The people that the ostomy industry forgot.

intestinal stoma is a profound alteration in body function that a patient must manage day to day over significant periods of time, often permanently. Although the creation of a stoma takes place in a tertiary care surgical context, long-term management is very often a primary care issue and most GPs and community-based nurses are familiar with patients with stomas. In developed countries, where the costs of stoma management supplies are often met wholly or in part by state or insurance-funded health systems, patients with stomas can choose from a range of disposable collection systems for stoma management that afford hygienic, discrete, and reliable collection. An entire subspecialty of nursing has grown that focuses on stoma care and guidelines have been developed for best practice in pre-operative and post-operative care, often including elements of counselling and stoma management education as well as medical care. But despite the health care and products that are available, the undoubted difficulty in adjusting to having a stoma results in considerable psychological stress in many, and the incidence of dermatitis and other complications around stomas is relatively high at between 15–43%. 3–5 Living with a stoma presents even more serious challenges for many people in developing countries. The Philippine General Hospital (PGH) in Manila is a tertiary care centre attached to the country's national university medical school that serves the large economically-disadvantaged sections of society as well as private patients. Through its charity wards, poorer patients can access essential surgery at affordable costs: the services of surgeons and a hospital bed are provided free of charge while the patient must cover the costs of medical and surgical consumables such as drugs or devices used during their surgery and hospitalisation. Following discharge patients must continue to self-fund any ongoing healthcare expenses and the creation of a stoma can present an ongoing financial burden that is insupportable for many: 21% of the population earn less than £250 per annum and disposable ostomy bags cost around £4 each and are designed to be used for only a few days at most. 6 Unable to afford the commercial disposable ostomy systems, many have to rely on their own skills and ingenuity to find other means of management. In a small study conducted in PGH and presented at the European Society for Medical Oncology in Barcelona in 2011, 20.5% of patients with stomas attending outpatient clinics were not using commercially available …