The Experiences of Black Men Who Survived a Gunshot Wound and Were Treated With a Colostomy.

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Learn more: PMC Disclaimer | PMC Copyright Notice Public Health Rep . 2025 Apr 12;141(1):24–30. doi: 10.1177/00333549251316808 Search in PMC Search in PubMed View in NLM Catalog Add to search The Experiences of Black Men Who Survived a Gunshot Wound and Were Treated With a Colostomy William Wical William Wical , PhD 1 Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Find articles by William Wical 1, ✉ , Bethany Strong Bethany Strong , MD 2 Department of Trauma Surgery, University of Maryland Medical System, Upper Marlboro, MD, USA Find articles by Bethany Strong 2 , Joseph B Richardson Joseph B Richardson , PhD 3 Department of African American Studies and Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA Find articles by Joseph B Richardson 3 Author information Article notes Copyright and License information 1 Center for Gun Violence Solutions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA 2 Department of Trauma Surgery, University of Maryland Medical System, Upper Marlboro, MD, USA 3 Department of African American Studies and Department of Anthropology, College of Behavioral and Social Sciences, University of Maryland College Park, College Park, MD, USA ✉ William Wical, PhD, Johns Hopkins Bloomberg School of Public Health, Center for Gun Violence Solutions, 750 Pratt St, Floor 15, Baltimore, MD 21012, USA. Email: [email protected] Collection date 2026 Jan-Feb. © 2025, Association of Schools and Programs of Public Health PMC Copyright notice PMCID: PMC11994633  PMID: 40219932 Abstract In the United States, rates of fatal and nonfatal firearm injuries differ substantially by race and sex, with Black men being more likely than any other group to be shot. Many people who survive a gunshot wound have complex physical, psychological, and social challenges during their recovery. Public health programs, including hospital-based violence intervention programs (HVIPs), have been designed to reduce the likelihood of reinjury for their participants and to support their well-being. However, little is known about how Black men who survive a gunshot wound and receive care from these programs conceptualize the best ways to support their healing and the barriers they experience in achieving their health-related goals. This case study, drawing from ethnographic research conducted during 2013-2023 at the second busiest HVIP in Maryland, examines the experiences of 6 Black men who were treated with a colostomy after surviving a gunshot wound. Emergent themes included increased psychological stress from being treated with a colostomy and wearing a waste collection pouch, disruptions to everyday life, and insufficient access to colostomy care and education. The findings from this case study highlight the importance of providing access to psychological services, colostomy education, and health care supplies to meet the needs of HVIP participants and improve health outcomes for this population. Keywords: hospital-based violence intervention program, colostomy care, gun violence Differences in the rates of firearm injury in the United States by race are notable. 1 In data from 2019-2020, the rate per 100 000 population of nonfatal firearm injuries was 80.8 for Black people in the United States versus 3.8 for White people. 2 Disparities also differ significantly by sex: Black males comprise more than half of all homicides with a firearm. 3 According to the Centers for Disease Control and Prevention, nearly 3 times as many people survive firearm injuries as die of them. 4 These injuries often result in serious physical and psychological consequences, including long-term disability, chronic pain, and psychiatric disorders. 5 - 10 However, little long-term qualitative research has been conducted on how people who survive a gunshot wound navigate their physical, social, psychological, and emotional experiences while recovering from their injuries. Despite colostomy being a common treatment for people who are shot in the abdomen and Black men being the most commonly injured population, research on the needs and experiences of Black men who are treated with a colostomy is scant. While public health programs—including hospital-based violence intervention programs (HVIPs)—have been developed to reduce the likelihood of repeat violent injury for their participants, their services are often not culturally responsive to the perspectives and lived experiences of those whom they purportedly serve. 11 - 13 HVIPs typically provide direct services such as case management, crisis intervention, peer support, cognitive behavioral therapy, and referrals to external service providers. 14 Improving the ability of HVIPs to meet the needs of the people for whom they provide care is a critical avenue by which to increase participant satisfaction and engagement, enhance health outcomes, and reduce the physical and psychological effects of surviving a gunshot wound. Purpose Colostomies are surgical procedures that create an opening, called a stoma, in the small bowel or colon to help remove waste, eliminating the natural ability of a person to control the contents of their intestine. Because control over both gas and stool are affected, the most commonly reported concerns for people who are treated with a colostomy are incontinence, rectal discharge, difficulty resuming work, poor body image, psychological distress, and decreased sexual activity. 15 - 17 Patients who are treated with a colostomy ideally are provided with education on how to clean and maintain their stoma and waste collection pouch. 18 - 20 Furthermore, patients may be connected with a wound care and ostomy nurse who specializes in education, care, and support after discharge. 21 However, common challenges to receiving adequate care include limited access to outpatient ostomy care; a lack of wound care, ostomy, and continence nurses; and difficulty in being reimbursed for outpatient visits that focus on ostomy education. 22 Having a colostomy—whether permanently or for a fixed time—can negatively affect one’s quality of life. Although improvements have been made in care techniques for stomas, it is common for people to encounter difficulties in managing their own colostomy. Challenges include skin irritation, waste collection pouch leakage, odor, and a reduction in previously enjoyed activities. 17 , 22 - 24 One study found that one-fifth of people treated with an ostomy did not seek assistance when they had issues with caring for their ostomy. 22 In addition, patients experience considerable psychological concerns related to wearing a waste collection pouch, including anxiety, embarrassment, fear, depression, and low self-esteem. 25 - 28 These changes can affect multiple aspects of the wearer’s life and people in their social networks. 29 - 31 Rates of creating a stoma and transfer to rehabilitation for Black and White patients are similar when patients are treated for penetrating colon trauma. 32 A 5-year sample of annual stoma formation and closures rates found that rates of reversal surgery (ie, reconnecting bowel to intestine and closing of stoma) were higher among White patients than among their Black peers (67% vs 56%) and among privately insured patients than among uninsured patients (88% vs 63%). 33 Similarly, another study found that White patients at every socioeconomic status level had higher rates of reversal surgery than Black patients in similar status levels and that socioeconomic status had a larger effect on reversal surgery rates among Black patients than among White patients; in addition, the study found that patients who were poor had a significantly longer wait time for their procedures than people who were not poor. 34 These findings are notable for HVIP participants because HVIP participants are disproportionately Black, poor, and uninsured. 35 - 37 In addition, Black men who survive a gunshot wound encounter structural barriers to engaging with health care systems and receiving adequate care, including inadequate access to transportation, inability to take time off from work, and racial discrimination. 38 - 40 One study found that gunshot wounds in military and civilian settings led to a colostomy or ileostomy in approximately one-quarter of cases, although data were not available on the frequency with which people treated at the hospital where the research was conducted received a colostomy after sustaining a gunshot wound in the abdomen. 41 Our case study examines 3 key themes from ethnographic research conducted at the HVIP associated with the second busiest trauma center in Maryland; it treats approximately 750 patients for violent injury each year. To our knowledge, because this is the first qualitative research conducted in an HVIP to examine the perspectives and experiences of Black men who survived a gunshot wound and who were subsequently treated with a colostomy and waste collection pouch, this study underscores the importance of considering the needs of this population and how HVIPs are best able to support their program participants. Methods This case study draws from 3 ethnographic studies conducted at the second busiest HVIP in Maryland. The research team (J.B.R. for the first 2 projects and W.W. for the third project) collected data from 2013-2015, 2018-2021, and 2021-2023. These studies were approved by the University of Maryland, College Park Institutional Review Board (first project: ID#343085-18; second project: ID#938948-6; and third project: ID#1767357-11). All participants completed written informed consent. These studies focused on the structural factors that affect the lives of Black men before and after they were shot. Nearly all participants at this HVIP were Black men who had survived a violent firearm injury. While none of the projects set out to explore the social experiences of program participants who were treated with a colostomy and waste collection pouch, the researchers were repeatedly informed by the men they interviewed that their experiences with wearing what they called “the bag” were critical to understanding the effects of gun violence. Of the larger sample of program participants (n = 49) who were interviewed during the 3 ethnographic projects, 6 (12%) men were treated with a colostomy. We focus on the experiences of these 6 men. Because little is known about the health care needs of Black men who survive a gunshot wound and are treated with a colostomy, we used a case study approach to examine their experiences. This approach offers an in-depth understanding of specific phenomena through analyzing multiple forms of data, including ethnographic field notes, participant observation, and detailed interviews. 42 , 43 In drawing from different kinds of data, a case study approach is well-suited for understanding unexpected and complex social experiences. 44 , 45 As researchers have noted, analysis of the experiences of 6 participants provides a robust sample to establish the majority of codes (ie, data patterns used to establish themes) on a given topic. 46 , 47 Two authors (J.B.R. for the first 2 studies and W.W. for the third study) conducted semistructured interviews, lasting approximately 60 minutes, with participants to collect rich qualitative data on how surviving a gunshot wound affected their physical and mental health ( Box ). Interviews were transcribed verbatim and coded by the research team. Throughout data collection and analysis for each study, experiences with a colostomy were meaningful. Emergent themes were (1) increased psychological stress from recovering from a gunshot wound and having a colostomy, (2) disruptions to everyday life, and (3) insufficient access to education and care. Codes and themes were confirmed by analysis of ethnographic field notes and participant observation across all 3 studies. In addition, preliminary interpretation of the data was discussed with key informants to ensure that it represented their lived experiences. Only themes that were salient across all studies and interviews were included in this study. Box. Sample interview questions from a study examining the emotional experiences of Black men who survived violent firearm injuries and participated in the hospital-based violence intervention program (HVIP) associated with a trauma center in Maryland, 2021-2023 Satisfaction with HVIP: • Can you tell me about the services the program provides that are most important to you? • How do you feel when you receive services from the program? • Do you feel the program could better support your needs? If so, how? • What do you feel are the largest barriers to receiving the services you need? • If you could make a recommendation to improve support for your needs or just in general, what you would suggest? Experiences relating to injury: • How do you feel about your health overall? • Can you tell me how your injury has affected you physically? • How has your injury affected you mentally or emotionally? • What has been most challenging about recovery? • What do you wish people understood about your recovery? Open in a new tab To establish the trustworthiness of the data collected across the 3 studies, the research team used 4-dimensions criteria for qualitative research, including credibility, dependability, confirmability, and transferability. 48 , 49 Strategies to promote the credibility of the data included long-term engagement at the site (at least 1 year in each study) and routine research meetings to discuss findings. To establish dependability of the data, detailed study protocols were developed and relied upon throughout all 3 projects. Efforts to ensure confirmability included triangulating codes and themes across all studies, including using ethnographic field notes and participant observations. Lastly, the transferability of this research was bolstered by having data from 3 projects during a 10-year period and analyzing only themes that were saturated across the entire sample of participants. Outcomes Increased Psychological Stress From Recovering From a Gunshot Wound and Having a Colostomy In contrast to other populations that are treated with a colostomy, HVIP participants were also simultaneously recovering from their gunshot wounds and had symptoms of a traumatic stress disorder (hypervigilance, nightmares, flashbacks, feelings of detachment). The men reported that the combination of their injuries and wearing a waste collection pouch resulted in a unique combination of psychological distress and anxiety. As Laurence (pseudonym), a 22-year-old participant, explained, I tell people, for anybody who ever gets shot in their stomach and if you ever get put on the bag, you gotta make sure you keep your head together, man. Because that bag will really mess your head up; it will fuck with your head. Furthermore, as is common with many Black men who survive a gunshot wound, the combination of social instability and returning to living near where they were injured resulted in well-founded concerns about safety and chronic stress. The concomitant stress of these factors indelibly shaped the social context in which program participants sought to heal from their injuries and adjust to having a colostomy. As Charles (pseudonym), a 28-year-old participant, explained, [After being shot], I was homeless, and I didn’t want [the person who shot me] to try and come get me or look for me. . . . Then you got to do all this stuff, like what I have to do [with my] colostomy, [doing] all this . . . that’s asking for a lot. With substantial concerns for safety and challenges with recovering from their injuries, the men often reported needing additional support in caring for their stoma and managing their waste collection pouch. Some participants received this care from their primary caregiver (typically their mother or girlfriend); however, in no instance did caregivers receive any educational support on how to best meet the needs of their loved one. Disruptions to Everyday Life All 6 men reported that wearing a colostomy collection pouch disrupted their everyday lives. The biggest challenges were difficulty with sleep, inability to return to physically demanding work, embarrassment about odor, interruptions to their sexual relationships, and changes to their diet. Laurence explained how wearing a collection pouch affected his sleep: I had to really sleep on my back the whole time, [you] can’t do no twisting and turning . . . I can’t say I [didn’t sleep], but I can’t go into deep sleep. Because if my bag gets full, and they can get too full, then I gotta empty [it]. Interruptions to everyday life exacerbated feelings of helplessness when recovering from a gunshot wound. Charles noted that the disruptions to being able to defecate on his own, clean himself, and lay down comfortably left him feeling frustrated and overwhelmed. He emphasized the difficulty of adjusting to having a colostomy: I can’t stand in the shower as long as I used to be able to stand in the shower. I can’t bend over and clean my toes as much as I want to. I can’t even wipe, I can’t even shit out of my own ass. Just these things I can’t do that I’m accustomed to doing on a daily basis, [I was] just taken away from that. I don’t think that’s fair. As the men struggled with the changes to their everyday lives, they noted that additional support and education on what to expect would have been helpful. Charles explained that he felt alone in navigating the changes to his health: “Not having nobody there, that was the most challenging thing for me.” For most of the men, discharge from the hospital without information on common ways that a colostomy may affect everyday life led to feeling embarrassed and frustrated. Insufficient Access to Education and Care HVIP participants reported being discharged from the hospital with no colostomy care education, information on how wearing a waste collection pouch would affect their lives, or when to schedule a reversal surgery. In multiple cases, this lack of information resulted in returns to the emergency department for problems with their colostomies, including blockages and bleeding around the stoma. As Charles described, I did all of my [health] stuff by myself. . . . I went back to the ER [emergency room] twice because I was cutting my colostomy filter wrong [and it made me bleed]. . . . Sometimes I still do it wrong [because] I had to learn it all by myself. In addition, some of the men did not have access to colostomy care supplies, including skin barriers, waste collection pouches, filters, or deodorants. While offering these materials was not part of the HVIP’s services, the primary case worker was able to provide some supplies for participants when they needed them. This form of support was particularly important for men who did not have family or friends to assist with managing their colostomy. Critically, the support offered through the HVIP often contrasted markedly with treatment by other staff in the hospital. As Wall (pseudonym), a 23-year-old participant who wore his collection pouch more than 3 years longer than needed, noted, If you are looking for sympathy, don’t look in a hospital. . . . [Staff] become numb to [the needs of patients]. I don’t blame them for not caring, just [treating] the number of [gunshot] patients alone, that is how you stop caring. Wall’s reversal surgery was scheduled only after a violence intervention specialist (a nonmedical case worker) inquired if he still needed to have a colostomy and asked a trauma surgeon to conduct an examination to determine his eligibility for the surgery. While support with providing supplies was greatly appreciated, HVIP participants did note that they would have benefited from being able to directly contact a wound care and ostomy nurse when they had questions about their colostomy, including when to seek medical attention, how to treat irritated skin, what possible dietary changes needed to be made, and when they were eligible for reversal surgery. Lessons Learned People who survive a gunshot wound have a wide range of physical, psychological, and social experiences while they heal and recover from their injuries. It is imperative that public health interventions, including HVIPs, reflect the diverse set of needs of those who seek care from them. This research supports expanding care for Black men who survive a gunshot wound in the ways that they determine to be most useful. Concretely, bolstering support for colostomy care offers an important avenue to improve health outcomes for Black men who survive a gunshot wound and improve their satisfaction with the medical care they receive. This support could ensure that men who are most disconnected from the health care system still receive adequate support for their healing. However, this study is not without limitations, namely, the small sample size of program participants who were treated with a colostomy. While we reached saturation in the data, the social experiences of wearing “the bag” may vary substantially depending on the resources available at different hospitals. In addition, access to colostomy education and supplies may depend on the level of support for the HVIP by the broader hospital system. HVIPs are well-positioned to contribute to this work because program staff have familiarity with the health care system and can assist in ensuring that participants have access to proper ostomy care education and supplies. Because HVIPs may employ frontline staff with lived experience, the expertise of these workers is well-suited to understanding the needs of program participants and advocating for quality health care for the men with whom they work. However, it is important to note that frontline staff have not been trained in wound or ostomy care. Thus, it is critical for HVIPs to establish and foster connections with nurses specializing in these areas to best meet the needs of their participants. Although our findings indicate that Black men who survive a gunshot wound and are treated with a colostomy have substantial gaps in support for their mental and physical health, further research is needed to explore the best strategies for promoting appropriate colostomy care education for this population. Lastly, research is needed to explore whether Black men who survive a gunshot wound have longer wait times for their colostomy reversal surgeries than other patients who are treated with a colostomy and how HVIP staff can best advocate for appropriate and timely care. This research emphasizes the importance of understanding health from the perspective of the people affected and recognizes the need to situate these perspectives within the social contexts that shape them. It emphasizes the need to address institutional and structural barriers to health care, such as limited access to colostomy care, inadequate health care services, and the broader effects of social instability. These barriers present opportunities for targeted improvements in service delivery. Using an ethnographic case study proves particularly useful in understanding these areas for improvement because it allows for an in-depth examination of how health is always socially contingent. While the generalizability of these findings to other patient populations may be limited, attention to the experiences of Black men who survived gunshot wounds and required a colostomy underscores the importance of considering the complex interplay of personal, social, and environmental factors when designing effective support systems. Acknowledgments The authors thank the men who participated in this research for their openness, insight, and willingness to share their perspectives about health, healing, and violence prevention. Footnotes The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Data collection and analysis were supported by the National Science Foundation (award no. 2117054), the Wenner-Gren Foundation (award no. 10164), the Lee Thornton Endowed Fellowship (University of Maryland, College Park), and the Charlotte W. Newcombe Dissertation Fellowship (Institute for Citizens & Scholars). Additional support was provided by the University of Maryland, College Park for the Dean’s Research Initiative Doctoral Dissertation Award, QRIG Advanced Doctoral Student Dissertation Award, and Harvard Injury Control Research Center (with funding from the Robert Wood Johnson Foundation). ORCID iD: William Wical, PhD https://orcid.org/0000-0002-1276-2454 References 1. Kegler SR, Simon TR, Sumner SA. Notes from the field: firearm homicide rates, by race and ethnicity—United States, 2019-2022. 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