Penn Dermatology Global Health

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The goal of the Penn Dermatology Global Health program, developed in 2008, is to provide and improve dermatologic care in developing countries through teledermatology, clinical care, education, and research.

Director: Carrie Kovarik, MD
Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases
University of Pennsylvania
Carrie.kovarik@uphs.upenn.edu

 

Teledermatology in Developing Countries

Africa Teledermatology

The Africa Teledermatology Project was initiated in January 2007, with the aim of creating abroad dermatologic teleconsultation network linking medical centers in sub-Saharan Africa involved in treatment of skin diseases, especially Human Immunodeficiency Virus (HIV) - related cutaneous disorders, to specialized dermatology units in Africa, Europe, and USA. Participating African medical centers are located in Botswana, Malawi, Kenya, Lesotho, Swaziland, Tanzania, and Uganda, whereas primary collaborating institutions include Departments of Dermatology, Medical University of Graz, Austria, and University of Pennsylvania, USA. Since 2007, over 1200 cases have been processed using the project website. A mobile application has been developed for this site and is used actively in many sites in Africa. We also support an initiative to process biopsies for cases submitted through the site that urgently need a tissue diagnosis. This site has been supported in part by the American Academy of Dermatology and the Commission for Development Studies, Austrian Academy of Sciences.

Mobile Teledermatology

Since 2008, we, as part of the Botswana-UPenn Partnership, have been working to institute mHealth initiatives in Botswana, particularly in the field of mobile telemedicine. Our mobile phone-based health initiatives in Botswana focus on four thematic approaches: specialist access to provide rural practitioners with specialized consultations, medical education and capacity building, SMS-based patient drug adherence and appointment reminders, and epidemiology and public health interventions. Our local partners include:  the Ministry of Health of Botswana (MoH), BOTUSA (US CDC- Government  of Botswana Partnership), University of Botswana, the Orange Foundation, and Positive Innovation for the Next Generation (PING). These programs have been funded by many sources including: the Botswana MoH, Orange Foundation, President's Emergency Plan For AIDS Relief(PEPFAR), the Botswana-UPenn Partnership, the University of Pennsylvania Center for AIDS Research (CFAR), the University of Pennsylvania Global Initiatives Fund (Office of the Provost), the University of Pennsylvania Perelman School of Medicine, the University of Pennsylvania Center for Public Health Initiatives, the University of Botswana, the American Academy of Dermatology, and the National Library of Medicine (US).

Botswana has approximately 0.4 physicians per 1,000 people. By comparison, Brazil has 2.06 and Norway has 3.9 (data from The World Bank Development Indicators). Most specialists are concentrated in the referral hospitals in Gaborone and Francistown, while, due to limited resources, access to care in rural areas is much lower. Mobile telemedicine programs provide rural clinicians with specialist access for oral medicine, cervical cancer, dermatology, and radiology consults.

Our objectives for the mobile telemedicine program include:

  • Developing provider-focused ICT tools for use within Botswana’s public health sector.
  • Expanding access to specialist care via telemedicine consultations with physicians.
  • Using technology to increase the efficiency and decrease the cost of health care provision.
  • Evaluating the relative strengths and weakness of various mHealth solutions.
  • Embracing open-source mHealth and electronic medical record technologies.
  • Proving that ICT tools using mobile phone platforms are efficacious, economical, and sustainable in Botswana, serving as an example to regional and global counterparts.

Establishing Teledermatology Sites

Clinical sites for teledermatology can be established remotely (through online training and shipping necessary materials) or by sending medical students/physicians to conduct in-person training. We have performed extensive onsite training in Africa and Latin America, including the following countries: Botswana, Lesotho, Swaziland, Malawi, Uganda, Egypt, Tanzania, Liberia, Costa Rica, Guatemala, Mexico, and Peru.

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Clinical Programs

AAD Residents' International Grant clinic

In keeping with its dedication to international educational opportunities, the American Academy of Dermatology providesfunding for 12 U.S. and Canadian senior dermatology residents to participate in a four week to six week elective in a developing nation where the Education and Volunteers Abroad Committee (EVAC) is establishing dermatology support programs and teledermatology consulting services. The primary site is Gaborone, Botswana, where participants rotate between the Botswana-UPenn Program at the Princess Marina Hospital and the Baylor International Pediatric AIDS Initiative (BIPAI). Residents take part in dermatologic HIV care for both children and adults, and will visit outreach sites in southern Botswana. The grant allows residents an opportunity to learn about the care of tropical and HIV-related dermatologic conditions, as well as how to practice routine dermatology with finite resources. Residents are expected to prepare lectures and presentations, develop a database of photos, submit teledermatology consults, as well as present a report of activities to the Academy and their home programs. Details and application are available from the AAD. Since its inception, over 50 residents from dermatology programs throughout the US and Canada have completed the rotation.

 

Educational Programs countryside

Related Research Publications

  1. Kaddu S, Soyer HP, Gabler G, Kovarik C. The Africa Teledermatology Project: preliminary experience with a sub-Saharan teledermatology and e-learning program. J Am Acad Dermatol. 2009 Jul;61(1):155-7.
  2. Kaddu  S , Kovarik C, Gabler G, Soyer HP. Teledermatology in Developing Countries. In Telehealth in Developing Countries.  Royal Society of Medicine Press, 2009.
  3. Weinberg J and Kovarik C. The African Teledermatology Project: Providing Access to Dermatologic Care and Education in sub-Saharan Africa. Pan African Medical Journal 2009 Nov; 3(16).
  4. Carroll K, Pierce J, Kovarik C. Perianal Bowen’s Disease in a Child with Human Immunodeficiency Virus. Pediatric Dermatology Mar/Apr 2010; 27(2): 166–169.
  5. Kovarik C. Kaposi’s Sarcoma. In Evidence Based Dermatology, 2nd edition. PMPH-USA, 2010.
  6. Kaddu S, Mulyowa G, Kovarik C. Hypopigmented scaly, scalp and facial lesions and disfiguring exopthalmus. Langerhans cell histiocytosis (LCH). Clin Exp Dermatol. 2010 Apr;35(3):e52-3.
  7. Desai B, McKoy K, Kovarik C. Overview of international teledermatology.
    Pan African Medical Journal. July 2010;6:3.
  8. Wanat K and Kovarik CL. Kaposi’s Sarcoma in the Paediatric Population. Edited by The Cambridge Research Centre and published in line with AIDS 2010, Vienna, Austria 18 Jul 2010 – 23 Jul 2010. Also available as an ebook: http://viewer.zmags.com/publication/d4b7caf8#/d4b7caf8/1
  9. Tsang MW, Kovarik CL. Global access to dermatopathology services: physician survey of availability and needs in sub-Saharan Africa. J Am Acad Dermatol. 2010 Aug;63(2):346-8.
  10. Introcaso CE, Hines JM, Kovarik CL. Cutaneous toxicities of antiretroviral therapy for HIV: part I. Lipodystrophy syndrome, nucleoside reverse transcriptase inhibitors, and protease inhibitors. J Am Acad Dermatol. 2010 Oct;63(4):549-61; quiz 561-2.
  11. Introcaso CE, Hines JM, Kovarik CL. Cutaneous toxicities of antiretroviral therapy for HIV: part II. Nonnucleoside reverse transcriptase inhibitors, entry and fusion inhibitors, integrase inhibitors, and immune reconstitution syndrome. J Am Acad Dermatol. 2010 Oct;63(4):563-9; quiz 569-70
  12. Chang AY, Kovarik C. Providing Dermatologic Care in Botswana. Pan African Medical Journal. 2010;7:19.
  13. Introcaso CE, Kovarik CL. Dermatology in Botswana: The American Academy of Dermatology's Resident International Grant. Dermatol Clin. 2011 Jan; 29(1):63-7.
  14. Tran K, Ayad M, Weinberg J, Cherng A, Chowdhury M, Monir S, El Hariri M, Kovarik C. Mobile teledermatology in the developing world: Implications of a feasibility study on 30 Egyptian patients with common skin diseases. J Am Acad Dermatol. 2011 Feb;64(2):302-9.
  15. Tsang MW, Kovarik CL. The role of dermatopathology in conjunction with teledermatology in resource-limited settings: lessons from the African Teledermatology Project. Int J Dermatol. 2011 Feb;50(2):150-6.
  16. Kovarik C. Cutaneous infectious diseases in the returning international traveler. Cutis. 2011 Mar;87(3):112-3.
  17. Fischer MK, Kayembe MK, Scheer AJ, Introcaso CE, Binder SW, Kovarik CL. Establishing telepathology in Africa: lessons from Botswana. J Am Acad Dermatol. 2011 May;64(5):986-7.
  18. Kovarik C. “Treatment of Kaposi’s Sarcoma.” Evidence Based Dermatology, 2nd Edition. Eds. Howard Maibach and Farzam Gorouhi. Connecticut: People’s Medical Publishing Clearing House, 2011.
  19. Littman-Quinn R, Chandra A, Schwartz A, Chang A, Fadlelmola F, Ghose S, Armstrong K, Bewlay L, Digovich K, Seymour A, Kovarik C.  mHealth Applications for Clinical Education, Decision Making, and Patient Adherence in Botswana. IST-Africa 2011 Conference Proceedings.
  20. Littman-Quinn R, Chandra A, Schwartz A, Fadlelmola F, Ghose S, Luberti A, Tatarsky A, Chihanga S, Ramogola-Masire D, Steenhoff A, Kovarik C.   mHealth Applications for Telemedicine and Public Health Intervention in Botswana. IST-Africa 2011 Conference Proceedings.
  21. Tetzlaff MT, Nosek C, Kovarik CL. Epstein-Barr virus-associated leiomyosarcoma with cutaneous involvement in an African child with human immunodeficiency virus: a case report and review of the literature. J Cutan Pathol. 2011 May 30.
  22. Quinley KE, Gormley RH, Ratcliffe SJ, Shih T, Szep Z, Steiner A, Ramogola-Masire D, Kovarik CL. Use of mobile telemedicine for cervical cancer screening. J Telemed Telecare. 2011;17(4):203-9.
  23. Azfar RS, Weinberg JL, Cavric G, Lee-Keltner IA, Bilker W, Gelfand JM, Kovarik CL: HIV positive patients in Botswana state that mobile teledermatology is an acceptable method for receiving dermatology care. J Telemed Telecare. 2011;17(6):338-40.
  24. Moore RL, de Schaetzen V, Joseph M, Lee IA, Miller-Monthrope Y, Phelps BR, Lekalake SS, Ratcliffe SJ, Nguyen H, He Q, Rady P, Tyring S, Kovarik CL. Acquired Epidermodysplasia Verruciformis Syndrome in HIV-Infected Pediatric Patients: Prospective Treatment Trial With Topical Glycolic Acid and Human Papillomavirus Genotype Characterization. Arch Dermatol. 2011 Sep 19.
  25. Armstrong K, Liu F, Seymour A, Mazhani L, Littman-Quinn R, Fontelo P, Kovarik C. Evaluation of txt2MEDLINE and Development of Short Messaging Service-Optimized, Clinical Practice Guidelines in Botswana. Telemed J E Health. 2012 Jan/Feb; 18(1).
  26. Chang AY, Ghose S, Littman-Quinn R, Anolik RB, Kyer A, Mazhani L, Seymour AK, Kovarik CL. Use of Mobile Learning by Resident Physicians in Botswana. Telemed J E Health. 2012 Jan/Feb; 18(1).
  27. Lamel SA, Haldeman KM, Ely H, Kovarik CL, Pak H, Armstrong AW. Application of mobile teledermatology for skin cancer screening. J Am Acad Dermatol. 2012 Jan 11.
  28. Weinberg J, Gormley R, and Kovarik C. “The Computer Will See You Now: Ethics of Teledermatology.” Dermatoethics: Contemporary Ethics and Professionalism in Dermatology. Eds.  Lionel Bercovitch and Clifford Perlis. New York: Springer, 2012.
  29. Weinberg J, Kaddu S, and Kovarik C. “Teledermatology in Developing Countries.” Telemedicine in Dermatology. Eds. Hans Peter Soyer, Michael Binder, Anthony C. Smith, and Elizabeth MT Wurm. New York: Springer, 2012.
  30. Wootton R, Geissbuhler A, Jethwani K, Kovarik C, Person DA, Vladzymyrskyy A, Zanaboni P, Zolfo M. Long-running telemedicine networks delivering humanitarian services: experience, performance and scientific output. Bull World Health Organ. 2012 May 1;90(5):341-347D.
  31. Chang A, Littman-Quinn R, Ketshogileng D, Chandra A, Rijken T, Ghose S, Kyer A, Seymour A, Kovarik C.  Smartphone-Based Mobile Learning with Physician Trainees in Botswana. International Journal of Mobile and Blended Learning, 4(2), 1-14, April-June 2012.

Last updated:  September 13, 2013

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