AVF Members Abroad: HHF Vein Mission Honduras
By: Armen L. Roupenian, MD, FACS, RVT, RPVI
“Thousands of migrants in the U.S. are children from Honduras escaping poverty and violence,” the headline announced.
As I read the article, my thoughts turned to the smiling faces of the many Honduran children I have met over the past eight years. Every spring, I join an international group of physicians, nurses, ultrasonographers, non-medical volunteers, and family members who travel to Honduras as part of the Hackett Hemwall Foundation Vein Mission. Our goal is to treat patients suffering from chronic venous hypertension, and to bring quality health care to a vulnerable and underserved community.
The Central American country of Honduras is one of extreme contrast. It is rich in agriculture and human resources, but widespread poverty, combined with a long and tumultuous history of political upheaval, means that much of the population lacks access to basic medical care. The Hackett Hemwall Foundation aims to fill that gap by providing free, high-quality care to people in need. By bringing together a team of hard-working and devoted professionals, we manage to treat over 1,500 Honduran patients each year.
We could not achieve what we do without assistance from our hardworking Honduran partners. News of our mission is spread by word of mouth, as well as through announcements placed in local churches across the country. Patients commonly travel for days on foot and bus to reach one of our three clinics: one in the city of La Ceiba, one in the coastal town of Tela, and one in Olanchito, in the country’s deep interior. Many patients arrive days ahead of time, waiting outside the clinics and often sleeping on the ground at night in the hopes of being seen in the morning.
Our volunteers, meanwhile, come from all parts of the world. We first meet at the airport in San Pedro Sula. As we slowly gather together as a group, the experienced vets greet each other with hugs and updates, but the heartfelt reunion quickly shifts its focus towards welcoming the newcomers. Through a camaraderie that is born of hard work, long hours, and the accomplishment of shared goals, these new volunteers will soon become important additions to the team, as well as lifelong friends. The airport reunion is followed by a three-hour trip to the city of LaCeiba, where the group spends their first evening. Packed into a fleet of rumbling old school buses, the newcomers often spend the ride silently looking out the windows as they take in their first images of Honduran life, while the older volunteers engage in animated discussions of the work ahead.
Once we arrive in LaCeiba, we immediately get to work. The volunteers are oriented on important topics ranging from treatment protocols to patient triage. One highlight of the evening is when Rick Owen, the Director of the HH Vein Clinics, delivers his famous talk on all aspects of Honduran life. He explains how to properly flush the toilets and delivers a stern reminder not to pet the dogs, no matter how friendly they might seem.
The following morning, we split into three groups. Some of us remain in LaCeiba, while others begin a long bus trip to their assigned sites elsewhere in the country. During my first year, I remember walking through the door of our clinic in Tela, which is located in a church school, and encountering hundreds of patients all shouting greetings of “Ole, Ole.” I was thrilled by their warm welcome, but I also wondered, slightly uneasily, how we could possibly treat them all.
The answer is a whole lot of coordination, as well as superhuman levels of hard work by every member of the mission team. On average, there are six to eight physicians at each clinic site, including both vascular surgeons and doctors with no prior experience in vein care. Nurses and non-medical volunteer staff are assigned the difficult tasks of triaging patients, resupplying rooms, helping to mix medications, and most importantly, providing TLC to the scores of Hondurans who are waiting patiently in anticipation of being seen. Treatment for CVI in our Clinics consists primarily of ultrasound guided foam sclerotherapy. Our protocol includes a diagnostic ultrasound to identify the source of pathology, followed by USGFS using international protocols directed towards the source of venous hypertension, and, when possible, the ulcer base. Our more experienced physicians can treat many patients in less than 10 minutes, a necessary concession that allows us to meet our goal of never having to turn a patient away at the end of the week. It is also important to note that the HHF Vein Mission would not exist if it were not for the generosity of our corporate sponsors. Kreussler and its CEO Stephan Travers provide the volume of polidocanol necessary to treat such a large number of patients. Sonosite provides loaner ultrasounds through their philanthropic arm, Global Health. Medi and Sigvaris donate large numbers of needed compression stockings that thankfully have replaced the knitted wool wraps sent by a women’s group in Wisconsin that we used during my first year!
In addition to offering treatment to patients, the HHF mission is an opportunity for learning. Every year we have physicians who are unfamiliar with the treatment of venous disease. Introducing the doctors to the basics of venous ultrasound and ultrasound guided treatment, and then watching them grow in confidence as they begin to treat patients independently, is a very rewarding experience. Additionally, one aspect of the mission I enjoy the most is seeing doctors work alongside their young adult children, many of whom accompany them as volunteers. This partnership is not only an opportunity for these young people (many of whom are curious about jobs in health care) to work alongside their parents for the first time; it also gives them a glimpse of what it means to struggle to survive in such an underdeveloped country. I was fortunate to have my daughter, a PhD candidate in English literature, join me for two of my trips, and I deeply valued the time we spent together.
Although, overall, the missions have met with great success, there are still aspects of the project we are trying to improve. One of the disadvantages of treating patients in an underdeveloped country is our inability to follow-up, since people often come to us from towns and villages scattered throughout Honduras. Each year, we see more and more patients who return to our clinics and report that their ulcers have healed, but we realize that these are only anecdotal results. To counter this, the Foundation has set out to create an online database that should allow us to track our treatment methods. Ultimately, we hope to share statistically significant treatment results with our medical colleagues.
Providing medical care in a third world country is an exhausting, at times frustrating, but always rewarding experience. I never leave Honduras without being reminded of why I chose medicine as a career.
You can learn more about the Hackett Hemwall Foundation Vein Mission by emailing either Dr. Roupenian at firstname.lastname@example.org, Rick Owens, Director of the HH Vein Clinics or visiting their website http://www.hacketthemwall.org/