Out of Africa: U.S. derm seeks volunteers for telemedicine project to help countries in need

National report

- Have a yen for mission work, but can’t commit to the travel?

The Africa Teledermatology Project is seeking U.S. dermatologists who have been abroad, speak French, Spanish or Portuguese, and understand problems and diseases for which they can provide long-distance consulting services to clinicians in other countries.

More volunteers are needed so the project can expand into Central and possibly South America.

The American Academy of Dermatology (AAD) launched the project in January 2007 with mission of reaching underserved areas around the world.

But it was a U.S. dermatologist who developed the turnkey program and secured partnerships with dermatologists and clinicians. Today, Carrie Kovarik, M.D., project and site coordinator, continues to drive the project. She also volunteers, taking on a good number of the dermatology cases submitted by clinicians abroad for consultation.

The Africa Teledermatology Project provides much-needed dermatology consultations to English-speaking African countries, including Uganda, Botswana, Malawi, Swaziland, Burkina Faso and Lesotho. The plan, according Dr. Kovarik, is to branch out into French-speaking Africa and into Central and South America.

Dr. Kovarik, assistant professor, department of dermatology, University of Pennsylvania, Philadelphia, has teamed with Steven Kaddu, M.D., a dermatologist from Uganda who is now at the Medical University of Graz in Austria.

Dr. Kaddu works with the U.S. dermatologist on the Web-based program and handles the majority of consultations coming out of Uganda. While the AAD is the major funding source for the project, other organizations also are donors, according to Dr. Kovarik.

Labor of love

Dr. Kovarik visited Uganda in early 2007 to find sites where she and colleagues could develop a program of teledermatology outreach.

"I initially partnered with the Baylor International Pediatric AIDS Initiative, which has many clinics throughout Africa … where the main intention is to provide HIV care to children in Africa," she says.

By March 2007, Dr. Kovarik had visited three African clinics and taught the providers there how to submit teledermatology consults. She also lectured on dermatology and provided the needed equipment, including a camera, for long-distance consults.

"In most of these areas, the healthcare providers are physicians who are caring for HIV-infected patients and these patients have a lot of skin problems," Dr. Kovarik says. "Just like in the U.S., the foreign healthcare providers do not get a lot of dermatology education, so they have all these HIV patients coming in with dermatology problems, but (they) do not have the training to deal with all of it."

Dr. Kovarik next enlisted the University of Pennsylvania, which has a partnership with local providers in Botswana, to provide dermatology consults there.

"We are constantly expanding. We started with Baylor, went to Penn, and now I have partners all over Africa, just from word-of-mouth. Anybody who wants to participate can. We have something like 300 registered users now, and I think we are in about 12 countries in Africa," she says.

Volunteers needed

Since the program began in 2007, volunteer dermatologists have handled some 500 consults, Dr. Kovarik says. The success of the program means more volunteers are needed to help with the caseload so that telederm.org can expand into Central and possibly South America.

Dr. Kovarik says that she and Dr. Kaddu are seeking dermatologist volunteers who have experience in dealing with patients in African, Central and South American countries (either through missionary or other trips) and can speak French, Spanish or Portuguese.

She explains that until the program has a more extensive orientation process for volunteers, it’s best to use people who have experience in caring for and communicating with the native people.

"It would be hard if an academy member came and said, ‘I want to provide consults in Honduras,’ yet that person did not speak Spanish and (had) no experience with problems in Honduras. What we are looking for … is dermatologists who have been abroad and understand the problems and diseases that they would (consult on),&334; Dr. Kovarik says.

Residents help

An AAD program that provides dermatology residents with international grants will provide additional telederm.org volunteers because residents will have gained familiarity with targeted countries through their training, according to Dr. Kovarik.

The grants fund residents who apply to do a one-month rotation in Botswana. This program has been developed by the Education and Volunteer Abroad Committee, which assists in providing education and service to developing countries or to regions where there is insufficient dermatologic education and care, according to the AAD.

"We send eight senior dermatology residents from Canada and the U.S. to Botswana to provide dermatology consultation services on-site,"Dr. Kovarik says. "Those residents are there from four to six weeks, and when they come back, they have pretty good experience with the types of skin diseases that are seen in Africa.

"We also have a few dermatology residents from Belgium who are going to be going, and they speak French. Through them and some other people, we may be able to expand into the French-speaking African countries."

To foster the transition to Central and South America, Africa.telederm.org has been translated into in Spanish.

"So it will not be hard to get that going; we just need the dermatologists who are fluent in Spanish," Dr. Kovarik says.

Region-specific care

Dr. Kovarik says her consulting experience in Africa has included a lot of HIV-related dermatology.

"We very rarely see the full-blown examples of that in the U.S. Most of our patients (here) are on antiretroviral medications," she says. "(In Africa), we see a lot of HIV-related skin conditions in babies and children.

"There are many local parasitic diseases and diseases that have gone on for so long that they do not look typical anymore. It also helps to have a familiarization with what kinds of medications are available (in a specific area), and to understand access and limitations."

Drs. Kovarik and Kaddu plan to expand the orientation process in the future so that even those dermatologists who do not have experience abroad can volunteer.

"But at this point, the next step is to tap into those dermatologists who have the experience," she says.

For those qualified to volunteer today, Dr. Kovarik provides a short PowerPoint presentation on how to answer a consult via the Web site. A volunteer can be registered on the site as an expert after viewing the presentation.

From there, either Dr. Kovarik or clinicians on site in other countries would send U.S. dermatologist volunteers the consults.

"When (volunteers) get a consult, they would get a notice on e-mail that they have a case," Dr. Kovarik says. "They would log on to the Web site and look at the case and accept it as a consult.

"Once they have accepted it, they can look at the photos and answer it right away, or close out and do research and get back to the clinicians abroad," she says. "Some (consults) are very simple and take five seconds; some are more difficult, and they might want to send it around to some other people to get their advice."

All communication is through the Web site, other than the initial e-mail notification.

"The good thing about having it there on the Web site is that all the cases are archived. So for clinicians, all the cases that they submit will be archived, and they will have access to those," Dr. Kovarik says.

"We also have lectures and cases up on the Web site, so … they can go on and look at case after case of examples of derm diseases in Botswana or elsewhere."

Want to volunteer?

Dermatologists who wish to volunteer for the telederm.org project should contact Dr. Kovarik at Carrie.kovarik@uphs.upenn.edu.

Dr. Kovarik says the work is well worth the effort.

"The most gratifying thing is when clinicians send me follow-ups on patients that I have helped them with, and the skin diseases have resolved or improved. That happens all the time," she says. "They want to show you that patients are better because of the advice that you have given." DT

For more information:

Africa Teledermatology Project: http://africa.telederm.org