Humanitarian missions bring challenges

Dermatologists responding to crises overseas can face both logistic and cultural hurdles, say two military dermatologists, but they can offer aid in a variety of ways.

"On humanitarian assistance visits, there's a wide range of things in which a dermatologist might become involved," says Col. Scott A. Norton, M.D., M.P.H., an active-duty military dermatologist at Walter Reed Army Medical Center who has participated in more than a dozen overseas relief missions during the past 15 years in locations including Bolivia, Haiti and the Philippines.

Dermatologists in such settings likely won't play key roles in responding to acute disasters, he says.

"When I've traveled overseas," he adds, "the other physicians I've been with have always been astonished at how pervasive skin disease is," especially in the rural developing tropics.

Training practitioners

In addition to serving patients directly, Dr. Norton says, American dermatologists also can assist in training local practitioners - most likely general practitioners and medical extenders - to manage common problems including scabies, head lice, fungal infections and atopic dermatitis. To that end, he says, "The American Academy of Dermatology has created a series of laminated cards that are ideal for instructing local physicians on the most common dermatologic problems they might face."

He adds, "The American Academy of Dermatology has simplified things for our members by partnering with Health Volunteers Overseas, a nonprofit, nongovernmental organization dedicated to improving healthcare education abroad."

It's also crucial to understand sociocultural and economic aspects of the local healthcare system, Dr. Norton says.

"For example, in some countries patients must pay for medicines out of their own pockets," he says. That means that chronic conditions such as psoriasis can easily consume 20 percent of patients' income.

Conversely, Dr. Norton says that relying on donations for medications could result in intermittent and unreliable supplies.

"In a centralized medical system, people may need to go to the national capital monthly to pick up their anti-leprosy medicines," he says.

Other considerations

He adds that in developing nations, medically inconsequential conditions such as tinea versicolor can carry "a huge social stigma far out of proportion to what an American dermatologist might expect, because a hypopigmented disorder in a young person reminds many communities of leprosy."

And while the typical American dermatologist manages very few sexually transmitted diseases, Dr. Norton says that's often not the case when one travels abroad. Likewise, he says that although one rarely sees skin signs of HIV stateside, such symptoms frequently run rampant overseas due to a lack of highly aggressive antiretroviral therapy (HAART).

As for personal safety, he says dermatologists overseas must recognize that motor vehicle accidents represent the most frequent reason that Peace Corps volunteers are unable to complete their service.

Also, one sometimes must be flexible, says Jeffrey Meffert, M.D., an active-duty military dermatologist on staff at Wilford Hall Medical Center, San Antonio.

For example, he says that when he volunteered as a dermatologist for a military healthcare mission to Bolivia about three years ago, "As we were deploying, I found out that, because I was the senior officer who had any experience in general medicine, I was actually chief of medicine, as well as the dermatology consultant." During the mission he says he treated 80 to 120 general medicine patients daily.

For more information: http://www.aad.org/http:// http://www.aad.org/NR/rdonlyres/90E09181-C8E5-4FA8-95C2-0596C63DA4F8/0/Baedeker.pdf