A group of 96 volunteers and physicians traveled to Honduras for the annual prolotherapy and sclerotherapy trip. Now in its 37th year, the Hackett-Hemwall Foundation has sponsored and organized this expanding trip, which now includes community outreach and educational support efforts, in addition to the medical work carried out in the Honduran cities of La Cieba, Tela, and Olanchito.

The 2006 trip included third year residents Luke Fortney, MD, Anneke Schlicht, MD, John Wilson, MD and John Porter, DO from the Madison Residency Program. They were joined by Mark Timmerman, MD from Madison and other physicians from across the United States, Canada and other countries. This provided an experienced medical team combined with those less experienced in doing prolotherapy.

The Hackett-Hemwall Foundation is a non-profit endeavor headed by the Department of Family Medicine faculty member, Jeff Patterson, DO who was placed at its charge 20 years ago by his mentor Gus Hemwall. The Foundation has since grown from the small personal interest of Dr. Hemwall into the now extensive philanthropic-research-education-service oriented entity that boasts the involvement of the international medical community.

Emphasizing learning through serving, the trip involves prolotherapy education and skills-training for physicians, as well as community and medical service for the people of Honduras. Recently, an x-ray machine was supplied to the small hospital in Olanchito where four Honduran physicians and surgeons oversee the care of more than 80,000 people in the surrounding area. This year, a truckload of medical and school supplies was shipped from Madison, providing greatly appreciated writing and reading materials, maps, and globes for local classrooms as well as supplies for hospitals and clinics. Last year, the visiting team pooled resources to fund vision-sparing surgery for an elderly gentleman in Olanchito.

In the spirit of reciprocity, service and relief efforts in the way of housing, transportation, translation, and daily meals were offered to the medical teams by the hospitable people of Olanchito, Tela, and La Cieba. Such kind reception and support truly blurs the arbitrary one-dimensional distinction between medical relief worker and patient, reminding us that healing and service is a mutual two-way street.

As far as medical education, skills practice, and treatment satisfaction are concerned, the Hackett-Hemwall Foundation-sponsored prolotherapy mission to Honduras compares far above most conventional medical learning experiences.

A typical day commenced with an early communal breakfast followed by a leisurely stroll past the town square to the clinic. On every occasion, an early long line of smiling patients from as far away as four hours awaited the start of clinic. After preparing the daily prolotherapy injection solutions, physicians were divided into groups of two and three and assigned to various treatment stations where an experienced prolotherapist oversaw each patient interaction and treatment. Regular reference to the skeleton model and Netter anatomy text was made prior to, during, and after the injections. Common areas for injection included:

• toes
• feet
• ankles
• knees
• back
• pelvis
• neck
• shoulders
• elbows
• wrists
• fingers
• TMJ
• occiput

In total, thousands of injections were performed leaving some practitioners with calloused and fatigued fingers.

At midday, a lunch was kindly and reliably provided by the Cruz Roja (Red Cross) women in Olanchito before the afternoon clinic. After the last patient was seen and the work stations were cleaned, a lecture and teaching session took place in which a different body part and presenting-pain vignette took place. Finally at twilight, the team came together for dinner and conversation. On rare occasions, a resident was seen late into the night mingling with the locals over a Salva Vida.

One case illustrates the slogan, "rebuilt by prolotherapy" very well. Mr. Madrid, an elderly and cachectic gentleman, arrived early to clinic from three hours away, hobbling slowly and awkwardly on his cane, eager to receive "la injeccion" for pain he had incurred from head to toe over a long life of hard physical labor. Choosing to limit injections to the ankles, knees, and shoulders, the residents explained to Mr. Madrid that the injections cause a local inflammation that can make the area sore for a few days. However, over time, the injections lead to a thicker and stronger ligament with concomitant change in how nociceptors relay pain signals to the brain, which ultimately leads to pain relief. Mr. Madrid came back a second time for more injections, stating that his knees and shoulders were essentially pain free for the first time in memory. Therefore, he elected to have his low back treated. Returning a few days later riding on the back of his grandson's bicycle, Mr. Madrid performed a cane-free dance to demonstrate his new found agility and freedom from pain. His final request was to have his neck treated, saying that it was now the only area where he had any remaining pain. On leaving Mr. Madrid expressed his deep gratitude and made further demonstrations of his newly acquired pain-free mobility. His example reminds those in research of the value of anecdotal case-based evidence. In illustration of simple but powerful evidence, Mr. Madrid simply stated, "Thank you so much. I have no pain."

With growing confidence in injection skills and the steady reinforcement of patient satisfaction, the once steep learning curve leveled out and the novice prolotherapists began to realize the veracity of the proverbial artisan saying, "You can learn a lot in a short time, but mastery takes a lifetime."

Unlike the draconian work environment of residency, the designers of the intensive prolotherapy mission saw the value of balance, and therefore arranged a weekend long respite to the Caribbean island of Roatan. The beautiful outer environment of the tropic breeze, white sand, and shifting tides of clear blue tepid waters hinted at the ensuing inner peace. Truly, the getaway afforded itself well to relaxation, community bonding, silliness, contemplation, and reef exploration in the true spirit of harmonizing work with rest and play.

With the completion of the trip, one could not help but to reflect and make note of the wonderful overall experience of which prolotherapy was only a part. From the exposure of living within a different culture, to being a minority in a reverse situation where white skin and speaking English afford no advantage, to seeing the direct impact of the social and political determinants on health, to being awed at the resourcefulness and resiliency of a great people, to feeling the harsh impact of a world where financial exploitation by wealthy nations ensures the propagation of poverty in the developing world and where natural resources are taken to the developed world in numerous forms, one cannot escape a thorough inner rewiring and expanded awareness of what really matters. In this sense and beyond, the annual Hackett-Hemwall Foundation trip to Honduras is indeed a rigorous medical, social, cultural, and humanitarian education.