Mission Possible: One Sole at a Time
He looked at us with his dark brown eyes, tears forming out of a face weathered from working in the fields. “Mejor quitenme los dedos para que no me regrese el dolor!” (If you have to, cut off my toes so the pain does not come back!). We looked at his red, swollen, and infected ingrown toenails as he removed his muddy and worn down work shoes. He looked down and explained he did not have any medical insurance. He had been dealing with his pain for months. He worked every single day as he was the sole provider of his household. His neighbor, who had visited the annual free student-run foot clinic multiple years in a row, recommended he visit. Unfortunately, he was forced to wait until we arrived. Both borders of his left hallux nail were avulsed. Then, he was given proper post-procedural care instructions and sent off with further instructions regarding ways he could prevent this in the future.
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On March 14, 2019, 15 podiatric medical students (PMS), 7 family nurse practitioner students (FNPs), 2 podiatry attendings, and 1 FNP attending embarked on a mission to the California-Mexico border to provide free medical care to the underserved population of San Ysidro, California. Once a church, Centro Romero now serves as a center to assist families in attempting to transition their lives to the United States. Every year, podiatric medical student volunteers from the California School of Podiatric Medicine (CSPM) and family nurse practitioner students from Samuel Merritt University (SMU) transform the center into a medical clinic. A check-in table is set up by the front door to greet both the new and returning patients. A waiting area with magazines is set up to create a comfortable environment. FNPs create an intake station for blood pressure, glucose checks, and pamphlets with nearby resources. Curtains are organized to create private areas for patient encounters. Careful consideration is placed on the clinic’s flow for maximum efficiency. This enables the clinic to see more than six patients at a time.
Leading up to the mission, the collaboration between podiatric medical students of all grades and family nurse practitioner students organize fundraising events, planning effective outreach and advertising, and coordinating all supplies and travel accommodations. To reach our goal, we held bake sales, contacted alumni and practicing podiatrists for monetary and supply donations, and matched our monetary donations through Starbucks. Six students traveled to San Ysidro two days before the clinic date to help advertise the upcoming clinic. Fliers were distributed to local businesses such as community centers, laundromats, bakeries, restaurants, grocery stores, etc. This advertising led to 61 patients showing up to the clinic over a span of two days.
The goals of this medical mission trip …. provide free health care to a population in need, and educate about the importance of diabetic and preventative medicine.
The goals of this medical mission trip are as follows: provide free health care to a population in need, and educate about the importance of diabetic and preventative medicine. Education emphasizing the importance of regular foot checks along with proper management of diabetes, hypertension, and high cholesterol are key components of our goal. These goals were achieved by providing patient education during the patient visit and by sending patients home with flyers of information about the specific condition they presented with to us. In order to see if we were effective in our diabetic education, we created a survey that each patient took before and after seeing our team of students. There was a designated area with bilingual Spanish-English volunteers who surveyed patients with type II diabetes. The questions ranged from normal blood glucose values, the symptoms of hypoglycemia and hyperglycemia, to the long-term effects of uncontrolled blood sugar as it pertains to the feet. The information obtained showed a trend of patient scores improving after their visit with FNP and Podiatry.
Following the model of “See one, Do one, Teach one,” we aimed to provide the lowerclassmen with the best learning experience while providing the best patient care possible. Because most students are unable to practice their hands-on skills until their third year of podiatric medical school, first and second-year students pair up with an upperclassman to see patients together. The mission also allows podiatric medical students a unique space to be able to practice presenting patient cases to residents and attendings before they begin their clinical rotations. The attendings provided great mentorship and made certain that every teaching opportunity was taken advantage of by the students. The clinic also creates a moment where first years, second years, and third years have the opportunity to perform procedures that provide instant relief to patients and allow for high-quality hands-on experience.
During lulls in patient flow, family nurse practitioner students and podiatry students were more than willing to practice parts of a physical exam on each other. FNP students would teach podiatry students about auscultation of heart and lung sounds while podiatry students would teach FNP students about the components of the podiatric physical exam and how it pertains specifically to diabetic patients. A great collaboration between professions was displayed throughout the planning and execution of the medical mission.
Overall, the medical mission trip to San Ysidro was a complete success. Both first-year podiatry students that attended the mission were able to give their first steroid injection, and multiple second and third-year students were able to perform procedures that they had never done. All questions pertaining to the patients’ pathologies were answered, and they were referred to nearby medical providers when need be. The clinic saw a total of 61 patients; 47 of those were Spanish-only speaking and 21 were diabetic. 26 different pathologies were observed, 6 cortisone injections administered, 6 nail avulsions performed, and pairs of orthotics were dispensed when appropriate. Throughout this trip, we each had a significant learning experience involving a patient encounter. We were all reminded of why we chose this specialty. Our motivation came from our strong desires to serve the underserved, to become the best podiatric physicians we could, and to provide the best patient care possible.
by Lily Skeel, Juan Ceja Solorio, Christina Han-Souksavong Ma
Student Organization: San Ysidro Medical Mission – CSPM
School: California School of Podiatric Medicine
1st Annual Hallux Magazine Writing Competition – 2019
Hallux Magazine Writing Competition – Finalist, 1st place winners
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