Teledermatology in Low-Resource Settings: The MSF Experience with a Multilingual Tele-Expertise Platform

Abstract

Introduction: In 2010, Médecins Sans Frontières (MSF) launched a tele-expertise system to improve the access to specialized clinical support for its field health workers. Among medical specialties, dermatology is the second most commonly requested type of tele-expertise. The aim of the present study was to review all MSF teledermatology cases in the first 4 years of operation. Our hypothesis was that the review would enable the identification of key areas for improvement in the current MSF teledermatology system.

Methods: We carried out a retrospective analysis of all dermatology cases referred by MSF field doctors through the MSF platform from April 2010 until February 2014. We conducted a quantitative and qualitative analysis based on a survey sent to all referrers and specialists involved in these cases.

Results: A total of 65 clinical cases were recorded by the system and 26 experts were involved in case management. The median delay in providing the first specialist response was 10.2 h (IQR 3.7-21.1). The median delay in allocating a new case was 0.96 h (IQR 0.26-3.05). The three main countries of case origin were South Sudan (29%), Ethiopia (12%), and Democratic Republic of Congo (10%). The most common topics treated were infectious diseases (46%), inflammatory diseases (25%), and genetic diseases (14%). One-third of users completed the survey. The two main issues raised by specialists and/or referrers were the lack of feedback about patient follow-up and the insufficient quality of clinical details and information supplied by referrers.

Discussion: The system clearly delivered a useful service to referrers because the workload rose steadily during the 4-year study period. Nonetheless, user surveys and retrospective analysis suggest that the MSF teledermatology system can be improved by providing guidance on best practice, using pre-filled referral forms, following-up the cases after teleconsultation, and establishing standards for clinical photography.

Keywords: LMICs; dermatology; low-resource settings; telehealth; telemedicine.

Figure 1

Number of clinical dermatology cases referred each year. The open symbols represent values extrapolated from part-year observations.

Figure 2

Confirmed histoid leprosy.

Figure 3

Suspected mycobacterial infection.

Figure 4

Neurofibromatosis.

Figure 5

Countries of origin of the referrers (n = 41) and specialists (n = 26). The countries of origin of the referrers are shaded: light gray = 1 case, dark gray = 2–5 cases, black > 5 cases. The countries of origin of the specialists are shaded in blue, with the number of specialists for each country shown.

Figure 6

Most common topics of the cases.

Figure 7

Suspected pox virus infection.

Figure 8

Dermatology history form.

Figure 9

Dermatology photography recommendations.