Neglected tropical dermatology in Ghana, medical alert

A devastating situation in the area of dermatological care motivated the Department of Dermatology at Utah University to collaborate with the Health Faculty (Cohk) in Kintampo to introduce the graduate program in dermatology and psychiatry to train attending physician assistants to fill the wide gaps in the system

An article published by Mr. Sam Stephen Dodoo, a physician assistant (medical) in Ghana with a focus on Tropical Medicine and primary health care, drew attention to Tropical Dermatology, which he said is the most neglected area in medical practice. According to the publication, skin disease is a significant cause of morbidity in Sub-Saharan Africa. “Studies conducted in Mali have shown that skin disease has an overall prevalence of 34,0% and is the cause of 11,7% of primary health care outpatient consultations. Skin infections such as pyoderma and scabies are endemic in African adults and children. International public health initiatives were created to reduce the prevalence of high morbid skin diseases, such as Buruli ulcers and lymphatic filariasis in Africa,” the publication reveals.

To learn more about the subject, the Communication Advisory of the Brazilian Society of Tropical Medicine (SBMT) interviewed Mr. Sam Stephen Dodoo, who is a member of the research and education committee of the Ghana Physician Assistant Association. Mr. Sam Stephen Dodoo says that dermato-venereology is an area in which he offers care and sees hundreds of cases in community outreaches that he visits in underserved communities in the sub-regions.

Check the interview in full:

SBMT: Why did you choose dermato-venereology?

Mr. Sam Stephen Dodoo: My practice is centered on primary health care in tropical medicine (community medicine and health). Most patients who visit the clinics and health centers either reports with a skin related condition or has an associated skin lesion which may not be their main concern. Lack of health experts in skin care has contributed to the high neglect of such conditions in the country. I was confronted with many of such cases so I was motivated to acquire more knowledge in dermato-venereology to be able to help the patient in the deprived and rural communities. I joined Rabito clinic which is noted for skin care to have a training session and clinical trials with one Prof Edmund Delle (Prof in dermato-venereology and tropical medicine) for about 1year. This additional knowledge helped me to render care to them on outreaches. My training was a mentoring training in Dermatology.

SBMT: Could you tell us about your work in underserved communities in the sub-regions of Ghana?

Mr. Sam Stephen Dodoo: I have rendered a lot of health care services to people in deprived communities in Ghana. I have been to several communities and towns such as Wassa akropong (a gold mining community)  situated in the Wassa Amenfi East Municipality in the Western Region of Ghana. Ive also been to Techiman in the bono east region of Ghana. Ive been to Jamra and Assikuma in central region of Ghana , Kintampo in the Bono east of Ghana , obuasi in Ashanti region, Dunkwa Offin in central region, etc. I organized outreaches in those communities across the country to help them because most of the population suffers from neglected tropical cases like scabies, cutaneous larva migrans, lymphatic filariasis, yaws, leishmaniasis , schistosomiasis, onchocerciasis , chemical related skin condition due to the mining activities of the people, etc just to mention a few. These mining communities has high prevalence of sexual transmitted infections such as HIV, syphilis, gonorrhea, Chlamydia infections and its related skin manifestation which is a serious public health concern but are all neglected in the deprived areas.

SBMT: Besides you, how many other doctors work in this area in the region?

Mr. Sam Stephen Dodoo: Ghana has less than 25 certified Dermatologist with all of them concentrated in the main cities of the country with none in the district or subdistricts and deprived communities. They are mostly found in the teaching hospitals so levels of care are restricted to the people in the neglected areas of the country. I identified that problem that led to my rural outreaches into the communities to help them. Ghanas population is projected to be 32 million in few years ahead so the patient Dermatologist ratio is woefully inadequate and that has led to such neglect.

SBMT: What are the most commonly observed disease categories?

Mr.Sam Stephen Dodoo: Throughout my outreach clinics Ive observed a wide range of diseases which differs from regions and districts. But the most common ones i see are Eczemas, scabies, cutaneous larva migrans, lymphatic filariasis, yaws, leishmaniasis, schistosomiasis, onchocerciasis, HIV and its related skin diseases, genital warts, mining related skin diseases, acne, chancroid, syphilitic chancre, few autoimmune disorders such as lupus, Vitiligo,  psoriasis etc. High prevalence of fungal and bacterial skin infections and STIs

SBMT: In your opinion, how to improve the access of the needy population to decent treatment?

Mr. Sam Stephen Dodoo: First of all human resources and expertise is Paramount. The middle level cadres such as physician assistant medical should be allowed into postgraduate Specialty program such as dermato-venereology and tropical medicine to offer care to them. In Ghana, physician assistant are custodians of rural health so its easier to equip them. The Utah University in collaboration with college of health trained a number of physician assistants in the Dermatology model but unfortunately, they are not duely recognized by the ministry of health in Ghana which has rendered them unproductive.

Secondly, a tropical medicine research center should be established in the regions and subregions to detect and trace those cases for immediate response and management.

Thirdly, the training schools for medicine and community medicine should include a comprehensive course on tropical medicine to well equip practitioners to render care especially the preventive aspect.

Fourthly, more investment into research should be done to help reveal the disease pattern in tropical cases and how it can be management within the context of Ghana and Africa. Because throughout my practice I realized some of the management protocol in the books do not necessarily work for our setting, so I have done some extensive study to come out with my own treatment plans which is giving me results.

SBMT: Does Ghana have programs for tropical diseases?

Mr.Sam Stephen Dodoo: Currently no university is offering a higher degree in Tropical medicine in Ghana, even though there is a bit of it in the curriculum at basic training level. The ministry of health and Ghana health services has a number of programs rolled out to detect some cases early and initiate treatment but I think its not really been effective so most of the target population do not get those services.

SBMT: Would you like to add something?

Mr. Sam Stephen Dodoo: After my training in Tropical dermato-venereology at Rabito clinic in Ghana I then decided to help other clinicians across the country to be able to manage basic skin conditions so I created a WhatsApp and telegram platforms which included doctors, physician assistant, nurse practitioners, pharmacist, family physician, medical students, disease control officers, etc. The whole idea was to train and share knowledge acquired with them so that patient will have easy access. I started 3yrs ago with over 780 clinicians on my platforms where I teach and discuss cases with them. Whenever they are faced with cases, they contact me for help across the whole nation. Its been a Herculean task for me but the passion keeps me going. Currently I have some clinicians who are into Dermatology from Utah, baypath university, also on the platform as well who are learning tropical Dermatology from me and am glad to share with them.

I currently have thousands of photos of neglected tropical cases in a gallery when I go on outreaches which I have plans of publishing an Atlas of tropical Dermatology.

The challenges I face mostly is with resources to reach those communities to help. Also they cant even afford the treatment given them which is a big challenge. I would be glad if the Brazil centre for tropical medicine will collaborate with my project to help train more and get more outreach visits to help the neglected population living with chronic skin diseases. Also am ever ready to collaborate with the centre for research trials and more publications on tropical Dermato-venereology. I would also use this opportunity to invite the journalists and other resource persons from the SBMT to visit Ghana for a coverage on the outreaches. I believe an atlas of tropical Dermatology can be published with such collaborations. Thank you for the opportunity.