Case Study Ms Amanda Walsh

Podiatry to the homeless

In 2010 Amanda took up post as lecturer in Podiatry, and as part of developing a new module for the 4^thyear undergraduate BSc Podiatry degree entitled working with vulnerable adults she made links with the local CRGN for the homeless, Joan Gavin, who worked across the HSE, Simon and Cope Galway homeless services. It was in 2011 that she started volunteering and set up the first ever monthly Podiatry clinic in the COPE Galway Fairgreen Hostel. COPE Galway Fairgreen Hostel is a 24-hour emergency accommodation service in Galway City Centre for homeless men.

The aim was to provide direct provision of foot screening and treatment to improve their foot health, overall health and prevent more serious complications and hospital admissions. Foot problems represent a relatively large proportion of complications among homeless people, which can lead to emergency department admission. Homelessness has a devastating effect on a person's health, both physically and mentally. Self-care is not a priority for those experiencing homelessness and feet are a particularly neglected area of the body.  Historically, health services often have difficulty engaging with socially-excluded people and vice versa. Often this group of people lead chaotic lives, maintaining poor relationships with primary care providers and face the double disadvantage of both health inequality and inaccessibility to health services.

Amanda attends the Fairgreen hostel (approx. every 4-6 weeks) whereby she facilitates the assessment, screening and treatment of any of the clients that are present in the hostel. She provides routine lower limb vascular screening, neurological assessments, routine treatment and advanced referral where necessary. Treatment ranges from basic nail care, skin pathologies (e.g. blisters, corns, and callus) biomechanical problems to in-growing toes nail and complex ulcer management.  Amanda says “It is always a challenge clinically as you never know what may present on the day nor the type of patient you may see, some clients have extremely complex health issues, who struggle with addiction and mental health conditions, and it can often take some time to build a rapport and gain the clients trust for them to fully engage with you”.

Amanda also manages to involve the undergraduate Podiatry students, who have volunteered alongside her whilst delivering extra clinics at the Cope Day Centre as part of the winter initiative each year. The students gain so much from the shadowing experience, being able to treat this vulnerable client group outside of their normal clinical environment and engage with different patient groups and encounter different clinical challenges. Footwear is often a contributing factor to poor foot health and Amanda has also worked with footwear companies to get donations of new footwear for the clients.

Amanda appeared on the Late Late Show on RTÉ in December 2019, to talk about the clinic and the Podiatry care that she provides in Galway for the homeless. As a result Podiatrists’ nationally who want to volunteer have looked for advice from Amanda on how to offer such a service in their local areas. Amanda also hopes in the future to expand and engage with other groups in the community such as those living in direct provision. 

Donna O’Neil (Manager COPE Galway Fairgreen Hostel) says “Amanda has always been very proactive in reaching out to this much marginalised community of people. Her commitment and approach has made our clients more aware of the importance of their feet and foot hygiene and this has helped them to become more aware of the importance of taking care of their bodies. She gives each person the time they require and ensures that any medical follow-ons are passed on to the client and their keyworkers to follow up on. Amanda shows not only professionalism and provides a very important service for our clients but also her acceptance, empathy, friendly and a non-judgmental approach has an enormously positive effect on the social well-being of homeless people”.

Amanda looks forward to continuing the Podiatry service in the Fairgreen hostel, working within the multi-disciplinary team to help improve the overall health and wellbeing of this vulnerable population.