In this guest editorial, Irene Anderson describes her experiences of running a wound care course for nurses and doctors in Romania.

Early in 2009 I was invited to Bucharest, Romania's capital city, to design and deliver a wound care course for nurses and doctors. The invitation came from the Romanian Ostomy Patients Support Foundation (ROPSF) in the UK. The organisation has been working for many years to develop and support ostomy care in Romania, including organising events and support for key practitioners, some of whom have attended courses in the UK.

Through this work ROPSF identified that wound and stoma care are inextricably linked; it also became aware of the immense challenges posed by wounds and related issues in Romania. There are key people, both doctors and nurses, who are developing a high level of expertise within Romania. In addition, ostomy patients have progressed from having no purpose-made appliances and living in isolation to having reasonably good access to appliances, better outcomes and improved quality of life. ROPSF has worked incredibly hard to raise funds over the years and has invested much money and expertise from clinicians and ostomy patients in the UK and Romania who are determined to make a difference.

To understand the educational needs in the country, I felt it was important to see for myself the structure of health provision and to identify the key wound care issues. So it was I found myself on a bright and sunny day in Bucharest with personnel from ROPSF and our host Cristian Dobre, Vice-President of the Romanian Ostomy Association, touring some of the hospitals in the city.
 
I was surprised to find myself having very similar conversations to the ones at home about resources, time, funding and wound care knowledge (or lack of it). Staff in all the institutions we visited were friendly and open about their challenges; many make great efforts to update themselves as best they can but have frustrations when they do not have the resources to implement changes in practice.
 
I met one surgeon who had just returned from a diabetic foot conference in Scotland and clearly had many ideas he would like to implement in his hospital. There are no podiatrists in Romania and we discussed the major problems posed by managing the neuropathic and neuroischaemic foot - the high rate of amputation and the lack of specialist prevention and management resources.
 
In the hospitals I visited, there were dressing trolleys, gauze swabs, sterile metal forceps and containers of antiseptic solutions, but very few dressings. Some patients may have interactive dressings but in general need to purchase these themselves. The clinical tour gave me the opportunity to talk to practitioners, see the resources available, evaluate the level of knowledge and identify key wound problems. These were: the diabetic foot, complex postoperative wounds, pressure ulcers and leg ulcers.
 
There is a shortage of pressure-relieving equipment and few compression therapies are used. People with chronic wounds are not prevalent in hospitals as they tend to be sent home to the care of relatives and community services. It is very difficult to quantify the volume of wounds as national data are not kept. As yet, there is no monitoring of postoperative infections, although the World Health Organization is encouraging this in Eastern European countries.
 
There is no lack of willingness to change and improve practice. Clinicians are open to new ideas and there was some evidence of people making great efforts to access literature. They rely mainly on free resources; these are a great benefit but with the usual caveats about quality and veracity, especially with Romanian staff having so few opportunities to access debates and discussion and to develop the necessary critical appraisal skills. Most of the doctors I spoke to had reasonable levels of English, but this was not true of the nurses, although many of them are able to read text in English, albeit slowly. This is important as there are very few woundcare resources available in Romania.