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Nathan Hellyer, Ph.D. leads a medical mission Honduras
Nathan Hellyer, Ph.D., P.T., right, with Mayo students in Honduras.

February 2, 2024

By Mayo Clinic College of Medicine and Science staff

Since 2008, Nathan Hellyer, Ph.D., P.T., has been traveling to Honduras with Mayo Clinic students in the Physical Therapy Doctoral Program to provide medical care in a country with limited resources. Read about his experience.

Nathan Hellyer, Ph.D., P.T., an assistant professor in the Physical Therapy Doctoral Program in Mayo Clinic School of Health Sciences, has been leading groups of physical therapy students to Honduras since 2008.

To date, Hellyer has mentored nearly 60 students through the Mayo International Health Program, which makes it possible for Mayo students to travel to developing countries to gain a new perspective on providing medical care in a culturally different setting with limited resources.

The international clinical program that Hellyer participates in began nearly 20 years ago when a U.S. physiatrist cultivated a partnership with Honduras Outreach International and the Department of Physiatry at the Universidad Nacional Autónoma de Honduras. Hellyer has been with the program for 15 years.

Hellyer and other U.S. healthcare professionals work alongside Honduran physicians, physiatry residents, Honduran functional therapy instructors, and students. The multicultural and interprofessional team has participated in formal medical education conferences and provided rehabilitation services in an underserved region of Honduras.

Students learn to provide high-quality rehabilitation care, meet the needs of the Honduran healthcare system, teach sustainable ways, and promote Mayo's mission to serve the underserved. Many students say the trip to Honduras is a highlight of their education at Mayo, noting that they learned how to provide services with limited resources, learned from a diverse group of professionals, and made new friends and colleagues in Honduras.

From his perspective: Nathan Hellyer, Ph.D., P.T.Nathan Hellyer, Ph.D.

"The need is great, and I am always excited to invite new clinicians to travel with us. Personally, my global experiences in Honduras ignite my passion as a therapist and educator, and remind me how important all the little things are in healthcare when I return home to Mayo Clinic.

I was fortunate to be invited to rehabilitation service in Honduras where the Universidad Nacional Autónoma de Honduras was already involved. Therapy is a relatively new profession in Honduras, and the university is the only professional school in the country. It has been a challenge to train enough therapists to meet the needs of the entire country.

I am happy to report that we have already worked ourselves out of a job in at least one Honduran region. Together with Hondurans, we have provided continued annual service to the Agalta Valley for over 17 years and have seen a local physical therapist raise the level of rehabilitation in the area.

The Honduran therapist who now serves in the Agalta Valley was a Universidad Nacional Autónoma de Honduras student on a previous service trip with us. The university continues to support students who want to practice in this remote region. The Honduran people we serve have a greater understanding of what rehabilitation services can provide, which is especially important in an area where medications are limited.

So on our last trip to Agalta, we asked ourselves, "Do we need to be here?" The answer was, probably not.

So why do we continue to go? Because I want to continue to work in other areas of the country that have needs for rehabilitation services.

With our success story in the Agalta Valley, Honduras Outreach International had asked us to travel to a new region of Honduras — San Lorenzo — which, from a healthcare standpoint, is where the Agalta Valley was when we began our work. I have discussed this new opportunity with Universidad Nacional Autónoma de Honduras, and the medical director has agreed that this would be an excellent opportunity for us to begin to create sustainable pathways for physical therapy education and services.

We have much to learn and will likely face new challenges due to different regional needs, but we believe that we can make short-term gains in providing personalized care and establish long-term relationships to improve healthcare capacity. Further, we can continue to promote measurable results.

Universidad Nacional Autónoma de Honduras has been actively collecting data from our trips, and we look forward to better understanding our impact over the long term. We first visited the region immediately before the COVID-19 pandemic locked down travel in 2020. The spring of 2023 was my first return since the pandemic began.

The region where we currently work is one of the only districts to not have Universidad Nacional Autónoma de Honduras therapy students or physiatry residency placement. The people who live there are underserved. It is difficult for them to access rehabilitation in larger cities, so we are working together with hospitals and communities to increase rehabilitation services.

This year, we will provide services in remote communities to begin to address needs. Universidad Nacional Autónoma de Honduras will continue to work on permanent placements, and we will continue to work with them through future brigades to provide services and education alongside current staff.

Over time, we hope that the clinic infrastructures will improve and our contributions will be less needed, but I don't see this happening quickly.

The educational benefits of the Honduras service trip are numerous. Educational highlights include shared multicultural learning with Honduran therapy students, interprofessional collaboration with physicians, providing clinical services to a medically underserved population, mentored practice of examination and treatment skills, and exposure to pathologies and rehabilitation barriers unique to the Central American region.

The lessons I've learned are many.

During the years we weren't able to travel, we held a joint video class between Mayo Clinic and Universidad Nacional Autónoma de Honduras students where each group peer taught the videoconference class.

I've become more culturally aware. When you leave the comfort of your own country and clinic and travel, you tend to leave your comfort zone. You work harder to understand the way people view their health and what they value. When you return home, you realize that for patients, the clinic is not their comfort zone. As a clinician, you need to work hard to understand your patient's culture and beliefs as if you are on neutral ground, so to speak, so that everyone feels at home.

I don't take the basics for granted in terms of their impact on patients. We don't have access to all the resources, medical records, and equipment that we have at Mayo Clinic. However, by taking time to get to know people and understand their health concerns, the simple act of connection and care goes a long way in beginning the healing process. Small pieces of education and simple interventions can make a huge difference and being reminded of this in international experiences, I tend to be less likely to ignore the little things that matter in healthcare.

I have so many fond memories of Honduras, I think I could spend some time telling stories. For me, what stands out is that every year I travel, I wonder if the trip will come together and be a success and whether we will make a difference. Some years I have more worries than others.

However, when I land, and am greeted by my Honduran friends and colleagues, I am warmly received and feel hope for the week. There are always highs and lows, but we get to work, and at the end of the week, we reflect on all we have done and learned and how we have enjoyed our time together. Then, we say goodbye and start planning for next time."