July 21, 2000

When a team of MGHers went to Honduras after the Hurricane Mitch disaster in the fall of 1998, the group assessed which medical services were most needed in the area. Among the gaps in medical service was the need for dermatological care for the Honduran people. It was then that Ernesto Gonzalez, MD, of MGH Dermatology, was asked how the MGH could best treat patients for skin-related illnesses at Hospital Escuela in Tegucigalpa, Honduras.

According to Gonzalez, both acute care and long-term care were needed. "The presence of a wet environment and exposure to chemicals in the area are causes of the various needs for medical treatment for skin infections," says Gonzalez. "These types of illnesses need to be treated by doctors and require a lot of resources that are not available at Hospital Escuela. We plan to make a few trips each year to treat these patients and to teach Honduran doctors about advanced techniques in treating skin illness."

The group also will set up a tele- dermatology service so MGH physicians can consult remotely with doctors at Hospital Escuela to diagnose patients and recommend treatment. This service, which uses a satellite and computers that project images back to the United States, is scheduled to begin this summer. Joseph C. Kvedar, MD, director of Partners Telemedicine, generously donated the equipment and expert advice for this service.

Leading these trips are Gonzalez; Thomas Durant, MD, of MGH Administration; Paula Buick, RN, of MGH Planning and Construction; Edwin Wyman, MD, of MGH Orthopædics; and Tim Chartier, MD, the Mohs Surgical Fellow at Mass. Eye and Ear Infirmary. The initial trips were sponsored in part by the Hingham Rotary Club and Rotary International.

"Honduras is one of the poorest countries in Central America, with an annual average income of $600," says Buick. "A socialized medical system with 'care for all' puts great demand on the Honduran clinicians. The impact that an MGH collaboration can make is great – both on a physician-to-physician basis and on patients' lives."

According to Chartier, who was a chief resident at the MGH when he began his involvement with the relief effort, results have already been achieved in the beginning stages of the collaborative effort between the MGH and Honduran doctors.

"We were able to get supplies and machinery donated to aid in the treatment and prevention of derma-tological diseases," he says. "For example, we were able to get cases of sunscreen and special sun-blocking clothing and hats for children who suffer from xeroderma pigmentosum – a genetic disorder whereby skin is ultra-sensitive to sunlight and skin cancers are formed at a very early age. In a place like Honduras, where avoidance of sunlight is nearly impossible and sunscreen and other forms of protection from sunlight are too expensive for residents, these kinds of donations can save lives."

Chartier also explains that the MGH was successful in getting expensive machinery donated to Hospital Escuela, such as an ultraviolet light box to aid in phototherapy and a cryo-gun – a liquid nitrogen bottle – to treat skin diseases.

"It's wonderful that we were able to get them this much-needed machinery, but we need to continue our efforts if we really want to make a difference in Honduras," he says. "Eventually, the machines will break and the sunscreen will run out. We need to find a way to continue to provide resources to Honduras to have a real, lasting impact."

Dermatology services would not be complete without adequate diagnostic abilities. A generous donation of services by Thomas Flotte, MD, of MGH Dermatopathology, will add to the MGH's efforts. For a six-month trial period, physicians in Honduras will have the opportunity to send slides to the MGH to be read. Continuation of pathology services will be evaluated at the end of the trial.

Initial seed funding for this project came from a generous donation by Jack Connors, chairman of the Partners Board of Trustees. Additional funding will be necessary to continue the project.

The next trip to Honduras is scheduled for August, when equipment for the teledermatology service will be installed. For more information about the project, call Gonzalez at 724-6967.