The Travelling Pod in Mexico | Part 2

We noticed a grandmother in her late 50s with a bandage around her foot and a cut, and modified sandal. After her shower in the communal Amigo’s del Tren bathroom, she appeared with her daughter.

The grandmother was deaf and could not speak, and her daughter who only spoke Spanish translated for us. The daughter told us that she had visited the hospital the day before and initially did not want me to touch her foot. I eventually persuaded the daughter to allow me to look at her wound, clean it, and provide a custom gift pack to manage her wound on her trip.

The patient’s story

The grandmother and her daughter were from Venezuela and had completed the dangerous and strenuous journey through the Colombian and Panama jungles called the Darien Gap.

I learned that the grandmother had type 2 diabetes when the daughter told me that her mum takes tablets for her diabetes. She reported that the doctor was happy with her blood sugar levels, but did not understand the blood test indicating the amount of glucose attached to the hemoglobin (A1C test).

The daughter explained that the wound started during the jungle journey.

Initial impressions

I concluded that her mother’s wound on her right dorsal 1^st metatarsal region started from shoe friction and prolonged water exposure from all the river crossings. Side note, I have also completed the same migrant journey through the jungle, therefore, understand its potential impact on their feet.

I know many migrants use cheap plastic boots in the jungle but also commonly swap for shoes along the way that have been left behind. Often, I met people wearing incorrect shoe sizes because they found shoes were in better condition than their current ones. Moreover, I concluded that friction was the cause of her ulcer when I was debriding the slough from her infected wound, and she did not feel any pain; indicating that she had peripheral neuropathy. The doctor confirmed this by using my 10-gram monofilament to test her sense of pressure at the end of her toes.

As previously stated, her wound had signs of infection with yellow slough and leaking serous clear fluid. Her day-old dressing seemed to be the material used for blister protectors (hydrocolloid) and was not appropriate because of its inability to absorb the leaking wound.

I treated her wound by first cleaning it with a saline solution flush and using ‘aqua oxigenada’ which is hydrogen peroxide that bubbled up and sat for a minute or so.

I used my 15-scalpel blade to do a soft debride and was only able to remove some sticky slough.

Afterward, I drenched her wound in Betadine and applied a non-stick silicone dressing and a secondary Mepalex padded dressing. Unfortunately, I was not prepared for her type of wound and used the best materials we had available.

I noticed the grandmother was wearing a padded heel cup protector given by the hospital. There was no problem with her heel so I used the heel cup to offload pressure from her wound site. I cut the heel cup into a large donut shape, and in between the bandage offloaded her wound. I gave her a spare donut protector in case she needed another one.

We had a visiting doctor from Puerto Rico who spoke Spanish and English, and he supported my work to calm the nervous daughter. We educated her about appropriate wound management, advising second-day dressing changes since they were going to leave and sit on the dirty coal carriages that travel towards the Mexican border. After giving her a gift pack of dressings and antiseptic, we said goodbye.

The next day

However, the next day, she was carried into the Amigos del Train centre by stretcher.

She was found sitting down exhausted on her way to the other side of the train tracks roughly 30 minutes away under the hot sun, and she was brought back to recover.

This gave me another opportunity to clean and redress her wound and use our newly bought Jelonet primary dressing combined with sterile gauze. Her wound seemed healthier with a small amount of slough reduction. I also created another offloading pad to give to her and wished her well for her continued journey.

Want to help?  Support The Travelling Pod’s upcoming trip to help remote communities; accompanied by a nurse, doctor, dentist and dental assistant.