Case Study

It’s important when discussing new objectives in any project, to see where the aims and objectives are currently being successfully utilised. Examples of dermatology integrated with the ethos of this initiative and incorporating the objectives promoted by the task force for Skin Care for All are figures 1-3 opposite.

Figure 1 is at the Institute of Applied Dermatology in Kasarargod in the Indian state of Kerala. The focus is especially on the lymphoedema due to the neglected tropical disease, Lymphatic Filariasis, 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.

The majority of twenty million affected persons are untreated. Community Dermatology at the Institute takes advice on skin care to previously inaccessible areas using integrated medicine, Yoga, local Ayurvedic herbals, advice on healthy eating, and the low technology of washing the skin, applied in a framework of biomedicine’s physiology. Neglected buildings have been rented and upgraded to become attractive treatment centres. With such help and community participation, 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 and the Bill and Melinda Gates Foundation.

Figure 2 at the Reginal Dermatology Training Centre in Tanzania shows a group of students being taught care of the skin of a paraplegic liable to pressure ulcers. Figure 3 shows students being taught low and affordable technology such as cutting toe nails safely to enable the comfortable fitting of shoes.