|hand washing at KCMC - just think about it next time you load your machine!|
I am sorry it has taken so long to post again but the last 2 weeks have been extremely busy at work (yes I have been working hard - the blog just seems to have been full of our amazing Christmas holiday exploits!)
I was back at work on Monday 9th January and preparations were well underway for the 17th International CME meeting at the RDTC on 11th-14th of January. I was relieved to see that we finally had a programme which looked full and very interesting. Michael, Vicky and I spent much of Monday and Tuesday going through the 3 ADDV students research presentations on the re-emergence of leprosy between 2005-2010 in a district of Uganda, the skin changes seen amongst Albino pupils at a primary school in Kenya and health care seeking behaviour among adult patients infected with tungiasis in the Mbulu district of Tanzania. The students worked very hard and their presentations became much clearer. I was pleased to see that the residents forum which we had suggested before Christmas was in the programme on Friday afternoon and Alice, Julia, Esther and Emmanuel presented to us. Unfortunately it was felt that Emmanuel's presentation did not have good histological back-up so this one was removed and in it's place Nohrasco was presenting a fascinating case of an apparently eradicated disease dracunculosis (guinea worm). It was great for the residents and ADDV students as all the international experts began arriving on Monday and were very kind and gave intensive teaching sessions to all on the days prior to the meeting. It was wonderful to see Claire Fuller, my previous colleague and now Medical Director of the International Foundation of Dermatology (IFD) who had travelled out with Professor Rod Hay Chairman of the IFD. Claire kindly came bearing a large heavy bag packed by Stacey our wonderful nanny in England which had gourmet goodies including cheese - cheddar and red leicester, nutella, marmite and 2 large bars of dairy milk chocolate. In case you are wondering how the cheese made it out here Claire, who is practised in the art of cheese transportation to Africa, told Stacey to freeze it first and then it is wrapped up in tin foil for the journey during which it gently defrosts. Still I was glad to get it all into the fridge...
Claire also came bearing large volumes of specialist dressings for the baby with Epidermolyis bullosa and dermasilk suits. I only hope we can contact the Mother and try to persuade her to bring her baby back to clinic where we can at least give Mum the dressings and suits even if she doesn't want to bring the baby back to the dermatology clinic again. I find it heartbreaking how hard it is to help sometimes and I wish I spoke Swahili as being able to speak directly to Mum might make a difference.
|Professor Masenga introducing the CME conference|
The CME conference began in earnest on Wednesday morning in the main KCMC lecture theatre which became my second home for the next 7 days. It was great to see old friends and to make new ones and I was so impressed at how much the international community embraces and supports the RDTC. We were reminded at how much the International Dermatology community and the RDTC in Moshi had achieved since it was officially opened in 1992. At that time there were fewer than 150 Dermatologists/ health care workers trained in Dermatology in SubSaharan Africa (excluding S Africa). To date 217 medical officers from 16 African countries have graduated from the RDTC and many of them were there at the CME meeting.
|The 500 club that helped to finance the RDTC|
There was a truly African welcoming session with representatives from the KCMC and the Tanzanian representative from Stiefel spoke in front of a beautifully decorated blackboard with a fantastic picture of the RDTC drawn on it. The next session was on leprosy during which I was proud to say that Kenneth our ADDV student gave an excellent presentation and handled the questions with applomb. Leprosy is meant to be an eradicated disease in many areas but since being at the RDTC I have seen about 6 cases, some of whom are the infectious multi-bacillary sort. It was very important to discuss the fact that leprosy is a re-emerging problem and a lively discussion was had by all on how to approach it. Many health workers fail to recognise the disease and a school boy who we diagnosed had been seen for the year previously at another hospital. This case raised many issues about the stigma of leprosy and also the ethical problem of contact tracing in a school in this situation. The day progressed with talks on psoraisis, acne and our colleague Dr Vicky Yates gave an excellent presentation on Tuberculosis of the skin.
That evening we were all treated to a wonderful dinner under the stars in the truly magnificent garden of Professor John Masenga which when decorated looked like the set of a Bollywood movie. The food, drink and company was fantastic but we were up bright and early the next morning. The first session was introduced by Professor Ryan and was a insight into the subject of nutrition and the skin. Mr Brad Snyder gave a passionate and fascinating insight into a project entitled Gardens for Health (www.gardensforhealth.org) that they have set up in Rwanda. In Rwanda there is much malnutrition so in conjunction with giving the food aid plumpinut, based on peanut and enriched with vitamins and minerals, parents and children are taught how to cultivate a garden at home. There is a demonstration garden at the health centre where the families are taught and given the vegetables and foods that are needed for a balanced diet whilst their garden is growing. They are given the seeds and the expertise (a home garden package) to make their own gardens so that at the end of the 3 month food supplementation period given to the malnourished child the gardens are ready for harvest. Brilliant - Brad an enigmatic, slim, vivacious man also talked passionately about empowering women and children and also about the involvement of men into the project. Following this talk Prof Ryan's sister talked about an equally brilliant garden project in India: www.earthtrustnilgiris.org.
|Brad's gardens for health talk|
Other highlights of the day were our 2 other ADDV students presenting their research excellently making us very proud as some of the students find presenting in English an understandably daunting process. The day ended with the now legendary RDTC quiz which I have to say was very difficult!!! Then another dinner at El Rancho - famed for it's delicious Indian food ( I didn't think I would eat so much Indian food in Africa)
Friday's highlight has to be our 4 residents' polished presentations: Dr Alice presented our case of junctional Epidermolysis bullosa, Dr Julia presented our case of Tuberous sclerosis, Dr Esther presented a very sad case of Proteus syndrome and Dr Nohrasco presented the case of dracunculosis complete with brilliant pictures of the 40cm worm being extracted from the patient's leg.
|Nohrasco, Esther, Alice and Julia holding their prizes (left to right)|
Everyone enjoyed the session and the residents all won prizes together with a previous resident, Dr S Kiprono's fascinating research presentation on the difference in skin flora found in the albino population. Sebastian and I found this particularly interesting as the post-operative infection rate in albinos is 100% and is still 30-40% with prophylactic antibiotics. Friday night was spent dancing at Mumbai Masala - yes you have guessed it another Indian restaurant. It is always reassuring to see how much Dermatologists love dancing wherever they are in the world... . Brad was a brilliant dancer and impressed both us and the local African dancers!
I have to say that I was flagging by Saturday morning as the lecture theatre was very hot and did not even have a fan. There was a reunion of previous ADDV students who presented many of their more difficult cases. Later in the morning some of the IFD committee members visited Mafalda who was busy preparing the latest batch of suncream created from mostly locally sourced materials. This Spanish project is brilliant - 2 suncreams are created locally in a small building with local materials. The titanium dioxide and zinc oxide I think had to be brought into Tanzania and we were all worried about Mafalda being stopped at customs bearing large volumes of white powder..... The first batch of suncream has been distributed to the Albino population who have then been asked about their experiences with the cream and a questionnaire completed. Mafalda was about to distribute the second suncream so that the Albino population could trial this one to. Then the suncream that was most favoured was going to be manufactured locally in large volumes providing employment for Albinos indoors away from the harmful sunshine as most work outside as subsitence farmers. Mafalda was very pleased as she had recently returned from Spain where she had worked hard to raise more funds to build a larger building in the RDTC compound grounds to manufacture the suncream and also a workshop to sew protective clothes for the community.
|Professor Rod Hay with Mafalda with suncream number 2|
|Just as good as Clinique!!|
No rest for the wicked - whilst my family went to the hot springs and spent a happy Sunday afternoon jumping off a high tree branch into the water I went to the opening session of the 7th Georg Rajka international meeting on atopic dermatitis (AD). As this meeting followed directly on from the CME it meant that many participants were able to attend both event. I felt very fortunate as I am very interested in atopic dermatitis and it was great to hear fascinating talks on the prevalence of AD around the world. Alan Irvine gave a brilliant lecture on fillagrin defects and Claire gave a very entertaining and informative talk on podoconiosis and coped admirably with a lack of electricity and hence slides for half of her talk! The meeting was from 15-18th January and gathered together a field of international experts. However sitting from 9am - 6.30pm in an increasingly stifling lecture theatre was problematic and I have to confess to dozing off in 2 particularly complex immunology lectures that seemed way over my head but did have very pretty green and purple pictures....
It was so lovely to meet more friends and the team from Nottingham's UK Dermatology Clinical Trials Network Jo Chalmers, Kim Thomas and Helen Nankervis gave excellent lectures and more importantly brought out more goodies for us. Yes more chocolate and a very kind present of a kitchen scales so that we can bake our own bread, cakes and cookies... Other highlights of the conference were a fascinating talk from Professor Grossman on AD and traditional healers - with so little dermatological expertise in Africa most people with skin disease go to a traditional healer (1 traditional healer per 100 of the population versus 1 dermatologist to 1 million of the population). I also learnt about the brilliant psychoneuroimmunology work being doen by Prof Gieler in Germany and there was a whole session on psychosomatic aspects and patient education. I was pleased to see that I did much better in the RDTC quiz this time so I must be learning......
|Carsten Flohr showing the African Dancers some moves!|