Case Study
Global citizenship Pt. 1
Kurt Muetterties, MD
Global citizenship—saving limbs and improving lives in Guadalajara, Mexico
November 20, 2017

Strategic Radiology physicians travel all over the world to share knowledge and expertise at international conferences and global community mission projects.

Every January in the dark of winter, Kurt Muetterties, MD, boards a plane headed to Mexico—and it's not for sun and sand. Muetterties, president of Southeast Radiology, a Strategic Radiology affiliate based in Media, Penn, leads an annual vein clinic operated out of a large church in Guadalajara, Mexico, since 2010. It provides diagnoses and treatment for thousands of patients with venous insufficiency and very limited access to health care.

I’ve seen patients who have journeyed on 16-hour bus rides from small villages in southern Mexico...Many of these villages don’t have a hospital.

Kurt Muetterties, MD
President,Southeast Radiology

“I’ve seen patients who have journeyed on 16-hour bus rides from small villages in southern Mexico,” Muetterties says. “Many of these villages don’t have a hospital.” 

Muetterties took a roundabout route to Mexico through his involvement with the Hackett Hemwall Foundation, a nonprofit service–learning organization founded in 1969. The Foundation’s primary focus was the development and delivery of prolotherapy, an injection treatment for chronic pain that Muetterties does not perform.  
However, an opportunity arose to use some of his vein skills and treat patients for venous insufficiency, and he went to Guadalajara to work in a vein clinic. Muetterties subsequently assumed leadership of that operation and has been going back ever since. 

Unique opportunity

Venous insufficiency is a common condition that can turn serious if untreated. Muetterties estimates that 40% of the adult population in the United States has the condition. Genetic and environmental factors—such as standing on your feet all day—can make the underlying problem more prevalent.   
In a normal, healthy vein, one-way valves prevent the blood from moving backwards and pooling in the lower legs. In those patients, the valves begin to “leak”, allowing blood to move in the wrong direction. Elevated venous pressure results, which can lead to swelling, bulging varicose veins, chronic inflammation, dermatitis, scarring, discoloration, and ultimately stasis ulceration.  

“Little wounds develop around the ankles and any minor trauma can cause a break in the skin,” Muetterties explains. “Because the tissue is so impaired, it sets up a chronic non-healing situation: it gets infected, the ulcers get bigger and bigger, and it never really heals. Until you treat the underlying problem, meaning you fix the veins, you are not going to correct the tissues and allow the ulcers to heal.”  
Manual labor, in fields or factories, where people stand on their feet all day, is one factor in the prevalence of the problem in Mexico. Very limited access to any form of health care is another. Consequently, there is a high incidence of people with late-stage disease involving big ulcerations and non-healing wounds. 

“As these complications begin to manifest, the patients struggle to keep the wounds clean,” he explains. “Unfortunately, these patients often do not even have access to the most basic forms of care, including wrapping in proper sterile gauze and wearing compression stockings.”

Global citizenship pt.4

Cost-effective, safe, portable

Working in make-shift treatment areas in the church, the treating physicians use portable ultrasound to scan the patient’s legs, find the leaky veins, map their anatomy, and then close down the faulty vein by injecting a treatment solution, forcing the blood to re-route through one of many alternate pathways.

“What is really unique about treating venous disease is that there’s one technique that is cost effective, safe, and very portable,” Muetterties says. “By bringing a portable ultrasound machine, we can not only identify the problem but we can utilize the imaging to accurately and safely guide very small needles into the problematic veins and inject a treatment solution.  
Patients stay awake during the 5 to10 minute procedure, they experience little to no pain, and they walk out of the clinic wearing a compression stocking for a week. 
Most have dramatic improvement in their symptoms, meaning less pain, fatigue, and swelling. Typically, patients with advanced disease—chronic inflammation or large ulcers—will notice rapid healing of their wound. 

Global citizenship pt.5
The 2017 interventional vein team in Guadalajara, Mexico, included: second row (from left) Bob Dietz, a local volunteer, Eric Wang, MD, Charlotte Radiology, NC, Adrienne Muetterties, Kurt Muetterties, MD (Southwest Radiology), Michael T. Dowd, MD, Tacoma, Wash. (kneeling); first row (from left) Sue Dietz, local volunteer, Jasmin Sanchez, MD, local physician, Ellen Muetterties, Christie Dowd.

Boots on the ground

It takes many volunteers many hours working in advance of the one-week in January to make the clinic what it is: A well-oiled, efficient operation.  
At least six months in advance, the Hackett Hemwall Foundation works in coordination with the partner church to advertise the clinic in newspapers, flyers, and radio ads and begin signing up patients that have been carefully pre-assessed for venous insufficiency. 
During the clinic, numerous volunteers help to set up the waiting, dressing, and treatment areas; help the patients get into their gowns; move them from room to room; and size them for compression stockings. 
“The volunteer community has become my family, some of the most giving and generous people I have ever met,” Muetterties says. “They host this, they are the boots on the ground, and they are the real heroes of this mission.”