The Gait Way to Sport and Exercise Medicine – a BJSM blog series
By Tom Chandy (@ChandyTom)
The 17th Homeless World Cup (held in Cardiff from 27th July to 3rdAugust) welcomed 500 players from over 48 countries, all of whom have experienced social marginalisation and homelessness. Both men and women competed over 8 days in a purpose-built arena in the heart of the Cardiff’s Bute Park, within earshot of the Millennium Stadium and a stone’s throw from Cardiff Castle. The event was hosted by the collaborative efforts of Street Football Wales and the Welsh actor and activist, Michael Sheen.
A fast-paced, high-scoring, entertaining match with many benefits to players
The format of the tournament gave an opportunity for each team to play every day. Each match consisted of two 7-minute halves with three outfield players, plus a goalkeeper and rolling substitutions, on a walled pitch of 22m by 16m. The teams have squads of 8 players and certain rules encourage aggressive attacking play, e.g. one player must always stay in the opposition’s half, leading to many three-against-two situations around the goalkeeper’s area.
This results in a quick-paced, high-scoring, entertaining match, almost analogous to a HIIT workout. Highlighted in Peter Krustrup’s BJSM blog, Football Medicine has numerous health benefits. Homelessness forces people into isolation, which affects their ability to share, communicate, and work with others. Street Football allows people to build relationships and become teammates who learn to trust and share. They have a responsibility to attend training sessions and games, to be on time, and to be prepared to participate.
The benefits to players are intangible: it’s an opportunity to represent their country, help regain self-worth and assist their re-integration into society. Furthermore, competitors become ambassadors and mentors for their country’s street football charities, with many returning as volunteers at subsequent tournaments. Players also gain access to an international refereeing course and to return as official Homeless World Cup Referees.
The local medical team
The event is reliant on volunteers. From team guides, information assistants, referees, pitch assistants, organisers and of course, the medical team. As someone aspiring to be a SEM doctor, the chance to be involved in this event was an opportunity I could not miss.
The local medical team was led by Chief Medical Officer Katy Guy, an Emergency Medicine Consultant, who has previously worked with Team Wales at the 2018 Commonwealth Games. Our local medical team comprised of SEM and Emergency Medicine consultants, General Practitioners, junior doctors, physiotherapists, sports therapists, and medical and dental students from across Wales. We provided the medical cover for players at daily morning and evening clinics in my old university halls of residence, which were transformed into the ‘Athletes Village’ for the week.
At the tournament site, we had a main medical tent and pitch-side cover across all three pitches. We came into contact with a vast range of medical issues. Management was often complicated by language barriers, as well as many players refusing pain relief due to previously suffering from addictions. The most common injuries were sprains, minor abrasions, lacerations, eye injuries, dehydration related fatigue and overloading MSK injuries. Less common complaints included testicular haematomas and unfortunately for one goalkeeper, their artificial hip replacement dislocated whilst making a save. Fortunately, the pitch-side care was swiftly on-hand to assist the player. They later required a new hip replacement after multiple attempts to relocate under general anaesthetic were unsuccessful. This player’s journey, from pitch to theatre, highlighted the importance of immediate SEM care, including good relationships with local emergency and hospital resources.
At the Athletes village, the team dealt with travel-related viral illness (and subsequently isolation to prevent an outbreak of mass illness) and management of chronic conditions such as wound reviews.
In the medical tent, we were supported by both physiotherapist students and lecturers from Oslo and Copenhagen Universities, who support the Homeless World Cup every year.
The high-intensity workload combined on consecutive days resulted in the physiotherapist being very busy. The majority of players, who have all been homeless or suffered with substance abuse in the last 12 months, have never had access to physiotherapy and limited input from wider healthcare.
Take-home message: a great volunteer opportunity!
The free, family-friendly event attracted thousands of spectators, celebrating the achievement of each player representing their nation’s street football foundation. An important step in recovery for the players is societal acceptance of them and their stories. It was a pleasure to make a small contribution to the success of the medical team that supports this event.
Bespoke to this athlete population is managing their medical needs without or with minimal pharmaceutical resources, particularly analgesia’s, due to previous substance abuse.
SEM students have opportunities everywhere. Working alongside new and familiar faces provided opportunities for learning new skills and networking, as well as enjoying a week of great football in the beautiful Welsh summer (with only one day of torrential rain!). Members of the medical team are liaising with partners involved in delivering the Homeless World Cup to improve NHS’s support for patients who are homeless.
I would urge anyone, at any point in their careers, to volunteer their time at events like the Homeless World Cup. You won’t regret being involved and will walk away with much more than you arrived with. You can read some inspirational stories (<5 minutes each!) from players at https://homelessworldcup.org, or better yet; join them next year in Tampere, Finland.
The Homeless World Cup Foundation
Founded by street-paper social entrepreneurs, Mel Young (co-founder of The Big Issue) and Harald Schmied (previous Editor-in-Chief of Megaphon), the first Homeless World Cup was held in Austria in 2003. Using football to inspire homeless people to change their lives, the Homeless World Cup Foundation charity operates through a network of more than 70 local street football partners around the world. The yearly tournament promotes a more compassionate approach to help those affected by homelessness, as well as improve public perception of homelessness.
Tom Chandy (@ChandyTom)is a final year medical student at Cardiff University and aspiring SEM doctor. He has an Intercalated degree in Clinical Sport Science and is secretary to BASEM’s national undergraduate SEM Society (USEMS) @UndergradSEMSand president of @CardiffSEMS.
Tej Pandya @PandyaTej is a medical student at the University of Manchester and co-ordinator of a new BJSM blog series aimed at undergraduates and recently qualified doctors. If you wish to contribute, please email him at firstname.lastname@example.org