International Society of Dermatology - Palm Coast, FL - USA

Primo congresso internazionale
"Dermatological Care for All: A Basic Human Right"
Etiopia (Addis Ababa / Mekele) dal 1 al 4 novembre 2006

 english ->

 galleria fotografica

 abstracts

Il Primo Convegno Scientifico Internazionale, organizzato in Etiopia dalla Struttura Complessa di Medicina Preventiva delle Migrazioni, del Turismo e di Dermatologia Tropicale dell'Istituto San Gallicano di Roma in collaborazione con l'Istituto Internazionale Scienze Mediche Antropologiche Sociali (IISMAS) Onlus e con il supporto dell'International Society of Dermatology (ISD), ha riunito ricercatori e clinici provenienti da USA, Messico, UK, Francia, Svezia, India, Germania, Kenya, Etiopia e Italia.

L'inaugurazione del congresso si è svolta ad Addis Ababa il 1° novembre, alla presenza delle autorità sanitarie Etiopi ed Italiane che hanno incoraggiato i partecipanti a continuare la strada   di stretta cooperazione intrapresa con le popolazioni più bisognose. Il 2 novembre i partecipanti si sono trasferiti a Mekele per la sessione clinica presso l'"Italian Dermatological Centre IISAMAS". Durante i due giorni   di lavoro sono stati esaminati pazienti e discussi casi clinici.

L'obiettivo principale del convegno è stato quello di analizzare e confrontare due diversi modelli di Sistema Sanitario e di Ricerca Scientifica.

I Paesi ricchi producono la stragrande maggioranza del cosiddetto "sapere scientifico" e possono spendere, per tutelare la salute dei cittadini, cifre che sono migliaia di volte più alte di quelle disponibili nei Paesi Poveri. In Etiopia, per esempio, il Sistema Sanitario ha a disposizione solo 7 dollari all'anno per ognuno dei suoi 76 milioni circa di abitanti. Se le risorse economiche disponibili per la salute dei cittadini più poveri sono ridottissime, quelle per la ricerca scientifica ed epidemiologica sono praticamente assenti. In molti Paesi dell'Africa Sub-Sahariana, Etiopia compresa, non è ancora possibile stabilire con certezza la prevalenza dell'infezione da HIV/AIDS così come quella di molte altre malattie infettive, alcune delle quali vengono anche tristemente definite come "malattie dimenticate" : Malaria, Lebbra, Morbillo, Diarrea, Tubercolosi, Difterite, Tetano, Poliomielite, Leishmaniasi, Tripanosmiasi, Oncocerchiasi e molte altre. Queste malattie provocano la morte di circa 20 milioni di adulti e bambini ogni anno nel mondo e rappresentano la principale causa di perdita di produttività (decine di miliardi di dollari all'anno) dei cosiddetti Paesi in Via di Sviluppo (PVS).

In questo scenario i partecipanti hanno dibattuto in particolare sui seguenti aspetti:

• In che modo e attraverso quali mezzi si possono migliorare le possibilità di diagnosticare, curare e prevenire tali patologie nei PVS ?
• È conveniente dal punto di vista economico e sociale investire per ridurre la mortalità da malattie infettive e migliorare il livello di salute globale nel nostro pianeta ?
• Qual è il rapporto tra salute e sviluppo economico che può essere implementato grazie alla cooperazione internazionale con Istituti Scientifici come il San Gallicano?
• Esistono delle linee guida per gli interventi sanitari nei PVS che permettano di misurare non solo gli esiti clinici dell'intervento stesso, ma anche il miglioramento strutturale dell'offerta sanitaria che i PVS sono in grado di offrire?

Sebbene non si possano dare risposte definitive a queste domande, sono state comunque elaborate alcune proposte che meritano l'attenzione del mondo scientifico internazionale, dei Sistemi Sanitari dei Paesi ricchi, delle aziende farmaceutiche e dei governi occidentali interessati ad affrontare con   politiche virtuose i fenomeni migratori.

Il principale risultato nuovo emerso dal confronto,   è stato la proposta di un nuovo modello di cooperazione scientifica, clinica e formativa rivolta ai sistemi sanitari dei paesi in via di sviluppo: è stata denominata Community Dermatology International (CDI).

Il contenuto principale di questo modello risiede nella implementazione di centri di ricerca scientifica, clinica e formativa, sostenuti da prestigiose istituzioni di ricerca del mondo occidentale, che si inseriscano entro i sistemi sanitari dei paesi in via di sviluppo, coordinando strettamente la loro attività con quella delle autorità sanitarie locali. Si tratta di evitare l'effetto "corpo estraneo" ovvero quello di strutture sanitarie gestite da ricercatori occidentali, magari anche di alto livello scientifico, che sono avulse dal contesto di programmazione sanitaria del paese ospite: quando per qualsiasi motivo (fine di progetti di ricerca, scarsità di fondi, problemi politici, ecc.) queste strutture non sono più operative al sistema sanitario del paese in via di sviluppo non rimane nulla.

Il coordinamento con la programmazione sanitaria locale sta diventando un requisito obbligatorio nelle nuove iniziative di cooperazione sanitaria internazionale del nostro paese, in tal modo si cerca di imparare dagli errori commessi nel passato:   le "cattedrali nel deserto sanitario" sono disseminate in molti paesi in via di sviluppo.

Uno degli elementi centrali del coordinamento risiede nella necessità di prevedere, accanto all'attività di ricerca scientifica e clinica, un intenso lavoro di formazione attiva del personale medico ed infermieristico locale e di formazione di nuove figure professionali inesistenti in Europa, come gli Health officers, i Community Health Workers, i Community Health Exestension Workers e i Primary Health Workers. Questi operatori sanitari che apprendendo nel corso del lavoro clinico nelle strutture con il supporto di esperti internazionali, ed anche a distanza utilizzando i moderni mezzi della telemedicina, possono arricchire le risorse umane del sistema sanitario locale: uno degli elementi di debolezza strategica di molti sistemi sanitari nei paesi in via di sviluppo. Si tratta contemporaneamente di combattere il fenomeno della "fuga dei cervelli" (Brain Drain) dai paesi in via di sviluppo: i professionisti qualificati che se ne vanno in occidente rappresentano una perdita economica e professionale spesso pesantissima per questi fragili sistemi sanitari.

Un altro elemento strategico del coordinamento è l'adattamento dei percorsi diagnostico-terapeutici proposti dai centri di cooperazione sanitaria internazionale al contesto strutturale del sistema sanitario locale: occorre proporre indagini diagnostiche, uso di apparecchiature e di farmaci che siano sostenibili economicamente e tecnologicamente in loco.

Il terzo elemento strategico è l'attività di ricerca scientifica e farmacologica sulle molte "malattie   dimenticate" che affliggono le popolazioni dei paesi in via di sviluppo: per molte di queste patologie che provocano morti, invalidità e relativi alti costi economici non esistono terapie adeguate per mancanza di profittabilità degli investimenti in ricerca scientifica e farmacologia.

Al termine del Congresso, i partecipanti hanno concordato di fondare una Società Dermatologica, "Community Dermatology International", che si pone come obiettivo di fornire e diffondere, nei paesi poveri, cure dermatologiche e formazione sanitaria sul campo, individuando la "migliore tecnologia a basso costo" disponibile. Sono state anche concordate le date dei prossimi congressi internazionali di dermatologia: Addis Ababa/Mekele 2007, Vadodara, Gujrat (India) 2008 e Acapulco (Messico) 2009.

The First International Scientific Congress, organized in Ethiopia by the Department of Preventive Medicine of Migration, Tourism and Tropical Dermatology, in collaboration with the International Institute of Social, Medical and Anthropological Sciences (IISMAS) and with the support of the International Society of Dermatology (ISD) has gathered researchers and clinicians from USA, Mexico, UK, France, Sweden, Germany, India, Kenya, Ethiopia and Italy.

The opening session took place in Addis Ababa on November 1 st , in the presence of Italian and Ethiopian health authorities who encouraged participants to strengthen their efforts towards a tighter cooperation with poor countries. On November 2 nd , attendees moved to the "Italian Dermatological Centre IISMAS" of Mekele for the clinical session, where patients were examined and clinical cases discussed.

The congress objective was to examine and compare two different models of health system and scientific research.

Rich countries produce most of the "scientific knowledge" and can spend, to preserve citizens' health, figures thousands times higher than poor countries. In Ethiopia, for example, health system invests only 7 dollars per citizen a year. While the financial resources available for citizens' health are very limited, resources for scientific research are nearly inexistent. In many countries of the Sub-Saharan Africa, Ethiopia included, the prevalence of HIV/AIDS infection has not been precisely established as well as the prevalence of many other infectious diseases, several of which sadly defined as "forgotten diseases" (Malaria, Leprosy, Measles, Diarrhoea, TBC, Diphtheria, Tetanus,   Poliomyelitis,   Leishmaniasi, Trypanosomiasis, Onchocerciasis and others). These diseases cause 20 millions of deaths each year among adults and children and represent the main cause of productivity loss (tens of billions of dollars each year) in the so called developing countries (DVCs).

In this context participants have debated on the following aspects:

• How and through which means to improve diagnosis, care and prevention of such pathologies in DVCs?
• Is it convenient from the financial and social point of view to invest in reducing mortality from infectious diseases and improving the planet global health level?
• Which is the relationship between health and economical development that can be implemented thanks to the international cooperation with Scientific Institutes, such as San Gallicano?
• Are there any guide-lines for health intervention in DVCs allowing for evaluation of both the clinical outputs of interventions and the health supply structural improvement offered by the DVCs?

Although there are no definitive answers to these questions,   a few proposals have been elaborated and deserve consideration from international scientific community, rich countries health institutions, pharmaceutical industries and western governments willing to handle the migration phenomenon through virtuous policies.

The main result emerging from this debate, has been the proposal of a new model of scientific, clinical and training cooperation addressed to DVCs' health systems, which has been called "Community Dermatology International (CDI).

This model focuses on the establishment of scientific, clinical and training research centres, sustained by prestigious western research institutes, who are integrated in the DVC's local health system and coordinate their activities with local health authorities. This to avoid the phenomenon of health structures managed by western researchers, that although their high scientific profile, are cut off from the health planning of the hosting country: if for any reasons (end of the research project, lack of funds, political problems, etcetera) those structures stop operating, no benefits are left to the hosting country.

It emerges that the coordination with the local health planning has become a necessary requirement when starting up new initiatives of international health cooperation; it is extremely important to learn from past errors: "white elephants" have been often disseminated in the DVCs.

One of the main aspects of the coordination is represented by the necessity to foresee an intensive scientific and clinical research as well as an intensive active training of local health personnel together with the training of new health workers, such as health officers, community health workers, community health extension workers and primary health workers. These health operators, who are trained during clinical work in the structures with the support of international experts and use distance learning via telematics, can enhance human resources of the local health system which is an aspect of the strategic weakness of many health systems in the DVCs.   This also to avoid the "brain drain" phenomenon which consists of the drain of professionals to western countries causing serious professional and economical loss.

A further strategic aspect of coordination is the necessity to adapt the diagnostic and therapeutic paths proposed by the international centres of cooperation to the structural context of the local health system: it is therefore required to propose diagnostic examinations, as well as the use of equipment and drugs that are economically and technologically sustainable in DVCs.

The third strategic aspect is the scientific and pharmacological research on   "forgotten diseases" still present in the DVCs: for many of those pathologies that cause deaths, disability and high expenditures, there are no adequate therapies due to the fact that investments in scientific and pharmaceutical research are not profitable.

At the end of the debate in Mekele, in the light of this worrying scenario, participants convened to establish the "Community Dermatology International", with the aim to implement and spread out in poor countries dermatological care and health training on the field, through the best low cost technology available. Attendees also agreed upon the dates and locations of the next International Dermatological Congresses that will be: 2007 Addis Ababa/Mekele, 2008 Vadodara, Gujrat (India) and 2009 Acapulco (Mexico).

Out of Africa …

The First ever “International Congress on Dermatological Care for All – a Basic Human Right” was held in Addis Ababa and Mekele, Ethiopia from November 1st to 4th, 2006. Those who have known Ethiopia for its infamous famines and poverty would have been surprised to see the basic and small but very clean and efficient International airport in
which we landed from so many different parts of the world.

I should begin the description of the congress by expressing my immense gratitude to the International Society of Dermatology for sponsoring this congress wholeheartedly which was held under the patronage of various agencies of the Government of Italy like the Ministries of Health, Interior, Justice, Italian Embassy in Ethiopia, to name a few. I would like to thank the ISD for choosing me as the recipient of the Travel Award to attend this wonderful conference. The ISD was represented by Luttgard Wiest of Germany who serves
the organization in the capacity of Executive Vice President. For those of us who are wondering as to what the connection is between Ethiopia and Italy, there is commendable work being done with a very generous support from the Italian government in many developmental programs of Ethiopia as Italy had occupied Ethiopia for a few years in the 1940s and has since maintained cordial relations with it and its people.
Prof. Aldo Morrone of San Gallicano Institute of Rome who is known far and wide for his invaluable and selfless help and support to the marginalized populations of Italy like the illegal immigrants, beggars, prostitutes and other unfortunate individuals, has set up a dermatological department in Mekele, Tigray region of Ethiopia. He and his team of two wonderful charming young Italian women dermatologists serve a population of 4 million for their dermatological needs. Interestingly they are the only dermatologists in the entire
region, a region suffering severely from the usual and also the most exotic of dermatological diseases which Prof. Morrone and his team effectively tackle taking help of teledermatology too at times when the going gets tough! It would be impossible to describe Prof. Morrone’s contribution to community dermatology in this short report but let me state candidly that if every country produced just one Aldo Morrone; the dermatological world would be a better place to live in! Bravo!

The conference was inaugurated in the presence of H.E. the Health Minister of Ethiopia, H.E. The Health Bureau Chief of Tigray, Ethiopia, H.E. The Italian Ambassador to Ethiopia, etc. Well-known ambassadors of community dermatology and champions of low cost and effective dermatology in developing countries like Terence Ryan and Prof. Paul Buxton attended the conference imparting their sagely advice and wisdom in many areas. Dr Luttgard Wiest gave a crisp presentation of the aims and activities of International Society of Dermatology.
The conference was attended by dermatologists and specialists from all over the world like Italy, USA, UK, Germany, France, Mexico, Sweden, Luxemburg, Kenya, and of course Ethiopia. I had the honor of representing India. The conference was marked by superb scientific material, lectures and discussions on topics ranging from health care issues of Ethiopia and the rest of Africa to the global problems of
managing skin diseases in resource poor countries, infectious skin diseases, dermatological rarities, epidemiology to telemedicine and digital imaging in dermatology. There was a good mix of dermatovenereology topics related to Ethiopia specifically, of Africa as a continent and with an international perspective. Issues related to HIV and leprosy too were discussed both by locals and international faculty. Aldo Morrone and his team had called many live cases in his department, an envious array of rarities with striking morphology!
It was a veritable live atlas of tropical dermatology with different presentations of cutaneous leishmaniasis, cutaneous tuberculosis, oncocerciasis, deep mycoses etc. There was much discussion and exchange of ideas and opinions, which contributed significantly in making the conference truly a learning experience for all.

This conference was a living example of the advantages of simplicity and compactness. The group was dedicated, interested, coherent and interactive. There was an atmosphere of bonhomie and camaraderie. The social programs organized with the help of the local Ethiopian doctors and politicians were memorable. We will never forget the Circus Mekele, an amazing show of acrobatics, agility and beauty of Ethiopian
children! Also equally memorable was the last night in Mekele when the whole group went to a local restaurant for a cultural evening and danced with abandon to the haunting and energetic music of Ethiopia. People of Ethiopia won everyone’s hearts by their friendliness and willingness to help, qualities which are not easily found in today’s world! It was also a unique gastronomic experience! Ethiopian food with its wonderful pungent spices and a variety of tender meats is a gourmet’s delight and everybody partook of it with gusto! The pungency of this cuisine was punctuated by two wonderful Italian meals at the residence of the Ambassador of Italy and at the residence of Prof. Morrone’s team. The latter will be remembered all the more fondly for an interesting development that took place postprandially! After a long and thought
provoking discussion with Prof. Morrone I made the official proposal to form a new society of Community Dermatology headed by Prof. Morrone and myself. I gave a short talk explaining the need and the goals of the society and it was received very well by all. The next day, that is on the concluding day of the conference I recapitulated the ideas to the audience and that marked the birth of “Community Dermatology
International” or CDI. A committee has been formed and the first conference of CDI will be held in Mekele, Ethiopia next year followed tentatively by India and Mexico. The goals of this society will be to provide dermatological care to the poor and disadvantaged, to train health care workers in providing dermatological care and to spread the message of dermatological health in communities of the entire world.

My special thanks again to ISD for their support in making this conference possible, to Prof. Aldo Morrone for organizing the entire event and to all the delegates for making it such a pleasurable experience with their willingness to teach, share and learn, all at the same time. I truly hope more and more of us are able to attend such conferences in the future, which help us grow in more ways than one.

Dr Shyam Verma
Recipient of ISD Travel Award
18, Amee Society, Diwalipura, Vadodara 390 015,
Gujarat, India
vermaderma@rediffmail.com

International Society of Dermatology
138 Palm Cost Parkway NE n. 333
Palm Coast, FL 32137—USA
Email: info@intsocdermatol.org
Website: www.intsocdermatol.org

San Gallicano Institute—IRCCS, Rome
Dep. of Preventive Medicine of Migration, Tourism and Tropical Dermatology
Via di San Gallicano, 25A—Rome , Italy
Email: s.gallicano-desk@libero.it
Website: www.ifo.it

IISMAS – International Institute of Social, Medical and Anthropological Sciences – Rome
Email: info@iismas.it
Website: www.iismas.it