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A Week in the Life of a Honduras Mission a Week Spent in Honduras to Volunteer on a Medical Mission (FPCA), in Which Dr

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A Week in the Life of a Honduras Mission a Week Spent in Honduras to Volunteer on a Medical Mission (FPCA), in Which Dr PPMA Update PENNSYLVANIA PODIATRIC MEDICAL ASSOCIATION AUGUST 2016 Photo Photo © Karen Lee Ensley Ensley Lee Karen l-r: PPMA Member Lee Sanders, DPM, smiles for a photo with a Honduran boy treated for flexible flatfoot deformity. Diverse Pathology Encountered A Week in the Life of a Honduras Mission A week spent in Honduras to volunteer on a medical mission (FPCA), in which Dr. Kramer’s wife Judi is a member, asked Dr. may seem like a short time to make any real difference, but to Kramer to be a part of this Mission, coordinated by “Serving at PPMA Members Neal Kramer, DPM, and the Crossroads.” The church had done Lee Sanders, DPM, it was the right “It was the patients in another mission about two years prior. amount of time to open their hearts to Honduras with their genuine Dr. Kramer was honored and invited Dr. the people of La Entrada and initiate the expressions of gratitude and Sanders to join him, including his wife, healing process. It was the patients in Deb, an RN. With both wives on board, Honduras with their genuine expressions being alongside other medical the whole group met Sundays over the of gratitude and being alongside other professionals that made a course of four months to plan, set goals, medical professionals that made a lasting lasting impression for these two and become acquainted with each other. impression for these two podiatrists. So podiatrists.” Dr. Kramer received donations from much so, that these former 1974 class- his podiatric vendors to buy medical mates from Temple University School of Podiatric Medicine say supplies to use when in Honduras. A mock clinic was staged without hesitation, they will volunteer again in the future. using members of the FPCA congregation as patients. Once Preparations for the Mission to Manos Amigas they’d arrive, the team was told they’d work in the Clinic from Clinic in La Entrada, Honduras 8:30 a.m. until the last patient was seen. Even with all the months It all started when the First Presbyterian Church of Allentown of preparation, Dr. Sanders says, “Yet we had little knowledge of CONTINUED ON PAGE 4 President’s Message Association to Offer Opioid Program Next Month Over this past spring and summer, you should through David Patti and our staff; have received a check from the Medical Care • National representation at the APMA level: and Reduction of Error (MCARE) Fund. This interaction with our Congressmen and payment came to you through the settlement of Senators; and a joint lawsuit PPMA participated in along with • Member Benefits, death, disability and life the Pennsylvania Medical Society (PAMED) insurance through the Guild 45. For more and the Hospital and Healthsystem Association in-depth information about all PPMA of Pennsylvania (HAP). The settlement contrib- benefits see page 8 for the PPMA Benefits uted $61 million to the MCARE Fund and distributed $139 million directly to Podiatrists, of Belonging brochure. Feel free to copy it Doctors, and Hospitals. and share! We received this settlement payment through As the climate of our national medical extended cooperation with PAMED and HAP industry changes, we need to remember that over our common issues that arose with our profession is relatively small, and that in Peter C. Smith, DPM MCARE. I cannot overemphasize the impor- order to protect, defend, and expand our tance of all of our medical associations working continuing role in medicine we have to run together in the current, turbulent, environment faster, jump higher, and persevere longer than of the medical industry. our competition. Our competition will be any This type of cooperation has also resulted in profession that comes forward to fill any void the creation of an Opioid Public Health CME that we define and we fail to fill. program for five credit hours. This program has What this means to me is that while our AMA accreditation for continuing medical edu- profession is developing the most well educated cation and can be used as a part of your CME and highly trained class of foot and ankle requirement for the current licensing term. This surgeons, we are still, at heart, podiatric “If we fail to program, “Be Smart, Be Safe, Be Sure,” was physicians who treat all conditions of the foot maintain our organized by PAMED and features Dr. Joe and ankle. If we fail to maintain our position as Gershey, immediate past President of PPMA the “go to” doctor for ALL foot and ankle position as the Opioid abuse is a growing problem with all of problems, other professionals will fill that need. ‘go to’ doctor our practices and patients. This program We are in a unique position to expand our for ALL foot re-educates us and educates your staff on the professional practices within our scope. Our and ankle Association will support, with representation science, legality, and recognition of problems problems, other that are occurring within the medical profes- and education, the expansion of our members sions related to opioids. A link to this free CME into foot and ankle surgical practices. However, professionals will program will be on our website next month. at the same time we will support with represen- fill that need.” Please use the link and have your staff use it tation and education the core practice of also. It is time well spent. podiatric medicine. Our programs must always I am bringing these two recent projects up address those core podiatric talents, in order to not only because of their importance to be sure that the profession does not abandon members with regard to payments and educa- ANY facet of podiatric medicine to any other tion, but as another example of why your medical or health professional. Association is vital to your practice: Again, I thank you for your membership and • PPMA membership gives you and your for the honor of working for you so far this practice Continuing Medical Education year. PU through the Foundation (Goldfarb); • Professional Liability Insurance through PMAP; • Peer Review Services through the Peer Review Committee; • Legislative and Regulatory representation PPMA Update August 2016 3 Honduras Mission 215 medical/surgical patients; diabetes. Patients ranged in young adults/middle-aged age from 10 months to 87 CONTINUED FROM PAGE 1 patients comprised 74 years. There were 58 males percent of all patients seen; and 157 females, 205 adults the diverse pathology that we so acute patients not able to 34 percent had diabetes, and 10 children. would soon encounter.” ambulate to the Clinic for most with T2DM; and two Of the patients with treatment. with previously undiagnosed diabetes, 75 percent had Diabetes in Honduras The numbers were: Total of For the first time, this Mission focused on diabetes and wounds. So Drs. Kramer and Disorders Evaluated and Treated at the Clinic in La Entrada Sanders chose to concentrate on diabetes and related lower Children Club foot in a 15-year-old child, metatarsus extremity complications, adductus, pes planus, leg length inequality, including chronic wounds. toe-walking They provided training to the Adults Mycetoma of the ankle and leg. A poten- local doctors, nurses, and tially serious, devastating, chronic, public health officials, as well inflammatory disease caused by aerobic as their own team consisting actinomycetic bacteria (actinomycetoma) or of one ER physician, one periodontist, one wound care fungi (eumycetoma) nurse practitioner, three RNs, Chikungunya—a mosquito-borne viral a neonatal nurse practitioner, disease characterized by acute onset of fever and nine non-medical and severe poly-arthralgia, and chronic support volunteers who just sequelae wanted to help others in need. “Diabetes and related Parasitic cyst on the arch of the foot, chronic conditions have been identification is pending largely neglected by epide- Chronic foot and leg wounds secondary to miologic and surveillance trauma & venous insufficiency programs in Central Amer- Decubitus ulcers in adult paraplegic patients ica,” says Dr. Sanders. In (secondary to gunshot wounds to the back) addition he says, “There is very little published data on Diabetes - primarily T2DM, in 34% of all the prevalence of diabetes, adult patients diabetic foot complications, Diabetic foot ulcers and amputations, especially in Diabetic peripheral sensory neuropathy rural settings.” This in part led with LOPS to the high number of patients Heel pain (common) the podiatrists treated, that Infected ingrown toenails and the fact in the prior months before the Mission, Osteomyelitis the villages received word that Plantar fasciitis (common) specialists in foot care, Puncture wounds diabetes, wounds, and emergency care were soon on Scabies (interdigital involvement, feet and their way. hands) Dr. Kramer was astounded Symptomatic bunions by the severity of lower Symptomatic cavus feet extremity problems that they encountered: wounds caused Tinea Pedis / Onychomycosis by parasites, wounds on Miscellaneous skin lesions patients who NEVER wore shoes, wounds from years without any treatment or healing, and painful wounds 4 PPMA Update August 2016 Photo Photo symptomatic peripheral sensory neuropathy, most with loss of protective sensa- tion. There were approximately 100 dental patients seen with periodontal disease, © many for tooth extractions. Tooth decay and gum disease are endemic problems Ensley Lee Karen in Honduras. Diabetes plays a crucial role in the pathogenesis of periodontitis, and there is a documented “two way” relationship between the two. Education Part of the Mission Of course a Mission wouldn’t be complete without training and education. Dr. Sanders presented two lectures “Foot Care for Persons with Diabetes: Prevention of Complications” and “Diabetic Foot Disease and Foot Care in a Rural Setting” for local doctors, nurses, and health officials. Both lectures were well received. Of course, working side by side with a multidisciplinary team made for many educational moments by sharing and collaborating on some of the same patients.
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