torsdag den 29. oktober 2015

En hjælper på Caminoen

b>Den britiske veteranpilgrim, David, drager hvert år afsted i en bil langs Camino Frances i flere uger for at hjælpe de pilgrimme, der får fysiske problemer undervejs.
Hvis man et par gange i de senere år har gået hele eller dele af Camino Frances, der går fra Saint Jean Pied de Port til Santiago, kan man ikke undgå at observere de pilgrimme, der allerede efter kort tid har problemer med rygsæk, vabler eller overanstrengelse, fordi de lagde for hårdt ud. En britisk gruppe, der kalder sig "The Society of Pilgrim Friars", og som ikke lægger skjul på deres kristne tilgang til livet, drager hvert år afsted på Caminoen - ikke til fods, men i bil for at hjælpe de mange pilgrimme, der får problemer undervejs. Hvis man vil læse mere om dem, kan de findes på denne hjemmeside: http://pilgrimfriars.org/
Netop hjemvendt fra 7 uger med førstehjælp langs Camino Frances har lægfranciskaneren, David, lavet denne rapport over nogle eksempler på pilgrimsskader, som kommende pilgrimme i et stort omfang kan undgå, hvis de bærer sig rigtigt ad. David giver selv en del eksempler. Det er blandt andet værd at bemærke, at han advarer imod Compeed. En advarsel jeg stort set kan tilslutte mig. Jeg har set en del pilgrimme, der har sat Compeed på - både punkterede og ikke punkterede vabler, hvor det er gået galt. Compeeden har i visse tilfælde flået et stort stykke hud af med et åbent sår til følge, som det er blevet mere end vanskeligt at fortsætte med at gå camino/pilgrimsvandring.
Her Davids rapport, som jeg har hentet på en engelsksproget hjemmeside:

Hi. I am recently back from doing seven weeks first aid. I am usually alone and having the comradeship, help, and support from JennyH94 really enhanced the whole experience for me (especially her wildly irreverent sense of humour that matches mine!). We met many injured pilgrims; Puenta La Reina was a great stop, being just a few days from St Jean, with many pilgrims beginning to fail there - at times the first aid would go on for over four hours non-stop, with Jenny using the torch on her phone as we worked into the late evening.
Anyway ... I have some thoughts about some of the problems I/we met with. These are personal opinions from repeated observation and hands-on experience in the field. Your thoughts may differ from mine but I am not trying to force my point of view, only offering it.
Boots - most foot problems were blisters and mainly to do with the wrong size or ill-fitting boots, as well as ignoring hotspots until it was too late. Boots were frequently laced too tightly and/or were too small. I know this is gender specific but I would say that over 90% of those whose boots were too small were women .. now, I don’t know if this was to do with women wanting their feet to look the right size, or inexperience, but again and again frontally located blisters were women with the wrong size/width boots.
I rearranged the lacing on many boots .... loosening the front section of the laces, with my fist stuffed inside the boot to spread it out, from the front to the third eyelets and then tying a half knot, at those eyelets, and then showing them how to put them on. Kick the heel right back into the boots, tie up firmly so that the rear of the boot is held firmly with the foot, and, with the half hitches at those mid eyelets, the front of the boot never tightens up but stays more open, allowing the toes to move freely.
We also found that many would lace up tight in the morning and leave their boots untouched until they finished walking at the end of the day, ignoring the increasing pain - some did not even know that their feet became larger during the day. One should stop at least every two hours, take the boots and socks off and have a break, then put the socks back on alternate feet (so that seam pressure points are moved) - for many this was the end of their daily discomfort or pain.
Blisters - rascally things! we met pilgrims who were in denial, just hobbling along in pain with terrible blisters and doing nothing about them. We found those who had self-treated poorly and made their situation worse; those who had drained their blister and left cotton thread in there to wick away liquid and then left them uncovered. This is a terrible idea unless you know exactly what you are doing. That sweaty environment inside the socks is a perfect petrie dish for microbes to breed and many had become infected.
There are two points of view here - cover and allow to heal, and drain and cover and allow to heal. Here is the thing. A blister is a burn under the surface of the skin. The body produces the fluid as a cushion but walking on it every day forces the liquid, with each step, to press against the outer edges of the blister under the surface skin - which widens it every day .. the blister gets bigger and bigger.
So I drain them - always. They have to be drained. I use a scalpel to make two tiny V shaped cuts that allows the blister to be completely drained. I then spray antiseptic (to get into all crevices and inside the cut sections) and cover with fabric plasters that have sticky all the way round the edge. I then sometimes fabric plaster on top of that to give more cushioning (I give the pilgrim back-up plasters to keep them going until they get to a pharmacy).
This treatment works well, almost instant pain relief. Why fabric plasters? Because I find that waterproof ones are never sticky enough and they allow the wound to sweat beneath them - so I always use fabric, which sticks well and breathes.
What we found, again and again, were pilgrims who had stuck Compeeds over a growing blister. The Compeed sealed all the way round, the constant pressure of each step enlarged the blister and they ended up in considerable pressure pain - and there was no way I could get the Compeed off without the strong possibility of further harm.
I no longer use Compeeds now, will never use them again. Although I met pilgrims who had self-treated with them and had no problems, our view - remember, we were only seeing the feet of those who came to us for help - is that they cause too many problems. We met pilgrims who hadn’t put them on properly .. dirt had got in, the blister had burst, and they were getting infected.
A Swedish woman: - we had met her before and met her again "purely by chance" on the Camino, another one of those extraordinary Camino ‘coincidences’ - we met her as she was about to walk up onto the Meseta. She was feeling a little dizzy and had put it down to lack of water or the heat. She then said she had a blister problem. The moment I looked at it I said she had to go to hospital. It took us the rest of the afternoon to find a casualty dept (in a small town about 20 miles away).
Her problem was that she had put a Compeed onto a heel blister. The blister had grown over the days of walking until it burst and forced an edge of the Compeed open. Dirt got in and it became infected - what did she do? Just kept walking. When we saw her she had blood poisoning, her ankle had already started to swell. Had we not found her she may have died of that blood poisoning somewhere, going to bed with “just a little fever” and waking up dead. The doctor cleaned it all up, gave her horse-pill sized antibiotics and told her that her Camino was over, she had to go home. The doctor then took me aside and said we had to keep an eye on her overnight and that if she became more ill we must take her to an emergency dept immediately, she was really concerned for her. We did that but she started to become better and the next afternoon we drove her way over to Pamplona and put her on a train home.
This is what had us instantly throw her in the car in search of a doctor.
Knees and shin splints - well, you all know the answer here - stop walking! We met with many of these but also discovered a method of lessening the problem. Try this. Stand up straight and become aware of all the muscles at the front of your legs, right down to the ankles. Now, with your arms hanging down turn your elbows out slightly and then lean your upper body a little forward from the waist up. You will instantly feel all of those front muscles go into tension. This is what happens when you put your pack on - before you have even taken a step! So, you have to stand and walk as if you are not wearing a pack, you have to stand relaxed and straight - then you won’t put all those muscles under stress. Also, we found some with these problems used big striding steps - this causes too much flexing and more stress. We showed pilgrims how to walk with half length steps, standing as if they weren’t carrying a pack, and they felt better instantly. Problems were also caused by a pilgrim keeping up with someone who walks a little faster than what their body is comfortable with - never do this. Bad enough with friends but if it is your husband/wife who won’t slow down for you then stuff a custard pie into their face and walk alone at your own speed!
The Camino is not a smooth trail, the surface is wildly uneven in places and that constant attempt by the knees to maintain balance causes many ligament problems. Again; walk as if not wearing a pack and walk at half length - or even less - steps. A pole for stability is a boon, so much better to be a tripod than a biped (kangaroos know this).
Once the problem is there it is difficult to treat. Ice, anti-inflammatory gel and pills (if one can take them without harm), rest, raising the limb; deep but gentle thumb massage into the tendons and ligaments - all these help recovery but they have to be allied with taking a day or two off. A knee brace helps ligaments from over-stretching but one shouldn’t wear one all the time as it allows the muscles to weaken. Take them off when not walking - ideally one should only wear them on rough terrain, ascents and descents, and take them off afterwards when back on ‘normal’ surfaces.
Shoulders - so many pilgrims with madly heavy packs of course but also badly fitted rucksacks! Not their fault I think. Their first walking adventure and no fitting help from the shop where they bought their pack. Not much to say here, except, go on You tube and see how to fit a pack - there should be at least a finger width between the shoulder straps and the shoulders - then Hey Presto! no more shoulder problems!
So - just a few thoughts, a little rambling from home ... I will be back out there next Autumn with Jenny, and possibly next Spring too alone. If you are interested in helping others then please do take a first aid course and carry a larger than normal kit with you - and if you are ‘religious’ and it is of interest to you please do visit my website www.pilgrimfriars.org (and perhaps also my www.donoharm.co.uk) - the whole mission is based upon the command given by Jesus/Yeshua at the end of the story of the Good Samaritan “Then go, Ye, and do likewise".
You know, this first aid, it isn’t just about putting dressings on. Many pilgrims are suffering internally and cover it with laughter and jolliness, but inside, if you look, you can see their pain, the anguish they are going through - one has to look at them, one has to see them; it is an integral part of the first aid mission. You might be amazed at how many apparently confident pilgrims burst into tears when you start helping them - it is, after all, about love.

Buen Camino