One of the experiences that has made me think the most in the past week was having my shoes shined in Queretaro, Mexico. It was the lavish care, almost love, that the shoeshiner put into his task that made me think.

I was seated in a high, metal chair in bright sunshine in one of the main squares in Queretaro, a Mexican city that has become a World Heritage Site because of its beautiful colonial centre. A series of squares are filled with fountains, statues, trees, and flowers. Many of the trees are pruned to be  striking green cylinders. In the centre of the square where I’m sitting there is a bandstand, and on Sunday night we watched a brass band play while many couples, most of them elderly, danced gracefully. (At the time I thought how our bandstand in Clapham, my home in London, rarely has a band and never has anybody dancing.)

My shoes, I must make clear, are a disgrace. I’ve owned them for eight months and cleaned them only twice. Three days ago I climbed the third biggest freestanding rock in the world (or so the guidebook says) and came down with my brown leather shoes covered in white dust. Most of the dust is still there.

The shoeshiner, an old looking man who is probably younger than me, begins with brushing away the dust with a huge brush. Throughout the 10 minute operation he didn’t ever look at me. His full attention was on my shoes. Next, he took soap and water on a sponge from his metal box and penetrated into every cranny of my shoes. After drying the shoes, he applied brown polish. He was very careful to avoid staining my socks but at the same time reaching every part of the shoe. He achieved this by placing his finger between my shoe and sock. Then he polished energetically. Next he put on wax, kneading the wax into the shoes with strong fingers. He did this a couple of times, bringing the leather back to life, it felt to me. After polishing with his huge brush, he completed his performance with a cloth, bringing the shine on my shoes to a point where it almost blinded me by reflecting the bright sun.

Now he looked up. I felt like applauding but instead tried to express my great admiration and pleasure with my face and hands but also saying “fantastico,” wholly unsure whether it was a Spanish word.

My first thought was that it was wonderful that a man could put such commitment, energy, and pride into a task that many might find lowly. I wondered how often I managed to do anything so well and concluded rarely.  And how many doctors do? Not many, I thought sadly.

He with his efforts had clearly “added value.” My shoes, which were filthy, were now clean. The world was a better place. Did I add such value? I can’t point to multiple pairs of clean shoes. I can point only to thousands of emails, conversations, meetings, documents, proposals, and words (many of them cluttering up bmj.com). Does their value amount to thousands of clean shoes? Quite possibly not. Indeed, they might even subtract value.

The square where I had my shoes is remarkably clean—no chewing gum, no cigarette ends, no wastepaper. This is partly because unlike Londoners people in Queretaro don’t seem to discard litter and partly because an army of street cleaners dressed in orange apply the same love to cleaning the streets that the shoeshiner has applied to my shoes. In contrast, the man who sweeps the street where I live in London is hopeless, working very slowly and missing most of the rubbish. I guess he feels demeaned. His shoddy work doesn’t upset me, but why are the street cleaners in Queretaro so energetic and the ones in Clapham so hopeless?

My final thought is of my grandfather. Whereas I’ve cleaned my shoes twice in eight months, even standing on platforms in front of a thousand people with filthy shoes, he cleaned his shoes every day. He would rather die than be seen with filthy shoes.

Is this all “moral decay”? Probably.

RS was the editor of the BMJ until 2004 and is director of the United Health Group’s chronic disease initiative.