From Sonoma Medicine Journal

Summer, 2018

Providing Medical Care to the Underserved in Honduras and Mexico

Robert A. Schulman, MD, FAAPMR, David Rabago, MD, and Mary Doherty

The Hackett Hemwall Patterson Foundation: a Service-Learning Medical Organization

We hear so often about the many things that trouble our world. While overall we are making advances in many ways, major medical and economic dilemmas affect people worldwide. Those at the lower end of the economic ladder, or in developing countries, are especially affected. It’s hard to know what to do. One charitable organization with local members provides both conventional and innovative medical services to those in need locally and abroad.

The Hackett Hemwall Patterson Foundation (HHPF) is a non-profit service-learning medical organization with IRS 501(c)(3) status. Our name identifies the leaders in our 50-year history. George Hackett, MD, a surgeon from Ohio, developed a technique for treating chronic pain without opioids called “prolotherapy” and used it in his medical practice. He later wrote the classic textbook “Ligament and Tendon Relaxation Treated by Prolotherapy,” first published in 1956, now in its fifth edition. 

In 1969, Gus Hemwall, MD, a surgeon from Chicago, established a foundation dedicated to providing medical care to needy people around the world. He named the foundation after his mentor, Dr. Hackett.

Dr. Hemwall established service trips to Central and South America for a number of years with just small groups of three or four doctors. In 1969 he took his first group of doctors to La Ceiba, Honduras. The medical focus was to treat underserved patients experiencing pain or varicose veins with prolotherapy and vein sclerosis, respectively. 

Jeffrey J. Patterson, DO, professor at the University of Wisconsin School of Medicine and Public Health, Department of Family Medicine, grew and modernized the HHPF, locating it within a university environment, and linking its care strategies to contemporary medical science. He was the foundation’s director until his untimely death in 2014.

Who are the members? They are physicians from around the world, including the U.S., Canada, Korea, Italy, Serbia, Mexico, Honduras, Spain, and Turkey. Overall, doctors from over 25 countries have trained with the HHPF to learn prolotherapy.

The HHFP is affiliated with the University of Wisconsin-Madison, where HHPF holds an annual conference devoted to the research and teaching of prolotherapy. HHFP provides three medical services: prolotherapy for chronic pain, ultrasound guided foam sclerotherapy for varicose veins, and ENT surgery.

On our service-learning projects, all services provided are free of charge to patients. Local organizations, including the Red Cross, help with the “clinics” and patients are asked for a donation. But the HHFP policy is that no one is turned away. All donations are used by the local organizations to help them provide assistance to local residents. All HHPF expenses for the Honduras and Mexico projects are covered by HHPF fundraising efforts.

Prolotherapy

Why prolotherapy? Prolotherapy is a simple, safe, inexpensive, and often effective therapy for chronic pain. Prolotherapy typically uses hypertonic dextrose as an agent that stimulates local healing when injected in or near painful joints. Early research suggests that dextrose may also directly “calm” irritated pain nerves and stimulate the growth of articular cartilage. Prolotherapy is growing in popularity, with aspects that are especially attractive for developing countries: the solutions used (dextrose, lidocaine, saline) are inexpensive and easy to transport. Prolotherapy is a treatment that can significantly reduce chronic musculoskeletal pain without the ongoing use of NSAIDs or other medications that are expensive, have side effects, and may be unavailable.

Vein Treatment

Untreated varicose veins in developing countries are often much more severe than those in Western nations. Lack of timely care can cause initially simple varicosities to form large ulcers that can threaten limbs. The HHPF is equipped to handle large varicose veins with up-to-date, non-surgical, ultrasound guided techniques. 

ENT 

HHPF sponsors an annual ear, nose, and throat (ENT) service project in La Ceiba, Honduras, alongside its prolotherapy and vein-care projects. Partnering with local surgeons, we perform ENT surgeries and limited facial/neck reconstruction surgical procedures. We also perform approximately 200 audiology/hearing tests annually and provide hearing aids to those with hearing loss.

HHFP provides these services in Honduras once per year in a large-scale service-learning project over three weeks, in the cities of Tela, Olanchito, and La Ceiba. One hundred physicians and volunteers treat 3,500 patients annually. To prepare for the trip, over 40 volunteers lay the groundwork for our efforts, and during the three-week project, over 100 local volunteers provide vital on-the-ground services. An additional 50 volunteers help with Spanish translation. 

The HHPF also operates a “brigade” in Mexico once per year, in the city of Guadalajara. The clinical focus continues to address chronic pain and varicose veins/ulcers. Twenty-five physicans provide over 1,200 treatments each year. One hundred local volunteers work during the year, and during the clinic, as well as about 25 local translators to help to facilitate clinical visits. 

A service organization of this type often must resort to creative practices to get the job done. In our case, we have to answer the question: “How do we get all that stuff to Honduras cheaply?” The answer is “by donated semi-trailer truck.”  Supplies are transported from Wisconsin to Honduras by truck and ship. A 42-foot shipping container is loaded each January in Madison, Wisconsin, and sent by land and sea to La Ceiba, Honduras. It is loaded with purchased medical supplies that we use in our clinics in Honduras, and also donated medical supplies that we give to Honduran public hospitals. We also ship donated school supplies. 

All projects combine charitable service with an apprentice-style learning component. HHFP training for physician includes an annual clinical and scientific conference in Madison. This is jointly sponsored by the UW School of Medicine and Public Health, and AMA Category 1 CME credits are offered. Our projects in Mexico and Honduras are staffed by faculty nationally recognized for expertise in a prolotherapy, vein sclerosing, or ENT work, and clinicians participate in closely mentored procedural work on site. Many physicians continue to return as students, and then become instructors. The one week “brigade” in Mexico is for physicians who have attended at least an entire two-week workshop in Honduras. 

HHPF is dedicated to the highest standards of medical practice and science, and participates in quality-improvement and research endeavors. At present the HHPF is working to standardize prolotherapy training through its standardization committee and the creation of a teaching manual.

Over the past 50 years, HHPF has played a major role in developing techniques and protocols for two therapies — prolotherapy and vein sclerosing — providing substantial services in both and related work in a third: ENT. We begin our next 50 years dedicated to continued work in all three.