AN OPEN LETTER FROM A WOUND: I was going to write this letter sooner. Unfortunately, someone put toothpaste on me. Allow me to introduce myself. I’m a cut on your child’s knee, a burn on your mother’s hand, some stitches from your father’s hernia surgery, the road rash after your cousin’s motorcycle accident, the C-section scar, a diabetic foot ulcer, and a kitchen knife mishap that everyone insisted ‘looked small’. We’ve met. Usually moments before someone opens the spice cabinet or the medicine cabinet or on particularly ambitious occasions – the garage.
First of all, I’d like to congratulate you. You survived the accident. The surgery was successful. The stitches were neat. The burn was manageable. The doctor was optimistic. So naturally, the next logical step was to invite ‘every’ relative within a five-kilometer radius to contribute to my treatment. Within minutes, my recovery had been outsourced to the entire neighborhood. Remarkably, nobody agreed on daily life affairs. Nobody agreed on sport. Nobody agreed on the price of daily use items. Yet somehow, ‘every’ single person reached ‘unanimous’ consensus that I required turmeric. One person swore by toothpaste. Another recommended coffee powder. Someone whispered aloe-vera.
In this scenario, someone else confidently suggested kerosene. An uncle proposed engine oil. A neighbor arrived carrying a tube of an expired cream whose original purpose remains unknown. By sunset, I had become less of a wound and more of a buffet. If bacteria had neighborhood WhatsApp groups, they couldn’t have organized my destruction this efficiently. I was created by a knife. I nearly died because of a toothpaste. Your doctor after going through Pediatric Burn Registry Studies, Regional Community Wound Care Surveys and God knows how many more reports found that toothpaste is being used as ‘first aid’ in 31% to 42% of domestic burn injuries, and turmeric is being applied to nearly 48% of ‘minor’ traumatic wounds managed at home.
Unfortunately, his years of medical education told him that neither belongs on an open wound. Toothpaste traps heat in burns and contains abrasives and chemicals that damage healing tissue, while commercially-available turmeric is not sterile and may introduce fungal spores, contaminants, and foreign particles into the wound. Now, I understand what you’re thinking. “But some ‘elders’ have been doing this for years.” Exactly. Humanity has been confidently wrong for most of recorded history. We believed the Earth was the center of the universe, bled patients to cure disease, prescribed cigarettes, and even put cocaine in cough syrup. If ‘we’ve always done it this way’ were a scientific study, we’d still be treating headaches by drilling holes in people’s skulls.
Time has never been the same thing as evidence. Wounds are rather inconveniently, not impressed by tradition. However, the fascinating thing about us is that we’re actually quite uncomplicated. Wash us. Protect us. Feed the human attached to us and leave us alone. Instead, you treat us like contestants on a cooking show. Every hour brings a fresh ingredient. A little turmeric, a pinch of coffee or perhaps some ash. Someone even suggested Vicks. ‘I don’t even know what that one was trying to achieve. At this point, I wasn’t healing. I was marinating’. The doctor called me a superficial abrasion. Your relatives called me an opportunity.
Then came my ‘favorite’ sentence in our medicine history. “Leave it uncovered, as it needs air.” An interesting theory. The flies agreed, so did the dust. So did the child who insisted on poking me every twenty minutes to check if I was ‘better’. For the record, I do not breathe. I heal. Preferably somewhere clean, protected, and out of reach of curious fingers. Evidence from wound-healing research, including Cochrane Reviews, shows that wounds heal up to 50% faster in a clean, moist, protected environment than when allowed to dry out. Open wounds are more vulnerable to contamination by dust, insects, and environmental bacteria.
But what chance does a Cochrane Review stand against a blurry WhatsApp screenshot forwarded by your aunt’s neighbor’s cousin’s pharmacist’s cat—complete with ten folded-hands emojis and the caption, ‘Doctors don’t want you to know this’? You dismissed the evidence with admirable confidence. I, unfortunately, had to participate in the field trial. In the rainy season, the humidity arrived first. The sweat followed. My dressing, which had started the day as a sterile barrier, slowly transformed into what can only be described as a damp studio apartment for bacteria. Somewhere nearby, Staphylococcus aureus was already unpacking boxes. Pseudomonas aeruginosa had begun browsing property listings.
The weather had done its job. The microbes were merely taking advantage of the excellent accommodation. You, meanwhile, looked at the soaked dressing and said, “It’ll dry.” It didn’t. Now, before you accuse me of being melodramatic, let’s see what the evidence says. Something considerably less viral—and considerably more accurate—than Dr WhatsApp MD. The rainy season’s humidity and extreme summer heat significantly increase the risk of wound complications. Damp dressings soften the surrounding skin (maceration), weaken the skin’s natural barrier, and create ideal conditions for bacteria such as Staphylococcus aureus and Pseudomonas aeruginosa. According to the World Health Organization, surgical site infections are the most common healthcare-associated infection in low- and middle-income countries, affecting up to 11.8% of surgical patients.
In Pakistan, published studies report surgical site infection rates of 8%–13% following elective surgery, increasing dramatically in emergency and contaminated abdominal procedures. To every patient who has ever returned home with a beautifully-stitched incision, allow me to offer my deepest sympathies. Because surviving the operation was only half the battle. The real challenge: was surviving the relatives. The real challenge: was surviving the well intentioned advices. The surgeon had spent three hours putting me together. Your family undid his discharge counselling before you even reached the hospital gate. “Don’t let water touch the stitches. No eggs. No chicken. No fish. No meat. Only khichdi. Don’t bathe. Don’t move too much. Actually… don’t move at all.”
At one point, I genuinely began to wonder whether the treatment plan was designed for me or an antique wooden cabinet. Then came the bathing ban. Apparently, somewhere in the rich oral tradition of South Asian medicine, a rumor began that water possesses an irresistible urge to sneak into stitches, throw a party beneath the skin, and manufacture pus. As someone who is, quite literally, the stitches in question: I’d like to clear up the misunderstanding. Water is not my enemy. Forty-degree heat wrapped inside three layers of sweaty clothing is, and a ‘dum karai hui patti’ drenched in ‘white goat milk’ is. You proudly announced, “Our patient hasn’t showered in eighteen days.” Congratulations. Neither has the bacteria. They’ve simply chosen to stay.
But don’t take my word for it. Take the word of those who literally study wounds for a living… yes they exist. South Asian post-natal care studies show that more than 60% of post-operative patients in many rural and peri-urban communities across Southeast Asia avoid bathing for one to two weeks—or longer—because of the belief that water causes wounds to become infected. In reality, in accordance with the WHO surgical wound care recommendations, once the surgeon advises that it is safe (often after the initial post-operative period or with waterproof dressings), gentle showering with clean water and mild soap helps reduce bacterial load on the surrounding skin. During hot, humid weather, avoiding hygiene allows sweat, oils and microorganisms to accumulate around healing wounds, increasing the risk of infection and fungal skin disease.
No you don’t stop at turmeric paste and bathing bans. As Pakistani, you must give yourself more credit than that. How can any ancestral wound care starter pack be complete without ‘the great protein confiscation’? The eggs disappear first, and the chicken follows. Fish is declared as heating effect. Milk became suspicious. Apparently, the official post-operative diet now consists of plain rice, weak tea, and optimism. Unfortunately, wounds don’t heal according to folklore. South Asian post-operative nutrition studies; Pakistan clinical nutrition research show that more than 70% of post-operative caregivers restrict protein-rich foods such as eggs, meat and fish because they are believed to have heating effect. Medical science says the opposite. Protein is essential for collagen formation, immune function and tissue repair.
Restricting protein delays healing, weakens newly formed tissue and increases the risk of wound breakdown. Ladies and gentlemen… I am trying to build skin. Not manifest it. Collagen is made from amino acids. Not family opinions. Every time you confiscate protein because someone said it makes wounds ‘hot,’ somewhere a fibroblast quietly resigns. But just when I thought things couldn’t become any more creative… Someone reached for antibiotics. Not to swallow. To sprinkle. The capsule was carefully opened. The powder was poured directly onto me. May I ask… Why? Am I spicy and tangy chickpea salad? Am I instant noodles? Was I supposed to absorb flavor? Unfortunately, bacteria don’t care about good intentions—or family recipes.
The same family that refused to let me meet soap and water had absolutely no reservations introducing crushed pharmaceuticals of uncertain dosage directly into living tissue. It was, medically speaking, an ambitious strategy… There is, however, a slight flaw in the plan. The World Health Organization identifies inappropriate antibiotic use as one of the leading drivers of antimicrobial resistance. Opening oral antibiotic capsules and applying the powder directly onto wounds is not evidence-based wound care. Instead, it can damage healthy tissue, trigger contact dermatitis and contribute to antibiotic-resistant bacteria. You’d think that would be enough trauma for one postoperative wound. It wasn’t… Occasionally, someone decided I looked too swollen. The solution, naturally, was to squeeze me.
“Get the dirty blood out. It’ll heal faster.” Allow me to explain what actually happened. The surgeon had painstakingly stitched together delicate tissue. You arrived with the enthusiasm of someone squeezing the last bit of toothpaste from a tube. Granulation tissue? Gone. Tiny blood vessels? Ruined. My dignity? Irrecoverable. Please stop treating surgical wounds like bubble wrap. We are not supposed to pop. By now, you’ve probably noticed a pattern. Whenever something happened to me… someone wanted to add something. Pour something. Remove something. Rub something. Ban something or squeeze something. Rarely did anyone realize what I really needed. Like any newly-wed couple in a highly-integrated joint family. I required one thing. To be left alone. Clean. Covered. Fed. And occasionally admired from a respectful distance.
Here’s the funny part. I was never particularly afraid of bacteria. At least bacteria are predictable. They don’t arrive carrying toothpaste. Or turmeric. Or expired creams. Or unsolicited nutritional advice. They simply exploit every opportunity we give them. Humans, on the other hand, well what can I say… And that’s precisely why this story matters. Because somewhere, right now, another wound is about to begin the exact same journey. In rainy season, emergency departments have ‘responsibility’ to ‘welcome’ fresh motorcycle abrasions, kitchen cuts, playground scrapes, diabetic foot ulcers, burns, Caesarean sections, appendectomies, hernia repairs and fracture surgeries. Most of us are remarkably good at healing.
You’ve spent millions of years evolving immune systems, clotting factors, inflammatory cells and microscopic repair mechanisms that work around the clock without asking for applause. Trust them. Trust the people trained to help them. Perhaps don’t trust the neighbor whose medical qualification is surviving a pressure cooker accident in 1987. Before reaching for the toothpaste… Before opening the turmeric… Before banning showers… Before hiding the eggs… Before squeezing the stitches… Before consulting someone whose greatest medical achievement was forwarding a voice note – “A ‘foreign doctor’ has confirmed…” Please, give me the one thing every over qualified unemployed person and every wound secretly dreams of a chance. Every cut, burn, stitch, abrasion, surgical incision, road rash, and innocent kitchen accident currently residing somewhere in Pakistan.
