s who have so much more life ahead of them.
It’s not that the amputations are completely unnecessary each time. The chances of survival for these kinds of surgeries vary. In a typical situation, a patient is given survival rates for a variety of alternatives to amputations, and then the patient chooses the alternative that they believe is best. Some people might opt for the most aggressive surgery, which is usually an amputation, while others might select wound care depending upon the margin for survival.
The biggest issue here, although there are many, is that these patients are being led to believe there are no alternatives to amputation and that the choice we spoke about above is not being given to them. It is being made for them. Patients are leaving these operating tables, having had single, double, or even triple amputations, and feeling like they did not give their full and informed consent. And yes, in many of these instances, the wounds would have healed.
The main reason this is happening is that these doctors believe unsheltered people with substance use disorder can’t or won’t be able to perform sanitary wound care on the streets. The worst part about that assumption is they are not entirely wrong.
Proper Wound Care Is Difficult to Perform Unsheltered, and That’s a Failure of Our City’s Systems, Not of Homeless People Themselves.
Homeless people are paying the ultimate price for our city’s refusal to provide them with services. This inaction is causing them to have parts of their bodies permanently severed, and to live out the rest of their lives as amputees.
“It is a nightmare of epic proportions to have our city’s leaders and this administration criminalize homelessness and mental health in the height of a toxic drug supply and overdose epidemic,” Laurel said.
“The political leaders that we have right now and the individuals that we need to take action have yet to respond to this urgent call to action,” Laurel continued. “So, now we are in this very exaggerated state where we have severe increases when it comes to amputations, a lack of housing availability, and a lack of public health resources.”
“This exacerbated situation was preventable, and is preventable with the right resources being poured into the community,” Laurel said. “However, now we are pouring all of our efforts into police enforcement and coercive treatment, which looking at this from a zoomed-out lens and working on the ground for years, I can tell you with the level of wounds that we have and the level of amputations that we have that are complicating people’s ability to access treatment and housing, sending them to jail and having this enforced treatment policy is going to cripple the systems.”
“They are using this lack of available services to make decisions that permanently and negatively alter people’s lives. And the excuse they’ll always say is like, well, we did what we had to do to save a life,” Kensington-based harm reductionist Billy Ray Boyer said. “And it’s like, okay, you did a thing. But was it the only thing you could have done? No. Because the other thing that might save a person’s life is probably having access to safe and stable housing and services. That, actually, is pretty lifesaving.”
Clean Water for Unsheltered Homeless People: A Simple Ask Denied.
“Just to give you a quick history, Sister Savage has been asking for running water,” Laurel said. “The wounds that our friends have, the reason that they’re being amputated is because they don’t have access to showers and toilets and clean wound care supplies on a regular basis. They are healing wounds given the right environment, even while consuming.”
“It is not a zombie flesh-eating drug,” she continued. “So, the city’s lack of urgency to respond to a public health crisis and provide showers, toilets, and housing has led to this increased number of amputations within our community. It’s not just, oh, it’s the drugs. It’s also the city deciding to actively ignore the fact that there are 1,000 unhoused individuals in need of showers and toilets on the street in a 5-block radius.”
Imagine losing a limb because you live outside and you don’t have access to showers and toilets. This is an immense systemic failure on behalf of our city’s leaders. Speak up for the young people who are losing life and limb, literally.
Talk to Your Representatives about Better Options for Housing and Healthcare
People living on the streets with substance use disorder are suffering unfathomable fates. Amputation rates in Kensington are rising at alarming rates as a direct result. Contact your local representatives and demand affordable housing and services to avoid more preventable amputations.
