Helping in Honduras: Cleveland dermatologist makes annual mission trip

Cleveland - Three years ago, when a Cleveland Clinic colleague approached Allison T. Vidimos-Stultz, R.Ph., M.D., about whether any one of the 25 dermatologists in her local practice would want to go on a medical mission to Honduras, she replied, “Could I go?”

Dr. Vidimos, chairman of dermatology and vice chairman of the Dermatology and Plastic Surgery Institute, Cleveland Clinic, has been making the annual weeklong journey ever since.

Dermatologist Allison Vidimos-Stultz, M.D., is shown in 2009 in Copan, Honduras, with a young girl she was treating for tinea corporis. (Photo: Allison Vidimos-Stultz, M.D.)

The trips give her the opportunity to see interesting cases while practicing basic medicine and dermatology - without the aid of high technology. The experience, she says, also gives her a heightened sense of appreciation.

Dr. Vidimos, the sole dermatologist, is among seven physicians who take donated medications and transportable surgical supplies to the city of San Pedro Sula in northwest Honduras.

“We venture out from there to different towns and villages that have been chosen by a local physician who understands the needs of the various areas,” she says. “So we go as close as 20 minutes away and as far as three hours away.”

This year’s trip, in late January and early February, was Dr. Vidimos’ third. The medical needs of underserved Hondurans keep the group busy, she says; this year, practitioners saw 3,300 patients in six days.

Scabies and more
Dr. Vidimos, who practices general medicine and dermatology on the mission trip, says about two-thirds of the patients the team sees in Honduras are children. Many of the dermatology patients she sees in the makeshift school-based clinics and operating rooms have scabies.

The condition is rampant, she says, “because they sleep on the ground and there are several people in the household.”

Despite having darker skin, locals are known to present with advanced stages of skin cancers because of the lack of preventive care and screening, Dr. Vidimos says.

“I took care of an elderly woman with a basal cell carcinoma that was fusing her eye shut. I took it off as best as I could. We don’t have any pathology down there, so we do the best we can with the equipment that we have, and in as clean of a fashion as we can.

“I was able to take off the skin cancer from her upper and lower eyelids and repaired the area with a flap and a graft, so that she could open her eye and see.”

Trauma common
Traumatic injuries are common, she says. Honduras is major producer of sugar cane, and machete injuries from fieldwork are seen frequently.

Dr. Vidimos says she sees a lot of contact dermatitis and cutaneous fungal and bacterial infections. Trench foot is prevalent, especially among men who work in coffee fields in wet boots. Women commonly suffer from venous disease and leg ulcers from prolonged standing.

Then, there are the extremely unusual cases. “Last year, I had a 7-year-old girl who had an extra thumb growing out of the end of her thumb - a supernumerary digit,” Dr. Vidimos says. “(The girl) said through the translator that she just wanted to look like the other kids.

“I bring things to do surgery, so I numbed it up, took it off and sewed it up. She was the happiest kid of the day.”

The doctors give all patients a two-month supply of pediatric, adult or prenatal multivitamins, because so many in the country are malnourished. The hope is that other medical mission brigades that make their ways to the region will continue the supplementation efforts.

“A lot of their diets are just tortillas. They don’t consume much in the way of fruits and vegetables,” Dr. Vidimos says.

Bare essentials
The doctors visiting Honduras operate in MASH-like units, setting up operating tables in schools and getting as close as possible to sterile conditions.

Dr. Vidimos says she worries about how many of the patients will fare. She says she treated one of her most memorable patients during the 2008 trip. A 5-year-old girl came to the dermatologist with an abscess the size of a softball on her neck. Dr. Vidimos drained it and put the child on antibiotics.

“We don’t have cultures, so we do the best that we can in guessing which bacteria to treat,” she says. “I was fearful that she was not going to do well, because she was in a remote area. It took us about an hour to drain the abscess. “I was sweating the whole time, and it was very emotional. But as she was being carried out, she said to her mom - the translator told us - ‘The doctors treated me really nicely.’”

Dr. Vidimos thought about the child for months after she got home.

“The next year, we went back to the same village, and I found her,” she says. “It was the highlight of my day, because she was still alive and doing well.”

Rich experience
Dr. Vidimos has taken one of her two daughters, Katherine and Kristen, on each of the last two Honduran medical missions. The teenagers escort patients and families to the physicians after the patients go through triage; assist with minor procedures; and do crafts with the children.

“What blew my mind,” says Dr. Vidimos, “is that one of the (volunteers) brought a camera and printer, and she took pictures of all the little kids and gave them the pictures.

“Some of the children had never seen themselves, because they don’t have mirrors. They were holding the pictures as if they were gold. You realize what we take for granted.”

The dermatologist and her daughters walk away each year with the satisfaction of having helped people in need. And they realize how happy these people are - despite having relatively little.

“You also realize how lucky we are to have all the diagnostic tests and labs and biopsies,” Dr. Vidimos says. “When you’re in a situation like that, you have to trust your gut feelings. It’s a real test of your basic dermatology knowledge.

“Currently, I do mostly surgical dermatology,” she says. “So, believe me, I was wiping off the cobwebs, looking at cases that I hadn’t seen since I was a resident.”