A Nursing Perspective on Malade Selection

Each year, we as the Lourdes Committee Nursing Leadership Team look forward to fall and the malade selection process. Although the plane will not depart for six months, the Lourdes pilgrimage begins for us in November. Between November and the assignment of teams in April, we have the privilege to interact with each malade who has been called to Lourdes by our Blessed Mother.


From November to early January, we review every application and speak with every applicant, as well as their companions and sponsors. We answer their questions about the pilgrimage, the rigors of travel, and the care and support that will be available to them during their travel by our team of medical professionals. We work with them to clarify application information and obtain any missing information that is crucial to our physician reviewers. We write nursing assessment notes based upon our interactions with applicants and schedule them for face-to-face meetings, when possible, either in Baltimore or in Houston. (Those unable to meet face-to-face will have a phone interview with a Malta physician.) 


Every year, our malades invite us to a confidential view of their journey between sickness and health, sharing with us their hopes and dreams as we delve into their health challenges to learn how the Order might best support them during the pilgrimage. We are always held in awe by their faith.


It is difficult for the medical team to make selections from the great number of applications received.  Each application presents a touching, sometimes heart-wrenching, story and we feel that each applicant is deserving of going to Lourdes. We become personally involved with them before we ever shake a hand, reach out to give a hug, or finally put a face to a voice.


In support of our outreach to potential malade applicants, we would like to invite the Federal Association regions to consider these critical questions about malade applicants as we all fulfill our mission to serve our lords the sick and the poor:


Will their disease or disability likely be so acute or progressed (at the time of departure) that foreign travel would be a risk? We encourage inviting potential malades who are in early stages of a chronic or acute illness rather than in later stages when the disease-struggle has ravaged their body to such an extent that they would not be fully able to participate in the pilgrimage. Exceptions are made, of course, taking into consideration that this may be the only opportunity to go to Lourdes. A system is in place if we need to replace an applicant within weeks of our departure.


Can the applicant, and their companion, fully partake in the pilgrimage? If the health challenges (physical, mental, emotional) of both the malade and companion preclude regular engagement in school, church, family or institutional-related activities, then one should question whether they would be able to participate in pilgrimage activities.


Would the applicant be able to travel without medical complications?  This question encompasses many components: Will their medical condition or age allow them to be “awake” for 24-plus hours for travel from Baltimore to Lourdes, as well as from their region to Baltimore? Will their medical condition allow them to participate in a 12-to-15-hour daily schedule while in Lourdes for a period of six days? Sponsors should consider that someone who is largely homebound or living in an assisted-living facility receiving nursing care will probably not be able to manage the rigors of international travel.


Is it one malade or two?  We sometimes find that the companion is, in fact, a second malade. This poses a challenge to the pilgrimage teams. When deciding on a companion, it is important to assess whether the companion is able to walk up to two miles at a time, stand for several hours, engage in a 12-to-15-hour day and be fully able to deliver personal care to their malade, if required.  Companions who need canes, walkers or wheelchairs for their own mobility are a challenge to the teams, which are sized to address the safety and care of just the malades.   


Is there a memory or wandering issue?  International travel—with its accompanying dehydration, sleeplessness, and strangers speaking multiple languages—can be very disorienting, especially for someone with dementia, Alzheimer’s or a social anxiety disorder.  Individuals with these diagnoses are generally not accepted for the pilgrimage.    


In conclusion, it is truly a blessing to be able to serve and support our lords the sick and the poor in the manner that we do. We appreciate the support of the regions in the application, vetting, review and final selection process. Our hearts are as sad as yours—and theirs—when malade applicants are turned down. Please know that we hold in our prayers all that you do to initiate the malade identification and selection process.