UTSW urologist leads medical mission to Honduras to restore hope and healing
Inspiration reveals itself in some of the most unlikely places. For Steven Hudak, M.D., it came in an austere operating room in San Pedro Sula, Honduras.
As a resident in 2006, he joined a medical mission led by his UT Southwestern mentor, urologist Allen Morey, M.D., to the Central American city 1,900 miles southeast of Dallas. Over the course of a week, he helped perform more than 20 complex urethral reconstruction surgeries – delicate procedures that restored livelihoods and dignity to a clinic full of grateful patients.
“It is definitely what inspired me to go into reconstructive surgery,” said Dr. Hudak, who completed a fellowship in urologic trauma, prosthetics, and reconstructive genitourinary surgery at UTSW and is now a Professor in the Department of Urology. “Every year I go back, it really rekindles that inspiration.”
This past summer, when he returned to Hospital Leonardo Martinez Valenzuela for his 11th trip to Honduras, Dr. Hudak paid it forward as mentor and leader of the outreach mission. And he now holds the Distinguished Chair in Urology for Urologic Reconstruction, in Honor of Dr. Morey, who first established the global health exchange. (Dr. Morey retired recently from UTSW.)
The 2024 surgical sojourn was particularly meaningful because it was the first since the COVID-19 pandemic upended missions of mercy like this one.
“Honduras has an incredibly resilient population,” Dr. Hudak said. “The surgeons are very dedicated and very skilled, but they are overwhelmed because of the small ratio of urologists to patients.” About 70 trained urologists serve a country of 9 million people – or about 1 urologist per 130,000 residents, he estimates. By comparison, an average U.S. city has about 1 urologist per 30,000 people. And even fewer surgeons in Honduras can perform a procedure as complex and specific as urethral reconstruction, which involves repairing or replacing the long tube that carries urine outside the body from the bladder.
Packed schedule, ‘intense gratitude’
Many of the Honduran patients scheduled to see Dr. Hudak in late July had suffered severe injuries, usually from a workplace or vehicle accident. One who was struck by a car, for instance, had his urethra separated from his bladder internally, severing the connection in the perineum, the tiny patch of skin between the genitals and anus. When an injury like that happens in Honduras, urologists or general surgeons typically put a tube into the bladder below the belly button as a stopgap measure. The patient might have to live with the catheter for many years, or even the rest of his or her life.
During the week they were in Honduras, Dr. Hudak and his team, which included current and recent fellows in UTSW’s Genitourinary Reconstructive Surgery (GURS) Fellowship program, were able to screen about 40 patients and perform 25 complex urethral reconstructions. They were joined by a small group of Honduran surgeons as well as urologists-in-training visiting from Cuba.
A critical partnership for this mission has been local urologist Daniel Chinchilla, M.D., who preps the patients several months prior to the U.S. team’s visit and sends pertinent medical records and information weeks ahead of the visit. The team arrives in San Pedro Sula on a Saturday, sees patients in clinic on Sunday, and then embarks on an intense but efficient schedule of surgeries Monday through Friday.
Before coming to UT Southwestern, Dr. Hudak had a decorated 15-year active-duty military career. A large U.S. military base in Honduras helped make it possible for Dr. Hudak to participate in numerous medical missions while he was on active duty, along with U.S. Army medical personnel from Brooke Army Medical Center at Joint Base San Antonio-Fort Sam Houston.
Each complex urethral reconstruction takes about three hours, during which the surgical team carefully repairs or replaces the damaged tissue and reconnects patients’ urethral tubes. The success rate is high – with more than 90% of patients permanently cured of their conditions. Follow-up care is minimal. The return on the surgery, which is performed pro bono, is priceless for patients and doctors.
“We’re fixing a problem that has typically plagued these patients for years. You see a sense of intense gratitude in their eyes,” he said. “Many of them travel several days from remote parts of the country for this opportunity, and it’s quite inspirational to hear their stories and make an impact in their lives.”
An invaluable learning experience
But it’s hardly a one-way street, Dr. Hudak said. The mission is emotionally and professionally invigorating for the surgeons. His team in the UTSW Department of Urology might perform 100 complex urethral reconstructions in a year; during that week in Honduras, they’ll do 25, sharpening their skills in challenging conditions.
“It’s a great front-line experience for all of us, but especially fellows and residents,” he said. “They learn how to do more with less. The scissors may not be as sharp and the lights might not be as bright, but the procedure is the same and we are intent on delivering the same quality outcomes for our patients.”
Alexandria Hertz, M.D., a current GURS fellow at UTSW, said her first trip to San Pedro Sula was a game changer.
“The week in Honduras provided us with the case variety and complexity that some fellowship programs won’t see in a year. To see that within the first month of my fellowship was invaluable,” she said. “I think we are all bringing those benefits back to our patients here at UT Southwestern. I am so grateful for the experience and hope to participate in a similar type of mission in the future.”
Beyond the turbocharged training, Dr. Hertz embraced the chance to connect with the locals and their culture. She grew up in Texas and majored in Spanish in college, so she was able to build trust with patients and establish a great rapport with nurses, fellow doctors, and OR staff, some of whom she has remained connected with via texts.
“The most impactful thing for me may have been realizing what a force Dr. Danny Chinchilla, the local urologist, is. He has been helping arrange these missions for nearly 20 years. He prepped all 40 patients we saw in clinic, and helped make sure the patients we operated on did well while in the hospital. And he continues to see all of them in follow-up, updating us on their progress,” she said. “He has changed countless patient lives with this, all while being an incredible host. He makes me want to be a better urologist and friend.”
That kind of inspiration is exactly what this mission is all about, said Dr. Hudak.