A visit to Tanzania’s Regional Dermatology Training Center

When I first started getting interested in global health in medical school, I remember googling “dermatology in Africa.” The first thing that popped up was a picture of the Regional Dermatology Training Center (RDTC) in Moshi Tanzania. I read about everything they had accomplished as one of the first dermatology training programs in East Africa. It was the first exposure I had to any formal practice of dermatology in the developing world. I was absolutely enthralled! I thought – how amazing would it be to get to work somewhere like that! How amazing must the people that started the RDTC program be! This is what I want to do!

When I was awarded a grant to do an international elective in my 4th year of med school, I wanted so badly to work at the RDTC! With the highest of hopes, I sent an email requesting to work at the center for 6 weeks. But alas…no reply. I sent a second email and….again no reply. My dreams were dashed! But that setback lead me to email Carrie Kovarik at UPenn in search of other global health opportunities. I wouldn’t know until much later, but building a relationship with her would be the most impactful turn of events for my life and future career. Years later she would be the one to lead me to my current position in Botswana and be my most influential mentor in dermatology. Everything happens for a reason!

IMG_20170320_120718 copySo now flash forward to 9 years later, with me sitting here amazed to find myself visiting the RDTC in Moshi! My visit included meeting with the chairman and the founder to discuss ideas for building up dermatology in Botswana, learning from their albinism programs in Tanzania so I can try to improve care for people with albinism in Botswana and teaching the local dermatology residents. Talk about visualizing something and then making it happen! As a wide-eyed first year medical student – I would have never in my wildest dreams imagine I would end up where I am today!

_63W1973The RDTC is part of the Kilimanjaro Christian Medical Center in Moshi Tanzania. It is a partially private/partially public hospital meaning there is a fee for service but it is much cheaper than other private hospitals in the country. It is a really beautiful site – literally at the base of the foothills of Mt. Kilimanjaro. All the building are white stucco and the grounds are well manicured and lush with flowers, palm trees and other local vegetation.

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The interior is modest – like any African hospital. But the rooms are clean, the staff is friendly and hard-working (especially compared to Botswana), and the patients appear well taken care of. The RDTC offers two training programs. The main one is a 4 year MMed Dermatology residency training program (in Africa residencies are called Masters in Medicine and you have to complete a thesis before you graduate). This is the equivalent to a US dermatology residency, however you do not have to take a board exam to become qualified as a specialist. They also offer a 2 year program to train “Community Dermatologists.” These are medical officers (the level of an intern) who learn basic dermatology skills and then return to practice in their local areas. I was most impressed by this program which is a fantastic way to solve the shortage of dermatologists across East Africa. I want to start a similar program in Botswana but have not had luck getting support.

I was so impressed with the resources and organization of the RDTC ! They have a huge clinic building dedicated to only dermatology – something that you rarely find even in the US. They also have an inpatient service and their very own private ward – something I have never before seen for dermatology!

IMG_20170320_115533 copyThey have ample support staff, trained dermatology nurses, two large procedure rooms in clinic, a lecture hall upstairs with good quality AV equipment and a room set up for viewing pathology with modern digital display screens. They do not have a dermatopathologist, but the dermatology department does have a dedicated pathologist who is skilled at dermpath. What a dream compared to the one-woman show I am running in Botswana!

Their clinics are chiefly resident run – with faculty who are in the building but not typically directly supervising. This was very surprising to me – in the US almost every resident’s actions must be directly supervised. In Botswana, I have been present in clinic everyday supervising as much as I can. I have seen the problems that arise when I am not there, and feel so guilty when the patients don’t get the best possible care or have bad outcomes that I could have prevented. Visiting the RDTC gave me the push to let myself take a step back and understand that things are not going to be perfect but sometimes I just have to let go in order to preserve my sanity at the only dermatology specialist in Botswana’s public health sector. I was pretty surprised to see the residents biopsy things like eczema, psoriasis and pityriasis rosea on new patients – diagnoses that are chiefly clinical and rarely ever biopsied. It was very eye opening to see how residents are trained and care is delivered in different environments!

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The real reason for my visit to the RDTC was to learn about their albinism programs. One of my major goals since arriving in Botswana, has been to improve albinism awareness and patient care. Chiefly, I want to find a way to provide sunscreen to all patients with albinism. When I found out that the RDTC has been locally producing and dispensing sunscreen to patients with albinism for a few years, I wanted to visit to find out more. I learned from the program’s founder that she had devoted 8 years to developing the product called Kili Sun. She started with funding and ingredients from a major European pharmaceutical company. Now they receive the bulk ingredients for free but all the rest is locally funded. They have built a Center For Care For Persons with Albinism which employs local people living with albinism to mix and package the sunscreen daily.

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the sunscreen production room

The sunscreen is distributed at dermatology clinic visits at KCMC and outreach clinic sites. Patients get two 200g tubs per dermatology visit. They are also always given a hat. KCMC also has an occupational therapy department that is working to increase the vocational skills of people living with albinism. They send public health workers to different villages to see what the resources and needs are present in that area. Then they find people to lead workshops to train people living with albinism at skills they can use to earn a living in their area (without having to work long hours outside) – like leather working, growing mushrooms, bee keeping etc. All of this is funded by the RDTC dermatology department! I literally could not believe how much funding and resources they have for people with albinism! INCREDIBLE! To say that I was impressed would be an understatement – I wish everything that is being done at the RDTC could be duplicated across Africa.

IMG_7044Aside from my time spent at RDTC, there isn’t an abundance of things to do around Moshi if you aren’t going to climb Kili, which is what a majority of tourist come there for.

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enjoying the coffee we made

I spent a day visiting a coffee plantation in Materuni village on the slopes of Kili to see the local method for making coffee. Who knew there were 14 different steps involved to get a single cup of coffee! Although I have visited many coffee plantations, I have never seen all these steps. Since I am not a major coffee lover, the final product didn’t taste significantly different to me…but I am sure coffee connoisseurs would feel differently.

Then I hiked to Materuni waterfalls. Even though the water is low this time of year, it was still a beautiful sight.

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I loved seeing the rainforest of Kili but alas no views of the mountain except for a glimpse on the way down when the clouds cleared for a few minutes. I went the local route and took a minibus to get to the village – it has been a while since I have used public transport! Good to remind yourself every once in a while how the locals have to live. A trip that should have taken 2 hours round trip took about 4 hours using public transport. While waiting for the bus on the way back I got a chance to try the local banana beer. Its made from mashed bananas, sorghum and millet. I did not particularly like it – but much better than the “shake shake” homebrew in Botswana.

I spent a good deal of time exploring Moshi. It is a relatively small but lively town. Much more lively than Gabs. When I would tell people how much more energy there was in Tanzania compared to Botswana – they would all laugh. They say that Tanzania is known for being very lazy, especially when compared with their frenetic neighbor Kenya. I said try visiting Botswana and you will feel like everything in Tanzania is in hyperspeed! I was pleased at seeing the bustling marketplace in Moshi with people hustling to make a living any way they can. In Botswana, I find this business ingenuity lacking in the general population. I hardly find anyone very enthusiastic about their work or trying to get creative about making money.

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For me, the best thing about Moshi was the fabric stores! IMG_7064Tanzania is famous for its local fabric designs called kanga and kitenge. Kanga are two pieces meant for a skirt and a wrap and there is a Swahilli saying on them – often a proverb or meaningful verse. The kitenge are colorful traditional patterns that come in larger pallets of 4-6 meters for making traditional dresses. I went a little crazy and bought 8 kanga and 4 kitenge! It was enough to fill a suitcase on its own but somehow I fit it in my already full backpack. I also had a dress made by a local tailor. It definitely turned out to not be what I had in mind but always a fun experience!

 

 

 

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