I believe there is never a wrong situation, through challenges or blessings it seems to always lead us in the right direction. My journey is no different. I started my volunteer podiatry service in Bolivia, Peru, Ecuador, and now in Mexico within various communities; jungle, orphanages, disability centers, and jails. I always said I’ll go where the need is, and there is a big need in Irapuato, Mexico with the passing migrants who are living on the streets next to the train tracks.


Amigos del Tren (friends of the train) not-for-profit organization invited me to volunteer my podiatry service in April 2023, and a year later I am still here. On average there are between 200-300 migrants temporarily living on the streets daily, however in November 2023 there were between 3,000 to 4,000 people passing through daily.


My daily routine

I sleep in communal accommodation at the organisation’s building next to the passing trains and opposite where the migrants sleep. The centre opens at 10am for showers, toilet access, clothing donations, a doctor’s service, and a cooked meal.


I take my equipment onto the street amongst the migrants. I work there on the street until there are no more people who need my service, stopping for a midday lunch break. On days with fewer foot complaints, I can spend more time talking with people practicing my Spanish.


Podiatry service on the street attracts many onlookers; the people are very curious about my work and are generally very appreciative.


Typical foot complaints


The migrants generally have a lot of foot complaints after their horrendous journey through the Darien Gap jungle, with many days of walking leading up to Mexico. Common foot complaints include; wounds from train accidents, blisters, infected ingrown nails, fungus, subungual hematomas, and soft tissue injuries.


A lot of the time I gift patients’ resources including gauze, antiseptic, bandages, and so forth, to maintain an appropriate level of care and infection prevention. On rare occasions I have a translator, but I mostly use my Google translator app to understand more complex complaints like soft tissue injuries.


Soft tissue injuries can result from a traumatic event such as falling off the moving train and slipping off uneven terrain in the jungle, or overloaded tissue. Overloaded tissues are inflamed from ongoing repetitive strain due to common factors:

  1. Poor footwear and usually unsupportive shoes. A lot of migrants wear chocs, sandals, and at best, flexible runners on their journey.
  2. Abnormal amounts of activity and a significant increase in loading due to the nature of their journey. Traveling from South America to Mexico forces them to walk through the Colombian and Panama jungles (Darien Gap), and commonly involves many days of walking through Guatemala and Mexico.
  3. Biomechanically they are at a higher risk of inflammatory foot problems with their genetically mobile joints. I have found that it is common for flexible and mobile joints to create greater instability.


All of these three common factors have caused different inflammatory foot injuries such as plantar fasciitis, and tibialis posterior tendinopathy. Also, irritation on the lateral ankle due to the increased forces that create a concave motion.


Clinical challenges

Treatment on the streets can be tricky when using sharps around crowds of people including small children, keeping me aware of my surroundings. There have not been many incidences of aggressive behavior but there can be local drug users amongst the people, and I have had to leave the street and report aggressive behavior numerous times.


Keeping my instruments and tools clean can also be challenging as the street is dusty and dirty, therefore regular cleaning is necessary. Sterilisation is not possible due to obvious accessibility and funding reasons, but I do my best by using a brush and a chemical product suggested to me by a Bolivian dentist. Treatments can vary as we all know in the podiatry world, and there are a few more factors that I have to consider before creating a treatment management plan.


Patients can leave literally at any moment as the passing train approaches unexpectedly. I have had people get up during treatment, grab their stuff, and run after the train. Thankfully never during an invasive procedure like a partial nail avulsion. Before starting an invasive procedure like that, I need to explain to the patient what is required, including staying still during the treatment. Treatment can be seen as dirty work due to the hygiene barriers faced by patients living on the street creating a new level of consideration for bacteria.


Treatments can be difficult with limited resources, and I have had to learn to economise; to make the most out of the little resources I have. There is no better way to learn than through problem-solving, and I have had to create my way of tackling these inflammatory issues.


In Australia at a private clinic where I worked, I would often create custom orthotics for patients with these painful inflammatory problems. However, I cannot produce the same quality of orthotics in Mexico with different techniques, technologies, materials, and funding available. I have had to create a different type of device. I recycle unused donated thongs, cutting and shaping the EVA medium-density material to make supports.


In closing

From this month onwards in STRIDE, I will continue to write a case study that I have seen or am currently facing each month to take you further along my journey in Mexico. 


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