by Dr. Lindy McHutchison

“You brought 10 people to Honduras?” I am asked in disbelief.

How could I deny so many close to my vein world the nominally priced opportunity the Honduras vein trip provides? All the elements of the perfect educational experience: education, camaraderie, altruism, culture and adventure. I love the Honduras trip, and it’s true that no one can prepare you for the extent of disease and the volume-of patients awaiting you there; you have to experience it yourself. However, I cannot resist sharing my experience, and hopefully, I can explain why others and I gravitate back year after year.

Who Comes?

We first meet up in the food court in the San Pedro Sula airport – all 50 of us! We are easily identified by the orange and green tape we previously had been instructed to tie on our luggage. From the first moment, the alums are dressed in casual, camplike clothes, seen laughing and talking with previous year’s friends. The newbies are in nicer travel attire, looking slightly bewildered, but are quickly given a warm welcome by Rick, Mary and other veterans. If the newbies haven’t become friends with alums in the food court, they will soon, as camaraderie and friendship on this adventure are inevitable, especially on the bus rides.

Except for the teenagers, it’s hard to know who is who, but it doesn’t matter as the entire group is a conglomerate of volunteer physicians, nurses, RVTs, vein clinic personnel, family, etc. Every type attends and are welcome from modest to wealthy and shy to extroverted. All come together with a common goal to learn, to help, to experience and to have fun! In Honduras, it’s first names only, even for venous blue bloods, like Giovani Mosti and Ted King.

Education

Educationally, I gained far more than I have learned at any medical meeting. Besides, earning approximately 50 category 1 CME credits from scheduled lectures to hands-on experience, there’s an added bonus – two phlebology blue bloods participating in a compression demonstration. Last March, in the tattered, ocean view event room at Sherwood’s Hotel, Giovani, a world authority on compression, presented to all of us. Then,Ted, wearing cargo shorts and flip flops, climbed on a table so Giovani could apply a short stretch bandage to his lower leg. Using a pressure meter, results were compared to compression gained from a traditional elastic stocking. The results were indisputable, and Giovani’s lecture results were confirmed.

The first weekend is spent in Sherwood’s event room in orientation, lectures, demonstrations and safety meetings. We then divide into three groups. The Tela group stays while the La Ceiba and Olanchito groups board Norman’s refurbished old American school bus and drive to their respective towns to set up the clinics and prepare for the mass of Monday morning patients.

When so many phlebologists come together for seven days, with little in common but veins, most of the conversations are about just that…veins! It’s priceless. For one week, in the comfortable, relaxed camplike environment, the attendees are immersed in exchanging and sharing everything from practice pearls to marketing. Countless discussions and stories on practice experiences, complications, outcomes, ideas, marketing, management, anecdotes as colleagues become friends with a unique bond.

Even after the trip is over, the Honduran physician attendees continue to collaborate through a large email list, exchanging questions and sharing treatment and management ideas.

Hackett Hemwall Foundation Vein Clinics

Hacket Hemwell Foundation (HHF) is a volunteer, nonprofit organization based in Madison, Wisconsin. HHF has over 40 years experience with medical expeditions to Honduras and Central America for patient care, physician teaching, and cultural interchange.

Dr. Jeff Patterson, professor in Family Medicine and Public Health at the University of Wisconsin, is HHF’s director. In 2002, Jeff approached Dr. Rick Owens, now director of HHF’s vein program, about starting vein treatments for the foundation. Soon after, the Honduras vein trip began.

Mary Doherty is the trip’s coordinator. Mary volunteers countless hours each year making sure every aspect of the vein trip is organized from collecting and distributing supplies to assigning rooms. I marvel at Mary’s passion and tenacity. Last year I crowned Mary “Reina de la Vena” as the trip could not happen without her dedication and diligence.

The Venous Disease

The clinics only treat venous insufficiency of the legs. The severity of venous pathology we see and treat would astound most and require years of busy phlebology practice to encounter. For first timers, it is hard to image the extent of venous disease that awaits them. The patients are seen by severity, not first come. Experienced nurses triage the patients and leg ulcers are seen and treated first. Last year 17% of the 1179 patients seen and treated had leg ulcers. It helps you understand why these patients would travel so far and wait so long for treatment. CEAP Classes 4, 5 and 6 are commonplace, as local leg care is virtually nonexistent.

The Patients

Local radio stations and churches broadcast announcements, while area clinics and hospitals post notices that doctors treating varicose veins and leg ulcers are coming to Honduras. Patients travel from all over Honduras to the makeshift vein clinics. Communities donate money to provide buses for those who have the worst leg veins and many travel 12 hours or more and wait three days just for a coveted 10-15 minute vein treatment. Every morning it’s a site to see as buses and patients fill the clinic courtyards.

The Makeshift Clinics

Three makeshift clinics are set up. Tela’s clinic is in a church, La Ceiba’s in the Red Cross building and Olanchito’s in a community center. My first year, I requested Olanchito, because I wanted my teenagers to experience a Third World country village with poverty, unpaved roads, and farm animals roaming the town.

Each clinic has 8-10 treatment stations. Each site is staffed with a mix of veteran and novice phlebologists, and each participant acts as both learner and teacher at various times during the week. The shared educational experience is both interactive and collaborative.

I have discovered that each clinic seems to have its own personality. It appears city slickers prefer La Ceiba, with a nearby Starbucks, Duncan Donuts and a hotel swimming pool. The gentry seem to prefer Tela, with an alleged gentleman’s pace and longer lunches, and the diehards prefer Olanchito. The comparisons are only in fun, as all work hard at each site treating hundreds of patients.

No one actually knows which clinic is best, because when all reconvene the last night back at Sherwood’s Hotel, everyone claims to love “their” clinic as all compare and share their week’s experiences and stories, while pledging to only return the following year to “their” clinic.

The Treatments

Many of the volunteer physicians and team members are highly skilled and accomplished phlebologists. Others come with limited or no prior experience. The experienced are teamed with inexperienced for direct, hands-on teaching of ultrasound diagnosis and treatment.

Duplex ultrasound exams are performed on each patient using portable ultrasound machines. Physicians and RVTs who have their own machines bring and use them. Sonosite loans many portable ultrasounds so all physicians have access to a machine.

Most all the treatments are ultrasound guided, foam sclerotherapy injections using polidoconal into incompetent truncal and tributary varicosities. During orientation, all are instructed to utilize very simplified treatment protocols which have previously been shown to be safe and effective. Maverick treatments are discouraged.

Appreciation Exchanged

Treating the Honduran patients is phenomenally rewarding. Literally hundreds of patients arrive each morning to the clinics in hopes of being treated. The patients are grateful, appreciative, patient and trusting. They rarely ask questions and willingly receive injections, in hopes that their quality of life improves. How could they know we felt the same towards them? As they waited and gained, we all learned, gained and were rewarded, too.

Being in Honduras, I saw venous disease far more severe than I see in my daily practice, and I collaborated with colleagues on interesting cases, as we compared and discussed veins at the end of each day. Although exhausted, we all felt rewarded for the lives we touched, and hopefully changed, with only a few injections.

The Data

Years ago, the wealth of data available was apparent. Dr. Carl Black created a program to collect the data, then Bill Zimmerman, an expert computer programmer and husband of Tatiana, an RVT, collaborated with Carl. Now, with the help of data sheets on every patient, an enormous amount of information has been collected. Last year 1179 patients were treated, 95% were female and 17% had one or more leg ulcers.

Food

The food is remarkably good and plentiful. Purified water is always available. The food is typically Honduran with lots of fresh fruits and vegetables. It is carefully prepared by previously approved kitchens so our tender, gentle and very susceptible stomachs will have minimal exposure to the endemic gastric pathogens. For those who enjoy more flavorful, savory foods, they may find the Honduran preparations relatively bland. Thankfully, Elizabeth brought a huge jar of Tapatio to Olanchito which provided extra zest to the food for those who desired it. Snack foods, while abundant on the bus rides, are scarce during the day, however the several boxes of Pop Tarts my daughter brought provided afternoon relief to many in Olanchito. For those with food preferences, like me, a low carb fanatic, the cooks were happy to accommodate me.

Donations and Supplies

Most of the supplies are donated or are provided low cost to HHF. For several years, Kreussler Pharmaceutical has donated the polidocanol. Sigvaris has also provided literally hundreds of compression hose for aftercare. Compression bandages have been made available at cost. The Standard Fruit Company donates the transportation of a large shipping container filled with clinic supplies annually. Many attending volunteers stuff their suitcases with collected and donated supplies from their practices. Not surprising, large and XL compression stockings seem to run out first.

Teenagers

Teenaged family members are welcome, especially the Spanish speaking ones, as there are never enough helpers in each clinic. In fact, teenagers can earn over 50 hours of community service for their participation. Although the trip rarely coincides with spring break, schools are usually happy to let teenagers miss school as the experience they gain from this trip can’t be taught in traditional classrooms.

The value the teenagers and the rest of us gain from this Third World medical service mission is inherent, life changing and truly unforgettable. Even typically lazy, unappreciative teenagers have become hard working, grateful converts by the end of the week. Usually 10 or so teenagers attend this trip with their parent(s) and within hours of arriving, the friendships begin. Old friends from previous Honduran trips reunite, and by the end of the trip, all attending teenagers have become fast friends. It’s heart-warming watching these teenagers congregate together on the last night and excitedly tell each other stories from their week. In the end, they all exchange phone numbers and become Facebook friends.

Friends for Life

Those who attend the Honduras Vein trip become part of the HHF Family. Not only do they become friends with each other, they become friends with Hondurans, like Teresa, who runs the bilingual school in Olanchito and who is an integral part of HHF’s coordinated efforts.

Two years ago, after being with me on the Honduran trip 2011, my daughter said it best, “I have never been around so many people who care about others more than they do themselves.”

Join the HHF Family

Next year’s Honduras vein trip is scheduled for March 9-16, 2013. Experienced phlebologist physicians wanting to learn more and RVTs are always welcome. Volunteers pay their own travel expenses, plus their share of room and board. CME credit is available through the University of Wisconsin School of Medicine

for a nominal registration fee. For information on the upcoming 2013 Honduras vein trip, visit www.hacketthemwall.org or contact Rick Owens at [email protected]. Yes, of course, we’ll be back….all 10 of us!