Being a first aider on Camino makes for a very different Camino. Were you to walk as a pilgrim you would more or less walk with the same group over days, drastically reducing the numbers you meet needing help, then, once a week or so has passed they would all be fit and independent. So I often take breaks, day breaks, to meet a new set of pilgrims. Otherwise I stay on certain sections.

Anyone healthy can walk a long day with a pack, then another .. but on average it seems to be the third and onward days from starting where the body encounters problems. With St Jean starters quite a few casualties bus from Estella (day 5) to Logrono (day 7) or limp into Logrono and then go home, sadly.

Another starting point is Burgos (day 13) some only manage to get to Leon (day 19). You can see how it works, once the body has had a week to shake down and get used to it there should be few future problems – and at the “failure” points a lot of people are wise enough to take a couple of days off to heal and then start again, others give up. So in a very real way helping them can change their lives... they heal and stay on Camino.

I don’t think I have ever helped a Spanish pilgrim, they don’t seem to need it. They are at home in their own country so many just walk for a few days at a time, when they have the time; and I have never done the section from Sarria, the 100kms to Santiago doing first aid… not sure why, probably because I think that in Galicia it rains all the time (it doesn’t) as it could be a very needful section – and one gets to arrive in Santiago once a week and then take a bus back!

There can be quite a few to help from Burgos but the main need, I have found, is from Roncesvalles to Logrono. So one has to decide on whether one is going to be a first aider pilgrim or to be a pilgrim with a first aid kit … not quite the same.

It is a good thing to do, to do the ‘Camino magic’ thing of just arriving where someone needs your help, and once you have done it for a while, if you surrender to the greater a sort of inner guidance system takes over, if you allow it, where you get the feeling to stop where you are and wait at that cafe, rather than walking on, and then someone limps in, in tears. Or you walk through a village and turn off the route and find a small fountain with an injured pilgrim sitting by it …

It can feel slightly lonely sometimes as so many make groups as they walk whereas you are always the single outsider .. and in all those years where I have helped when people are walking (rather than in a refugio) I have been profusely thanked and they walk away but not once, not once has anyone looked back over their shoulder and waved .. once they walk on (no longer limping) you are in their past

First rule! Do no harm – if in doubt, don’t – get them to a doctor.

Over here in the UK a St John’s Ambulance Brigade first aid certificate gives global insurance (never had to use this) and a print-out certificate, a good thing to carry, though I have never been stopped or asked by any official ever. I do renew as although it doesn’t really cover Camino situations I do like to practise the CPR methods again.

In these times people can be afraid of helping others … but all I ever do is simple first aid, anything that looks serious I don’t touch. As an aside, it is a criminal offence in France not to go to the aid of a citizen. If you do and you do something wrong you cannot be held at fault as it is considered that you were only doing your best.

The first aid often moves over into pastoral care, as you might expect. 101 here is to Look – be aware – look at them .. they may need to unload on you .. listen, be kind … it is only their stresses and upwelling memories releasing – a Camino thing. It can be surprising how some will burst into tears when you lay your hands on them to do a blister or similar.

Blisters

An odd one really as there is actually no reason anyone should get one. It is essentially a friction burn under the skin, so the body releases fluid to pad that area .. but before a blister even starts to form that specific area gets hot and can be felt. If one gets a hotspot and immediately stops, removes shoes and socks and pads that area –anything will do, a plaster (band aid), tissues, toilet paper – sheep wool off a fence, any soft padding – then the friction will stop and no blister will appear. When it is in between toes one only needs to pad in between the toes and sometimes above and below.

Showering in the morning is not good as it strips off the protective natural oils.

Feet get larger throughout the day but I have seen so many who walk all day, never take their footwear off (let alone loosen their laces), even as it all gets tighter and tighter, and then are surprised that they have problems. The ideal is every hour – or two at the most, stop, put pack down, take off footwear and socks, wriggle, feel the air … when putting socks back on swap feet, which means that any seams will be on the other foot, so less potential problems. If wearing trekking sandals there is no problem.

Of footwear … you will meet so many pilgrims with footwear that doesn’t fit, usually too small or too narrow.

Seasoned hikers know what they are doing but I estimate that perhaps 80% of those wearing footwear that is too small who have come to me for help are females … now, I don’t know why this is .. do they look in the mirror and think “oh, but these look huge” and buy a smaller size? Some young males will wear thin plimsols – (cheap sneakers?) - that sweat, give no support, have thin soles, totally inadequate.

With footwear that is causing blisters at the toe end remove the laces and then put the laces back on but miss out the lowest two pairs of eyelets (three with some styles). This allows the footwear to be done up but leaves the toe end more open and flexible, giving more room.

If they are carrying sandals “for the evenings” get them to wear those instead. I have met many who did this later down the Camino and they were problem free, happy, and never wore boots again (you will see boots left at waymarker posts).

Shin splints and knees and other leg problems.

Try this. Stand up, straight and relaxed, hands down your sides. Lean forward a little at the waist, only the waist, keep the rest of the body not moving. You will instantly feel the front of the legs go into stress, tighten up .. walk a few hours like this and all sorts of problems occur, knees, ankles, shin splints ….

So – this is what happens when someone wears a rucksack .. they automatically lean forward a little to counter-balance the weight .. here the root of the problems.

The answer is three fold …

1. So many pilgrims are not hikers, not outdoors people, so they don’t know how to wear a rucksack, that the hip belt is the most important thing. With other straps loose the hip belt is placed so that the centre line runs along the top of the hip bones and then cinched tight. This means that all the weight is on the hips, not the shoulders, so the tendency to lean forward is reduced as it is fixed just below the waist. Then the shoulder straps and so on are tightened up for comfort and to stop the bag swaying, no tighter .. there should be one or two finger widths gap at the top of the shoulders where the straps go over.

2. The pack is too heavy. Get permission to empty the pack and go through everything, separating all that is not needed. They need to go to the next post office, buy a box and post it all to Ivar’s storage locker in Santiago.

3. Stand straight upright, shoulders back, head up, when walking and walk in a relaxed manner, relaxed (the Aussies are brilliant at this, a country trait). Also, shorten steps – it isn’t a race and long strides are stressful.

Roman soldiers carried huge amounts and could walk 20 or more miles a day – they walked upright with short steps and lifted their knees higher than we do with each step – stress free.

These tips you will find yourself teaching pilgrims.

Re shin splints – I have found that mostly young men (and some stubborn older men) tend to get them.They stride along, huge long strides, too fast, heavy packs … of course, they get shin splints. Looking back, I don’t think I have met a female with shin splints.

Knees

Knees (ligaments really) tend to go from descents … a pack is an unstable thing, makes one top heavy, not good for descents, and on uneven ground the knees swivel all the time and this is where the ligaments fail. A good staff, to make one into a triped, is pretty essential on rough descents (and ascents but not so much). By the way, it has to be a long staff, or fully extended hiking pole so that when gripping it the hand is about chest height, this makes the body stand straight, not leaning forward and is much more comfortable and practical in use.

So, that brings us back to packs .. they need to be fitted to the hips (so the weight is there, not higher up on the shoulders) and need not to be heavy. All that extra weight that the body isn’t accustomed to flows down through the knees – put the knees under terrain stress and that extra weight is really going to affect the situation.

Also, pilgrims need to go slow, really slow on descents, so that the knee swivelling is kept to a minimum.

Shoulders and back problems

Rucksack not fitted properly … usually shoulder straps tight on the body, and/or hip belt done up round the waist, not the hip bone (and pack too heavy).

Faintness, weakness … dehydration and more.

In hot weather many pilgrims don’t drink enough so dehydration. Or drink water copiously and leach out essential electrolytes, which also causes weakness and fainting. Salt is essential yet the modern ‘wisdom’ is to try not to have any – yet animals in Africa will walk miles and miles to find a salt lick. We came from the oceans and are basically bags of sea water, we brought the ocean with us so we need good salts.

If the pilgrim has brown urine – dehydration, if not urinating, same, if not sweating, the same. A good self tip is to taste one’s sweat regularly. If it isn’t salty there is a severe lack of salt – not good.

Dioralyte sachets, morning and evening are brilliant for replenishing electrolytes.

Re salt .. the body will flood each cell with salt until it is all in balance, then any extra salt goes out through the urine so a healthy person doesn’t need to be concerned about having too much.

The body signals anyway, gives you thirst so that it can flush out the excess.

I hope that the above helps.

Buen Camino!

David