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Honduras, one this hemisphere's poorest nations, is beset with very poor access to medical care, even for the most common of problems. While the wealthy are able to purchase quality care, those less fortunate have almost no access. Venous insufficiency is an entity that untreated, leads to years of chronic pain, leg discoloration and ulceration of the skin at the ankle (clinical class II-VI). In the country of over 6 million, there is no physician dedicated to the treatment of venous disease, leaving the population without recourse.
I just returned from a secular medical mission to Honduras with the Hackett-Hemwall Foundation (HHF), based in Madison, WI. While the original mission of the Foundation was treatment of painful joints with prolotherapy, a newer initiative has been the treatment of severe venous disease, varicose veins and venous stasis ulcers.
Despite my many years of practicing phlebology and vascular surgery, I did not anticipate the severity and frequency of such advance venous disease. Our clinic in Tela, Honduras was staffed with 9 physicians. At each day's opening at 8am, 30-40 patients, many of whom had slept on the sidewalk to be at the front of the line, were present for evaluation. Some had come from up to 8 hours away, primarily by bus and once by horseback.
Our treatment was limited to foam sclerotherapy (injection of medication into the vein to shrink it and alleviate symptoms). The special medication was generously donated by its manufacturer in Europe, as were the necessary support hose, donated by American vendors. The advanced varicose vein problems would be better treated in the United States with other modalities (such as VNUS Closure or endovenous laser and phlebectomy), but the lack of resources and availability of physician follow up makes this impossible.
In fact, many patients present to us with very severe bilateral vein disease, but sclerotherapy dosing limits our zone of treatment to a relatively modest area. Follow up for these unfortunate patients is only on a yearly basis when HHF returns. No local physician assumes care of these patients.
Almost 500 patients with very painful legs and very advanced venous disease were treated at our clinic in Tela. Similar numbers of patients were treated in clinics in La Ceiba and Olanchito, Honduras by other team members.
HHF was done an outstanding job coordinating the local support teams for the vein trips, and the success of the trips is largely due to the donated time of the participants combined with the medical suppliers, without whose help, this would not be possible.