SUDBURY, ONTARIO – He stands more than six feet tall and was once built like a brick house – strong, sturdy and imposing. But these days, Joseph Wawia, 33, has more pain than intimidation in his eyes. They are deep, dark pools that betray his hard-won pride and whisper of the hardships he has endured over the past seven months. His hands? They scream of his struggles.

Wawia was hanging out last August in a wooded spot behind Dumas’ Independent Grocer, cooling off with a frosty cider when he was beaten to within breaths of his life by a man carrying a two-by-four.

“He started arguing with me and I told him to f**k off and I turned around to walk away,” he says. “He swung that two-by-four he had in his hand and hit me right in the stomach. A rib went through my liver and I hit the ground right away. He knocked me silly. He planned on killing me. He told me he was going to kill me.”

Wawia said a man has been charged, but the courts have yet to deal with the case.

Wawia was homeless at the time, as he has been, on and off, for the past five years. The perpetrator wrapped him in a tarp and left him for dead. Twenty-two hours later, Wawia’s friend found him, as he wavered in and out of consciousness.

His friend carried him to the Sudbury Action Centre for Youth and called an ambulance. Wawia woke up a month later, a patient in the intensive care unit at Health Sciences North. He had been comatose for a month, and says he also suffered a lacerated liver, damaged kidneys, a broken rib and a fractured right arm (he protected his head with his hands during the beating).

“I was on life support for a month – that’s how severe my head injury was,” he says. “I wasn’t supposed to wake up. My family came from all over to say their good-byes.”

Because he had been unconscious and immobile for so long, the 33-year-old’s hands stiffened into clenched fists that remain tight to this day. They now resemble the arthritic, crippled claws of a 90-year-old, painful and hardened after years of manual labour.

In early December, Wawia was released from HSN (or kicked out – the facts are fuzzy), wearing only “a pair of pyjama pants and a pair of Crocs,” as well as a spring-weight jacket. He was given neither his HIV medications nor the antibiotics he was taking at the time.

“When I came out of ICU, I was swelling up like the Michelin man,” he recalls. “They had to cut off my L-shaped cast (covering his right arm) and put on a new cast, and they saw rub marks on my wrist and the back of my arm. They highlighted it and put on a half-cast, so that I could get dressing changes twice daily. That didn’t get done for two-and-a-half weeks. One night I felt bleeding coming from my arm.”

What was once a simple rub mark had evolved into a festering, seething infection. The blood was coming from an eight-inch wound running along the back of his right forearm.

Nosocomial infections are surprisingly common. The Public Health Agency of Canada estimates more than 200,000 patients are infected annually while in hospital, while 8,000 die from their infections. Nearly 80% of the most common infections are spread by health-care workers, patients and visitors.

“I was pouring out hundreds of milliliters of pus at every dressing change (thereafter),” he says.

A self-admitted alcoholic (though he says he is currently dry), Wawia asked to be transferred to a detox centre. He spent about two weeks there, but was re-admitted to HSN in mid-December for surgery.

“To them I’m just another statistic, another homeless Indian who deserved what he got and deserved to be kicked out of the hospital,” he says.

Dan Lessard, HSN’s spokesperson, cannot comment on specific incidences, but says protocol dictates the care of wounds and dressings.

“We follow evidence-based best practices to develop a plan to treat that wound. That plan takes into consideration the severity of the wound and how the wound evolves. We assess the wound on an ongoing basis and will adjust the treatment plan accordingly,” he comments. “When a patient is getting ready for discharge we would also review with them and educate them about wound care on an ongoing basis, and we would include wound care when developing a discharge plan for the patient after they leave hospital.”

It may go against protocol, but neglect of wounds and dressings does happen, says one long-time care-related employee of the hospital – usually as a result of communication lapses.

“It is a possibility, but it’s not the norm,” he says (he has asked The Star not to name him). “It would depend on the workload, the experience of the staff involved, that type of thing.”

In the intensive care unit, a non-emergent wound could be overlooked if more pressing cases present themselves.

“There could be a scenario when there’s been a very severe accident of some kind, or someone with a very severe injury and everyone is tied up – like a cardiac arrest could have occurred,” he continues.

“It could also depend on the information the staff in that area has been given when the patient arrives in the unit as to what’s wrong with them. They should do a head-to-foot examination, but it doesn’t always get done.”

In early February, Wawia was finally released from HSN to a safe bed at a detox centre. He stayed there until Feb. 20, but was released without a follow-up plan for physiotherapy, even though he is reliant on others for nearly every menial, daily task.

“They said most likely (my hands) won’t get better; I can’t move each finger independently,” he says. “I’m crippled right now.”

Lessard says post-discharge treatment plans are developed collaboratively with community-based care groups, as well as the patient.

“If a patient is homeless, we have social workers who work with them to find accommodations where their care needs can be met once their acute care has been completed,” he adds. “The social workers will either arrange accommodations with the appropriate agencies in the community or will provide the patient with information about their options.”

Wawia says he was discharged from HSN without a plan for follow-up physiotherapy, and no accommodations were arranged.

“When it comes to a plan for physiotherapy or rehab or a similar service, a patient has to be referred to that by a physician if the physician feels the physio, rehab or occupational therapy is appropriate and beneficial for that particular patient,” Lessard comments. “The patient must then also agree to take part in such a plan, as physio/rehab involves a longer time commitment from patients than acute care.

“All acute-care medical issues must be resolved before they can begin rehab to avoid complications, for example, wounds that won’t heal.”

Wawia relies on others for everything now – getting dressed, lighting a cigarette, using a fork and turning door knobs. The pain is unbearable – you can see it in his eyes. His right arm is still wrapped in layers of gauze and an external fixator pokes out from beneath his jacket sleeve, only increasing his vulnerability. He has splints for his hands, but they need to be removed daily. Homeless and with no help on the horizon, Wawia says they are useless.

Each day is a challenge. With this new reality, Wawia’s spirits are low and the struggle, at times, seems insurmountable.

“The jails don’t let people out in this state; I was thinking of doing something stupid to get arrested so I could go to jail, so they’d have to take care of me,” he says. “If I find it too overwhelming out here and I can’t take care of myself, I’m going to have to go to jail.”

Published on March 3, 2015 in The Sudbury Star