Situated in the Mara region of Tanzania, in the northwest between Lake Victoria and the Kenyan Border, the rural village of Shirati is home to the Shirati Hospital. Mennonite missionaries founded Shirati Hospital in 1934, making it among the oldest mission hospitals in the country.
Shirati Hospital has 200 beds and five doctors for the six wards which include: Maternity, Pediatric, Female, Male, Leprosy, and Out-patient, in addition to an HIV/AIDS clinic, two operation theatres and an on-site, two-year nursing school.
Approximately 11% of the patients at Shirati have HIV/AIDS. These patients commonly present with various skin conditions, such as Thrush and Kaposi’s Sarcoma. While Dr. Bwire Chirangi, Chief Medical Officer at Shirati, and his team treat many illnesses, primary care physicians are not as able to identify common skin diseases when compared to dermatologists. For this reason, primary care physicians frequently refer patients to dermatologists for evaluation or a second opinion. However, in Shirati, as in many rural villages around the world, there are no dermatologists.
The Road to Dar es Salaam
In the past, To treat skin issues, patients have been referred to the closest regional hospital, Mwanza – a 5 hour bus journey. The roads from Shirati to Mwanza are bumpy at best, and can be treacherous during the rainy season. For those that need even more specialized treatment and who are healthy and wealthy enough to travel, the closest specialty clinics are in Moshi and Dar, which are 9 and 17 hours by bus, respectively.
Additionally, busses only run one or two times per day and are relatively expensive, unreliable, and dangerous. The majority of patients remain in Shirati, with rudimentary treatment and possibly without an accurate diagnosis.
Hope – and Second Opinions – Come from Connected Health
Over the last six months, Dr. Chirangi has been working with international mHealth start-up iDoc24 to use teledermatology consultations to aid in patient diagnosis and referral rather than sending patients to Dar blindly.
Chirangi uses iDoc 24’s mobile app, First Derm, and a dermascope, a LED-lit polarized magnifying lens, to take photographs of his patients’ skin issues. The photographs are sent through the app to board-certified dermatologists who review the cases and offer second opinions to help triage the patients.
The majority of cases in Shirati are lesions or sores associated with infections or nutritional deficiencies. For Chirangi, triaging with First Derm means that his patients can remain at the village hospital under his care while he administers proper treatment regimens. It also provides an opportunity for educational training for his clinical staff. For Chirangi’s patients, using First Derm allows them to conveniently get the care they need, when and where they need it, without the added expense and worry of risky travel.
However, for those that do require additional care, the physicians in Shirati are now able to make better referral decisions regarding the necessary specialists and facilities needed. Though referrals will still consist of a long, rough ride to a district or regional hospital, doctors will be able to refer with confidence that the patient will receive treatment they are unable to provide.
Rural Health Goes Global
First Derm has the power to help physicians around the globe – and especially those in remote rural areas – to triage their patients. Even in the United States, the service is used in rural communities where patients would still have to travel hours for specialized dermatologic care. In one survey, 89.3% of primary care pediatricians reported that there were too few pediatric dermatologists in their region to meet demand. A general pediatrician using teledermatology could provide this care in his patients’ communities, without long wait times and extended travel.
Currently, the service is offered on a sliding scale subscription to general practitioners in low-income countries depending case volume. Overhead costs for doctors are low due to the ubiquity of smart phones. Doctors can download the app and start sending cases within minutes. The biggest challenge thus far has been the reliability of the telecommunication networks in developing countries, though network coverage has been improving every year because of rising demand.
You don’t need to be a physician with a dermascope to use First Derm. In fact, you don’t even have to leave your house. Anyone with an iPhone can download First Derm for free from the App Store, and instantly have access to a library on skin issues and instant dermatological care for a small fee ($25-$40). Users simply take two pictures – one overview and one close-up – and send them in for review. It’s quick, economical, and gets you personalized health information when you need it, wherever you are, anonymously.
Disclosure
Nicholas Hu is a Co-Founder of the digital health company, iDoc24.
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