A middle-aged farmer in arid rural northern Ghana suffered two 13cm² full-thickness LLE wounds four months prior to initial visit. Perceived pain left him completely incapacitated. Drainage from both wounds was extremely foul but scant. The patient refused to bathe and had to be restrained to cut off loose bandages of rotten leaves and rags applied by a shaman when the wounds were fresh. Dressings needed to reduce pain and stay in place during manual farming. The wounds needed to be kept appropriately moist in this very dry locale. Use of standard foam and hydrocolloid dressings led to dramatic fungal and bacterial infections in this very warm setting. Flexible polymeric membrane dressings have demonstrated ability to reduce wound pain and inhibit infection, and they help bring moisture to dry wounds. Silver has additional anti-infective properties. Therefore, silver polymeric membrane dressings were initiated. Treatment included prayer, oral antibiotics and direct wound care. Silver polymeric membrane filler in two layers was used initially. Three days later infection had cleared, so a thick polymeric membrane dressing without silver was used. Dressings were changed when patient permitted wound care. Despite sporadic clinic attendance (intervals of three, five and even ten days) woundbed remained clean and infection-free and healing progressed. The patient remained fearful, had to be held down for every dressing change and adamantly refused even periwound skin cleansing. But, he was able to return to manual farming immediately. He missed appointments regularly, twice going ten days between dressing changes. Wound healing was slowed due to prolonged intervals without dressing changes and farming-related wound trauma. None-the-less, the wounds healed completely in ten weeks. Polymeric membrane dressings provided effective wound management for this very non-compliant patient from initiation of treatment to complete wound closure.