Case Study

It’s important when discussing new objectives in any project, to see where the aims and objectives are currently being successfully utilised, an example of dermatology integrated with the ethos of this initiative and incorporating the objectives promoted by the task force for Skin Care for All.

Two of these include The Regional Dermatology Training Centre in Tanzania and the the Institute of Applied Dermatology in Kasarargod in the Indian state of Kerala. 250 Africans from 14 countries have been taught to be practitioners and teachers of Community Dermatology. They learn both advanced and up to date technology but do not ignore low and affordable technology like cutting toe nails to fit shoes.

In India the focus, especially on lymphoedema due to a neglected tropical disease, draws attention to an extreme example of skin failure amenable to restoration of function. It is devastating the lives of agricultural workers in remote villages and fisher folk by the sea who take to their beds with the enormous disfigurement of elephantiasis and suffer from intermittent high fevers and painful inflammatory episodes due to bacterial infection. Medicines that break the transmission of the disease by mosquitos are available but they do not improve the size of the legs.

A few are managed by debulking surgery or occasional costly microsurgery to the lymphatics. The majority of seven million affected persons are untreated. Community Dermatology at the Institute providing skin care has measured the burden of disease, studied quality of life, focused on empowerment of women, sought clean water and applied the low technology of washing the skin. Using integrative medicine, Yoga and local herbals, as well as advice on healthy eating, have all been applied in a frame work of biomedicine’s physiology. Advice to inaccessible areas has been given through telemedicine. Neglected buildings have been rented and upgraded to become attractive treatment centres. Using locally available sustainable and low cost measures, coupled with self help and community participation, their legs return to an acceptable size and earning a living becomes once again possible. Careful measurement, statistical analysis and partnerships with the leaders of evidence based medicine and participation with International frameworks of disease have led to international accreditation and increasingly strong support from the government of India.