I smashed the bones in my face in horror crash but that wasn’t the worst of it – years later I was fighting for life
A WOMAN who survived a brutal car accident was fighting for her life years later after suffering a series of infections that left doctors baffled.
Vanessa Carter had never heard of antimicrobial resistance when she was the victim of a traumatic car crash in 2004, which left her with internal injuries, shattered her cheekbone and cost her an eye.
And it would be years yet before she was acquainted with the painful reality of what it means for common antibiotics to no longer work for you.
Years after the crash, Vanessa was struck by a series of infections that kept coming back, despite being prescribed multiple courses of antibiotics in between surgeries to treat them.
Eleven months passed before she found out that she’d developed a resistance to the antibiotics she was being given by doctors.
Not only were the drugs ineffective, they fuelled the bacteria causing the infection to evolve faster.
Prior to that, she’d believed antibiotics would always work when she needed them.
Since then, Vanessa has fiercely advocated for raising awareness of the risk of antimicrobial resistance (AMR) and how to use antibiotics safely and responsibly.
AMR occurs when microorganisms such as bacteria, viruses, fungi, and parasites evolve to become resistant to the drugs that are used to treat them.
This means that the medicines become less effective or completely ineffective.
AMR can lead to longer illnesses, drive up healthcare costs, and in some cases even result in death.
Posing a threat to the effectiveness of commonly used antibiotics and other antimicrobial drugs, AMR has become a growing public health concern.
A sweeping analysis of the impact of AMR titled the GRAM paper – which was published by The Lancet in 2022 – estimated that resistance to antimicrobial drugs had caused 1.27million deaths in 2019, and that antimicrobial-resistant infections played a role in a further 4.95million deaths.
Though AMR tends to be driven by factors like poverty and inequality, it affects all income levels and countries – including the UK.
Just last month, a coalition of industry and health charities led by former health minister Maggie Throup and the British In Vitro Diagnostics Association (BIVDA) called for urgent action to tackle the threat of AMR.
It estimated that AMR-related deaths in the UK stand at 12,000 per year – “the equivalent of deaths from breast cancer annually”.
“Ten million people each year are predicted to die globally from AMR by 2050 unless urgent measures are taken,” the coalition added.
MP Maggie Throup called AMR “a tremendous threat”, saying it’s “critical that we don’t miss opportunities to slow the progress of resistance”.
“That is why we are calling on the government to prioritise the effective adoption of point of care testing in community and primary care settings,” she said.
“The pandemic underlined that the government and health system can move quickly to roll-out diagnostics and respond to major health threats – we must act now, with the same urgency, to tackle the problem of AMR.”
‘I completely smashed bones on the right side of my face’
Vanessa was in a car accident in 2004, when she was just 25 and living in Johannesburg, South Africa.
She was sitting in the passenger seat when a car overtook them on the wrong side of the road.
“They came at quite a speed and turned back into our lane and almost caught the front bumper,” prompting the driver next to her to swerve out of the way, she said.
But the car’s front wheel caught on the curb, sending it spinning into a concrete wall.
Vanessa sustained multiple serious injuries.
I got into my car and I pulled down the rear-view mirror and there was pus coming out of my face and I thought, ‘What is going on?’
Vanessa Carter
As she was jolted forward from the impact of the car, her pelvic bone was fractured by her seat belt.
She also suffered injuries to her neck and back, as well as to her intestines and stomach, causing internal bleeding.
“There were no airbags in the car and I hit the dashboard really hard where the radio casing was,” Vanessa added.
“I completely smashed a lot of bones on the right side of my face and I lost the right eye.”
She was resuscitated at the scene and, on life support, was rushed to the Johannesburg Academic Hospital, where she underwent emergency surgeries and facial reconstruction.
Her nose, jaw and cheekbone were broken and surgeons had to remove her eye, as she’d completely lost her vision in it.
Though she was discharged a month later, it took Vanessa a year to recover from the intense pain.
“I couldn’t walk for a while because of the broken pelvic bone and the internal injuries were really, really painful,” she said.
She also suffered “excruciating” headaches due to her broken facial bones.
In the second year after her accident, Vanessa had an orbital floor implant at the rim of her eye socket to address the distortion in her face. She also had an artificial eye made.
But her right eye remained much lower than her left, so she saw a maxillofacial surgeon and had a cheekbone implant inserted six years after the crash.
“I started to get scar tissue on the prosthetic and it was pulling down the lower eyelid which made me susceptible to infections,” Vanessa said.
Two weeks after doing a touch-up surgery to release the scar tissue, Vanessa was out shopping when she felt moisture trickling down her cheek.
“I got into my car and I pulled down the rear-view mirror and there was pus coming out of my face and I thought, ‘What is going on?’,” she said.
“They booked me back into hospital for an emergency surgery because they said it was an infection.”
Surgeons carried out a debridement, which involved cleaning the prosthetic, and reconstructed skin that had been eaten away by the infection.
But two weeks later, it was back – and worse.
‘Red and inflamed’
“The skin was red and inflamed and there was more pus coming out and it was not looking good at all,” Vanessa said.
She underwent another similar procedure, only for the infection to return once again after two weeks.
Vanessa then saw an EMT surgeon to have her sinuses drained but, sure enough, the infection was back after another couple weeks.
She went to an ophthalmologist, a plastic surgeon, and a maxillofacial surgeon, all of whom had different opinions about what was causing the infection and how to deal with it.
“Each time I was having surgery, it would come back again,” Vanessa said.
This process of “ongoing surgeries, of not knowing where it was, why this infection wasn’t going away” dragged on for eleven months.
My face looked terrible. It had completely collapsed
Vanessa Carter
Vanessa was due to have another operation and have her sinuses drained when her plastic surgeon recommended that her prosthetic be removed.
“When I woke up from the surgery, it had been removed and my face looked terrible, it had completely collapsed,” Vanessa said.
She was told the prosthetic had been sent for ‘testing’, which rang alarm bells for Vanessa.
“This was the first time I had heard the word ‘testing’ and I said to myself: ‘Why has this doctor taken such a big risk on your shoulders? What is wrong? Why was this infection so special?'”
Vanessa remembered feeling like she was “in a lot of danger”.
Concerned, she asked for the test results to be sent to her too.
Describing the document, Vanessa said: “There were a whole lot of different antibiotic names on the left hand side, and on the right hand side a whole lot of Rs and Ss and at the top the word MRSA.”
MRSA stands for Methicillin-resistant Staphylococcus aureus (MRSA) and refers to an infection caused by a type of staph bacteria that’s become resistant to many of the antibiotics used to treat ordinary staph infections.
But not knowing what everything meant and feeling alarmed, Vanessa did a quick Google search and came up with the term ‘antibiotic resistance’.
“I started understanding what was actually happening to me,” she said.
“All the Rs were me being resistant to a certain antibiotic and all the Ss meant I was susceptible to a certain antibiotic. Either one would work or one wouldn’t.”
The bacteria ravaging her face had become resistant to about 12 antibiotics in the penicillin class.
Vanessa had never heard of antibiotic resistance prior to this moment; it hadn’t been mentioned by doctors as she had surgery after surgery and was prescribed different courses of the drug.
I was looking in the mirror and seeing my face disappearing
Vanessa Carter
“I would go see a surgeon, they would prescribe a course of antibiotics,” she said.
“For example, I’d go see the maxillofacial surgeon and he would say while looking at the prosthetic, ‘I think that’s fine, I don’t think we need to take it out, but go back to the plastic surgeon and see what he says, and here’s another 14-day course of amoxicillin while you wait to see him, because I know he’s got a bit of a waiting list and then see how it goes’.
“That antibiotic that he was prescribing was what I was already resistant to.
“And this was one doctor, so each of those different doctors were kind of doing the same, because for them it was like, ‘Here’s an antibiotic because you have an infection’.
“But the problem was, it was being done very blindly.”
All the while, Vanessa was being prescribed antibiotics that couldn’t combat the infection in her face, making it worse and worse.
Not only that, “giving me an antibiotic that the bacteria had already developed a resistance to was making that bacteria evolve faster”, Vanessa explained.
The doctors should have prescribed her something different once they saw that the antibiotics she was given weren’t combating the infection, but that didn’t happen.
And Vanessa said she wasn’t able to ask questions about her care because she had no idea what antibiotic resistance was in the first place.
“The prosthetic would have had to have been removed anyway, because it was completely colonised with resistant bacteria, but it should have been removed sooner,” she said.
A second infection
Vanessa went on an antibiotic called vancomycin and had to wait another year and a half before surgeons could touch her face again.
This time, they didn’t use a prosthetic to reconstruct her cheekbone, but used the bone left in her face.
Unfortunately, Vanessa was struck with a second infection, which doctors feared had penetrated the bone as well as her skin.
This meant there was a risk the bacteria could reach her bloodstream and cause sepsis – a sometimes fatal complication.
“It’s like eating away at the skin and of course it’s going to do the same with the bone,” Vanessa said.
“I was very lucky that I didn’t get to that stage.”
Vanessa was able to recover from the infection after three or four months by rotating different types of antibiotics.
But she battled both physical and emotional side effects throughout.
She remembers “looking in the mirror and seeing my face disappearing”.
“It was very stressful, I was very afraid,” Vanessa added.
Life-changing impact
Before understanding what antibiotic resistance was, Vanessa felt helpless, questioning why she kept getting infections.
Once she had answers about her condition, she was at the mercy of a second bout of infections and was fearful that she’d never be able to get rid of it.
But at least some things felt within Vanessa’s control, like sticking to a strict schedule with taking her antibiotics, making sure her home was sterilised, sanitising her hands and washing them after touching objects in public.
“If my antibiotics were due at 5am, I needed to set my alarm for 5am,” Vanessa said, recalling the lengths she’d go to.
“By then the doctors were explaining, if you give it a 20-minute window, you’re giving the bacteria the chance to evolve, to mutate.
“I was more strict because I understood what needed to be done to try and get rid of this antibiotic resistance.”
The road to advocacy
Thankfully, the new antibiotics and Vanessa’s efforts paid off and she was able to overcome the infection.
“I looked in the mirror and I felt like a human being again,” she said.
By that time, it had been almost 10 years since her car accident, but she felt “bothered” by the fact that antibiotic resistance didn’t seem to be common knowledge.
As a patient who was at massive risk of the condition, Vanessa recalled becoming “a little bit obsessive” about the lack of knowledge about AMR and why there aren’t more posters about it in hospitals or warnings on pharmaceutical packaging.
She started spreading word on social media, began meeting health representatives and even got invited to a conference in Paris to share her story.
Leaving her career in marketing and advertising behind, she threw herself fully into advocacy work.
When people see my face, they realise what AMR can do
Vanessa Carter
After moving to the UK in 2019, Vanessa became an adviser to the World Health Organisation (WHO) Strategic and Technical Advisory Group for Antimicrobial Resistance, which makes policy recommendations for tackling the issue globally.
She’s also chair of the WHO Task Force of AMR survivors, which was launched in October 2023.
Each of the group’s 12 members has survived drug-resistant infections or cared for someone with one, aiming to give a human face to the global issue.
On top of this, Vanessa is involved in national action plans to tackle AMR in the UK as a lay member of the government’s Advisory Committee on Antimicrobial Prescribing, Resistance and Healthcare Associated Infection (APRHAI).
After being an advocate for 10 years, she decided to start her own charity called The AMR Narrative, focused on raising public awareness about AMR while also helping patients to advocate for themselves in healthcare settings or have their voices heard in policy making.
Communication between a prescriber and a patient is “a huge part” of safe and informed antibiotic use, she said.
“When you are prescribed a course of antibiotics, you should be told about the risks, about resistance, and told to come back if the infection doesn’t clear because you may have developed resistance,” Vanessa added.
But wider messaging about the condition is also important.
“If you look at the way Covid was also marketed and the funding that went into Covid communication, we’re nowhere near that level for AMR, but it needs to be because the death rates are so incredibly high,” she went on.
Taking antibiotics responsibly
Antimicrobial resistance (AMR) occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to medicines, making infections harder to treat and increasing the risk of disease spread, severe illness and death.
It can make historically treatable illnesses harder to combat too.
According to the GRAM project, everyone is at risk from AMR, but the data shows that young children are particularly affected.
In 2019, one in five deaths attributable to AMR occurred in children under the age of five.
It’s possible to become resistant to medications aside from antibiotics.
Antimicrobials can be grouped according to the microorganisms they target, so antifungals kill fungi, antibiotics attack bacteria, antivirals are used viruses, and antiparasitics treat parasites.
One of the major contributors to AMR is the overuse and misuse of antimicrobials, according to the AMR Narrative.
One of the ways this can happen is if doctors prescribe antibiotics based on symptoms a patient presents, rather than a confirmed diagnosis.
Common medical conditions where antibiotics are prescribed unnecessarily are flu, colds, and COVID-19 which are caused by viruses as opposed to bacteria.
How can I take antibiotics responsibly?
- Don’t take antibiotics unnecessarily – you should never take antibiotic when you have an illness caused by a virus, as you’re putting yourself at risk of getting antibiotic resistance
- Don’t double dose if you forget to take your antibiotics
- Don’t stop taking antibiotics if it looks like the infection is getting better
- Don’t keep an unfinished course of antibiotics to take later or pass round to friends and family
- Regular hand-washing is one of the most basic but crucial ways to reduce the spread of resistant bacteria – to this day Vanessa washes her hands every 30 minutes
Vanessa dwells on surviving the drug-resistant infection outside of her advocacy too.
“I still live with those prosthetics,” she said.
She also recently decided against having a small procedure on her lower eyelid to lift it up.
“I think it’s just the fear of having a surgery that I could potentially live without not doing,” Vanessa said.
She also stills feels afraid any time she takes an antibiotic for an ailment like a urinary tract infection (UTI), and it takes a while to go away.
“I’ve never been against antibiotics because they are life saving medicines, but I have become more aware of the importance of using them correctly,” she said.
And though her body is not rid of the MRSA bacteria, she still makes doctors aware of her drug-resistant infection in case it would be best to take an alternative treatment.
Overall, Vanessa reckons antibiotic resistance “is not taken seriously enough”.
“It could happen to anybody,” she warned.
Vanessa herself is reminded daily of this risk.
“I’m disfigured on the right side of my face – I live with a scar that I’ve got to look at every day,” she said, acknowledging that this was hard for her to come to terms with.
“Your face is your identity and I effectively lost half of mine as a young woman.”
But Vanessa also realised that her scar is an extension of her advocacy.
“When people see my face they realise what AMR can do,” she added.
“I was lucky that I survived to tell my story; I don’t know how it didn’t become sepsis or worse.
“It’s not easy being an advocate. It’s very tiring and the majority of your work is voluntary.
“But everything happens for a reason. I guess I was just that type of person where if something happens to me, I have to speak up.
“If nobody speaks up, then who will?”