In 1858, at Lourdes in southern France, 14 year old Bernadette Soubirous is reputed to have seen the Virgin Mary. Lucy Carter accompanied some of the 5 million pilgrims who visit each year seeking spiritual healing and perhaps a cure

Giving up part of your hard earned summer holiday for a spiritual visit is not something I found easy to explain during my years at school and at sixth form. People who have been to Lourdes tend to agree: you can really only grasp how much more there is tangled up in the whole pilgrimage experience when you have seen it for yourself. Volunteering as a helper on pilgrimages--including 6 am shifts and bed pans--has been an important part of my summer for the past five years. This year was my first pilgrimage as a medical student.

A pilgrimage group recruits ill pilgrims, clergy, youth groups, and hospital helpers from a collection of local churches that form a diocese. A typical British pilgrimage includes between 20 and 50 ill pilgrims, with illnesses and disabilities ranging from epilepsy to multiple sclerosis and from cerebral palsy to spina bifida. Pilgrims with more demanding needs are accommodated in one of two purpose built facilities. These hospitals are run by nuns; a handful of professional staff; and a separate team of volunteers that, remarkably, changes in personnel and number from week to week.

State of the art care

The hospitals accommodate two groups of pilgrims on each floor and designate each group to specialised side wards. Each ward is shared by two, four, or six disabled pilgrims and is equipped with hospital beds, panic alarms, disabled toilets, and shower rooms fitted with a seat and hand rails. Some beds with fittings such as oxygen taps and specialised power supplies are reserved for pilgrims in less stable states of health.

Underestimating what a challenge a pilgrimage is for the medical team is tempting; under what other circumstances would you find a patient with cerebral palsy sharing a ward with someone with multiple sclerosis, or a frail elderly woman who lives independently at home alongside someone in need of total care? More incredible is that these patients with their diverse illnesses and disabilities are looked after 24 hours a day for a week by a group of volunteers led by nurses and a small team of doctors.

Lourdes is a place of healing, but the motivation for the pilgrims is rarely hope of a miraculous cure. More important is the wish to do just as Our Lady told Bernadette: to come in procession and to wash in and drink of the spring. The responsibility of the volunteers, doctors, and nurses is to maintain the level of support that pilgrims receive at home while allowing them the freedom to experience Lourdes as a holiday and pilgrimage.

GARO/PHANIE/REX

Queueing to be cured

Congregation planning

Excursions are typically daily during the week for groups or even larger international services and processions. These need a high degree of planning. As well as mobilising a group of 40 wheelchair using pilgrims, we must plan the carriage and supervision of emergency medical equipment and its strategic positioning amid the throngs of visitors and pilgrims at the shrine. Adequately supervising pilgrims amid such large crowds can itself pose a challenge for volunteers. During a busy programme of events, the medical staff of the pilgrimage rarely ends the week without an incident of some sort which needs emergency attention.

A medical event during a large open air mass amid a congregation of at least 3000 posed a serious challenge for our medics. During these events, discreet ear piece radios are at their most useful; the permanent medical team resident within the grounds of the sanctuary can be alerted and an electrical mini-ambulance carrying additional supplies and equipment is sent from the small sanctuary infirmary. From the infirmary the patient could be whisked away by municipal ambulance to the general hospital at Lourdes for admission or further attention.

More regularly, the medical staff of our pilgrimage is also responsible for running a drop-in clinic. The clinic is set up at intervals during the week to tackle any medical queries posed by any of the several hundred pilgrims who are staying in hotels.

Respite with a difference

From whatever background of care the pilgrims originate--whether the family home or one care facility after another--the level of attention and friendship that patients receive during a pilgrimage is almost always revitalising. For some pilgrims, a week away spent in the charge of energetic young volunteers is the most appealing concept of the whole trip. Pilgrimages to Lourdes illustrate the impact of illnesses and make the difficulties and burdens of long term sickness and care all the more real. This is respite care with a difference.

Keeping the pilgrimage running safely and to plan can seem a huge challenge, but the pilgrimage can pose an even greater challenge to the pilgrims themselves. This year was not the first time that I sat with a sick pilgrim who was saddened and close to tears at seeing the handicap of another patient. No matter how much of a triumph it may have been for a patient to make the visit, amid all the hope and expectation the pilgrims bring to Lourdes, rarely do they think about their own disabilities. This year in particular I saw a variety of perceptions of illness that I had never come across before.

Despite Lourdes providing no formal experience to complement my medical studies, the pilgrimages are opportunities to interact with a diverse range of patients in a great learning experience. I gain an understanding of people that is easy to lose sight of in the early stages of medical training. In this year's pilgrimage, my first as a medical student, it was not just the pilgrims who gained.

Guidelines: We intend publishing within 24 hours all responses that contribute substantially to the topic under discussion. To avoid points that have already been made please read other people's responses before posting your own. All responses will be eligible for publication in the paper studentBMJ, providing that current appointment and place of work are given. Name and email address are required to send a response and will be published with the response.

Please note: When writing a respnse to a response, please enter the original title of the article and the author of the response you are responding to.