Technology Expands AMPATH Dermatology Care
New technology allows people in rural western Kenya to access dermatology screening, triage and linkage to care without the difficulty and expense of travelling to a referral hospital to be examined by a dermatologist in-person.
Doctors trained in dermatology are extremely rare in Kenya and throughout East Africa and patients often have to wait a long time and travel long distances at great expense to be seen. Sampson Kiprono, MD, head of dermatology at Moi Teaching and Referral Hospital (MTRH) and Toby Maurer, MD, professor of clinical dermatology at Indiana University (IU) School of Medicine, worked with other colleagues at AMPATH to establish a teledermatology (telederm) system to allow for the remote diagnosis of dermatologic conditions.
Supported by the Department of Dermatology at IU School of Medicine and IU Health, the system allows clinicians at remote clinics to utilize an iPad to photograph patients with skin issues which are then reviewed by a local dermatologist at MTRH. Maurer estimates that 65 percent of patients can be treated by their primary care providers without having to make a long and expensive journey to see a specialist in person.
Dr. Toby Maurer worked with AMPATH colleagues to install a teledermatology system at AMPATH.
“Because we have this platform and technology, we don’t need to have resources beyond what we have now,” said Maurer. “It would be great to have 30 dermatologists, but we don’t. Right now we can do a lot of this with one dermatologist, the technology and trainees in our upcoming MMed program,” she added.
The telederm technology is supported by a robust team of trained patient navigators, research nurses and clinical staff, a phototherapy unit donated by the University of California-San Francisco and a well-established biopsy system. “It was so incredibly important to have this telederm system so that the rest could follow and link us to all of the work that has happened for the last 10 years. For me it’s a dream come true,” said Dr. Maurer. “Credit goes to Dr. Kiprono who has shown so much dedication and commitment and has been the springboard for all of this,” she emphasized.
The first site utilizing the system is the AMPATH Clinic in Chulaimbo in Kisumu County. The area was selected because of a high prevalence of people with Kaposi Sarcoma (KS), a type of cancer that causes lesions on the skin and other parts of the body. The disease often affects people living with HIV/AIDS. Dr. Maurer expects that the system could eventually serve up to 1,000 patients per month just in Chulaimbo. The plan includes future expansion to Busia County, Homa Bay (AMPATH oncology) and other areas.
The telederm system has also allowed Dr. Kiprono and his colleagues to create a Kaposi Sarcoma Center of Excellence (KCE) in Chulaimbo and at MTRH. Because many people seek initial treatment due to a skin problem, the department of dermatology often serves as the entry point for patients. “The objective of this center is to provide diagnostics for patients with KS, clinical service and treatment, including chemotherapy, designed for each patient as well as a setting for research into KS,” said Dr. Kiprono.
One of the key initiative of the KCE is also supporting insurance coverage through the National Hospital Insurance Fund (NHIF). “NHIF will allow people with KS to get appropriate chemotherapy they could not afford without NHIF,” said Dr. Kiprono. “The KS mortality rate is 40 to 50 percent and we are hoping that we can reduce that by supporting NHIF premiums.” He added that travel for chemotherapy is still one of the biggest barriers that patients face and that challenge has been exacerbated by COVID-19.
Dr. Maurer has also worked with colleagues at the Infectious Disease Institute (IDI) in Kampala, Uganda, to implement the telederm system there. Working with National Library of Medicine to analyze photos from Kenya and Uganda, the eventual goal is to develop enough images to teach computers to make diagnosis through artificial intelligence. The telederm system also plays a key role in a U54 research grant from the National Cancer Institute. “It’s going to be the basis of a lot of our future work and our grant proposals,” concluded Dr. Maurer.