Tropical Dermatology; the most neglected area in medical practice

Dermatology is a medical Specialty that deals with diseases and disorders of the skin, nails, hair , mucous membrane and sexual transmitted infections.

Skin disease is a significant cause of morbidity in sub-Saharan Africa. Studies conducted in Mali showed that skin disease has an overall prevalence of 34.0% and motivates 11.7% of outpatient primary health care visits . Cutaneous infections such as pyoderma and scabies are endemic to African adults and children. International public health initiatives have been created to reduce the prevalence of high-morbidity skin diseases such as Buruli ulcers and lymphatic filariasis in Africa. Epidemiological studies of the burden of skin disease in Africa have helped shape directions for physician training as well as public health campaigns. Fewer than *25 certified dermatologists* serve the entire population of Ghana, a rapidly developing West African country of approximately 25 million people. To improve access to quality skin care, the Ghana Society of Dermatology, founded in 2011, aims to develop Ghana’s local capacity of dermatologists. In conjunction with the Ghana College of Physicians and Surgeons, they established Ghana’s first and only dermatology training fellowship at Korle Bu Teaching Hospital (KBTH), the largest public hospital in Accra, in 2012.

*Source* : The pan African medical journal (Africa field epidemiology network), a retrospective review of skin disease at the Korle Bu Teaching Hospital Dermatology Clinic.

Fast forward in 2022, Ghana has less than 40 certified Dermatologist serving over 32.37 million population with majority of the people in rural and deprived communities scattered across the country. Unfortunately, the physician Dermatologist are located in the teaching hospitals situated mainly in kumasi and Accra. Others are retired and not in active practice with some also in private practice in the cities.

From Kumasi to Paga which is about 10 hr 31 min (580.6 km) away has no single *certified* physician dermatologist practicing including the Tamale teaching hospital. This incredible shortage of Specialist in such areas may cause a patient to travel for days just to have access to Dermatology care.

According to research findings the most commonly seen disease categories were infections (24.6%) and dermatitis/eczema (24.6%). Malignant and pre-malignant conditions were rare (2.8%). Overall, atopic dermatitis (8.4%), acne vulgaris (5.3%), and scabies (5.1%) were the most commonly diagnosed diseases in Mar 2017. This statistics shows how serious skin condition is on a rise yet the most neglected in Ghana and sub Saharan Africa.

Source : The pan African medical journal.

Ghana has a programme on tropical diseases which covers some conditions such as buruli ulcer , pyoderma, leishmaniasis, lymphatic filariasis, cutaneous larva migrans etc, just to mention a few. Upon all these programme in place we still see increasing number of cases been recorded in Ghana. There are fewer centres in the country purposely for Dermatology such as Kokofu Dermatology centre, Ankaful leprosy centre, Akawe Dermatology centre. These centres do not have resident Dermatologist or may have a physician Dermatologist visiting once in a whole while to see some few cases. Due to that those centres are left to general practitioners to manage the cases to their level of competence in that area.

The situation is devastating and needs urgent discussion.

This devastating situation in the area of Dermatology care motivated the *Utah university* department of Dermato-venereology to collaborate with college of health (cohk) in Kintampo to introduce Dermatology and psychiatry post-graduate program to train physician assistants in these neglected areas to bridge the wide gaps in the system. The program curriculum was rolled out by Dermatology professors from Utah in consultation with the ministry of health and the Ghana society of Dermatology in Ghana. The course runs for 2yrs duration with a mandatory housejob for 12months under Specialist training. One must hold a BSC in physician assistant ( medical) with over 3 to 5yrs working experience or more before admitted to offer the program. The MOH gave study leave to over 22 physician assistants across the country for 2yrs to enroll into the Dermatology program at cohk and completed their mandatory housejob after completion under consultant training. Several years after the training the MOH and the GHS has refused to employ and appoint them as clinical Dermatology officers (CDOs) as their designation was given and paid appropriately.

These men and women trained in the program returned to their various facilities the same way they left for training and now doesn't even practice the Specialty they have acquired to the benefits of Ghanaians in the deprived communities suffering from skin diseases.

The regulator MDC has also refused to recognize them as practitioners in those areas so they are left to their own fate. This unfair treatment has caused so much apathy in their practice.

Few years after the introduction of the 2 medical Specialty for physician assistant at the college of health the program has suffered several trials and tribulations which led to it's collapse under the very watch of the ministry.

Conclusion and recommendation

The world is growing so fast and Ghana should start to consider allowing physician assistants into various medical Specialty to meet the world health organization vision to provide quality health care to all persons in rural communities. Physician assistant are primary health care providers and can really be of help to the health system if properly used to bridge the gap of patient to specialist ratio in the country especially the deprived areas. It will take an average of 6 - 7yrs to train a physician assistant to perform so well ( 4yrs in school) plus 2 to 3yrs residency in a specialty.

The 2 programs should be revived and others introduced to help close the huge deficit and provide care for the neglected masses in Ghana.

Sam Dodoo Stephen ( Vigilante president)

(Physician assistant)