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DERMATOLOGY IN TANZANIA: A MODEL FOR OTHER DEVELOPING COUNTRIES AARON E. J. MASAWE, M.D., AND M. H. iSAMITZ, M.D. From the Department of Dermatology, Facu/ty of Medicine, University of Dar es Salaam, United Republic of Tanzania and the Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Dermatology is poorly developed in tropical Africa. By this report, we hope to present a model for dermafology in other developing countries in tropical Africa.* Throughout this paper, dermatologic services may be taken to mean all educational, curative, preventive and research activities relating to dermatology, venereology, leprology and allergy (clinical immunology) (Fig. 1). Basic Information
Dermatologic disorders and their medical, social and psychological components cut across the lines of pediatrics, surgery, internal medicine, psychiatry, obstetrics and gynecology, and public and occupational health, and include curative, invesAddress for reprints: M. H. Samitz, M.D., 1715 Pine Street, Philadelphia 19103. * Dr. Samitz recently returned from a six-week stay in Tanzania where he served as a consultant and visiting professor in the Faculty of Medicine, University of Dar es Salaam. This was supported by a grant from the Milbank Memorial Fund for the purpose of organizing a training program in graduate dermatology as a basis for a dermatologic institute in East Africa. Dr. Masawe, the first protege of the International Affairs Committee of Dermatology, received postgraduate training at the University of Pennsylvania School of Medicine (1971-2) under Dr. Samitz.
680
tigative and preventive aspects. In industrialized countries, they account for between 15 and 20% of all medical problems. Although reliable statistics are not readily available for the developing countries, we believe that an estimate of 50% would be modest. For instance, on the basis of Table 1, which summarizes the findings in different sections of Tanzania, it can be seen that skin diseases account for between 20 and 60% of all the medical problems encountered in those areas. A majority of the conditions were infective. The commonest causative organisms were Sarcopies scabiei and a variety of other parasitic organisms — Staphy/ococcus aureus. Croup A betahemolytic streptococci, Corynebacterium diptheriae, herpes simplex virus, wart viruses, chicken pox virus, leprosy and tuberculosis organisms and various venereal disease organisms. Table 2 lists the 15 conditions most commonly encountered in 7 dispensaries in the Bagamoyo district of Tanzania between June and August of 1973. Constraints and Prevailing Problems
Not only are dermatologic services virtually nonexistent in Tanzania, but the discipline is not considered one of the defined health priorities of that country. Several factors account for this unfortunate state of affairs — colonial tradition,
No, 9
TANZANIA
Masawe and Samitz
681
ALLERGY AND CLINICAL IMMUNOLOGY
DERMATOLOGICAL SERVICES
TRAINING OF DOCTORS AND PARAMEDICAL STAFF
BASIC AND OPERATIONAL
Fig. 1.
OCCUPATIONAL, ENVIRONMENTAL OTHER MEDICAL SPECIALTIES
Outline of dermatological services.
lack of dermatologic training, lack of manpower, lack of facilities, and lack of reliable statistics upon which the problem might be realistically assessed. Coioniai Tradition Health Services in Tanzania (as in most other newly independent countries in tropical Africa) were developed within the framework of the "home" colonial health system, and were pioneered by doctors trained for the most part in general medicine and surgery. When the graduates of such schools entered the health services in the colonies they did not, for obvious reasons, stress dermatology. Some dermatologic conditions, like ulcers and tumors, were considered surgical and were left to surgeons; others, like scabies and pyoderma, were con-
sidered medical and were left to internists. Conditions that did not fall into either category were ignored or managed by nonprofessional laymen (missionaries and practitioners of folk medicine). Lac/c of Training in Dermatoiogy : As a result of colonial traditions and heritage, the teaching of dermatology and allied subjects in all schools of medical training in Tanzania was ignored until recently, and even now workers at all levels of health care know little or no dermatology. Most nurses do not know nor were they taught the basic principles of caring for patients with skin conditions. In Tanzania the teachers in the medical training schools and in the University do not know much dermatology themselves. Furthermore, teaching facilities —
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DERMATOLOGY IN TANZANIA: A MODEL FOR OTHER DEVELOPING COUNTRIES AARON E. J. MASAWE, M.D., AND M. H. iSAMITZ, M.D. From the Department of Dermatology, Facu/ty of Medicine, University of Dar es Salaam, United Republic of Tanzania and the Department of Dermatology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Dermatology is poorly developed in tropical Africa. By this report, we hope to present a model for dermafology in other developing countries in tropical Africa.* Throughout this paper, dermatologic services may be taken to mean all educational, curative, preventive and research activities relating to dermatology, venereology, leprology and allergy (clinical immunology) (Fig. 1). Basic Information
Dermatologic disorders and their medical, social and psychological components cut across the lines of pediatrics, surgery, internal medicine, psychiatry, obstetrics and gynecology, and public and occupational health, and include curative, invesAddress for reprints: M. H. Samitz, M.D., 1715 Pine Street, Philadelphia 19103. * Dr. Samitz recently returned from a six-week stay in Tanzania where he served as a consultant and visiting professor in the Faculty of Medicine, University of Dar es Salaam. This was supported by a grant from the Milbank Memorial Fund for the purpose of organizing a training program in graduate dermatology as a basis for a dermatologic institute in East Africa. Dr. Masawe, the first protege of the International Affairs Committee of Dermatology, received postgraduate training at the University of Pennsylvania School of Medicine (1971-2) under Dr. Samitz.
680
tigative and preventive aspects. In industrialized countries, they account for between 15 and 20% of all medical problems. Although reliable statistics are not readily available for the developing countries, we believe that an estimate of 50% would be modest. For instance, on the basis of Table 1, which summarizes the findings in different sections of Tanzania, it can be seen that skin diseases account for between 20 and 60% of all the medical problems encountered in those areas. A majority of the conditions were infective. The commonest causative organisms were Sarcopies scabiei and a variety of other parasitic organisms — Staphy/ococcus aureus. Croup A betahemolytic streptococci, Corynebacterium diptheriae, herpes simplex virus, wart viruses, chicken pox virus, leprosy and tuberculosis organisms and various venereal disease organisms. Table 2 lists the 15 conditions most commonly encountered in 7 dispensaries in the Bagamoyo district of Tanzania between June and August of 1973. Constraints and Prevailing Problems
Not only are dermatologic services virtually nonexistent in Tanzania, but the discipline is not considered one of the defined health priorities of that country. Several factors account for this unfortunate state of affairs — colonial tradition,
No, 9
TANZANIA
Masawe and Samitz
681
ALLERGY AND CLINICAL IMMUNOLOGY
DERMATOLOGICAL SERVICES
TRAINING OF DOCTORS AND PARAMEDICAL STAFF
BASIC AND OPERATIONAL
Fig. 1.
OCCUPATIONAL, ENVIRONMENTAL OTHER MEDICAL SPECIALTIES
Outline of dermatological services.
lack of dermatologic training, lack of manpower, lack of facilities, and lack of reliable statistics upon which the problem might be realistically assessed. Coioniai Tradition Health Services in Tanzania (as in most other newly independent countries in tropical Africa) were developed within the framework of the "home" colonial health system, and were pioneered by doctors trained for the most part in general medicine and surgery. When the graduates of such schools entered the health services in the colonies they did not, for obvious reasons, stress dermatology. Some dermatologic conditions, like ulcers and tumors, were considered surgical and were left to surgeons; others, like scabies and pyoderma, were con-
sidered medical and were left to internists. Conditions that did not fall into either category were ignored or managed by nonprofessional laymen (missionaries and practitioners of folk medicine). Lac/c of Training in Dermatoiogy : As a result of colonial traditions and heritage, the teaching of dermatology and allied subjects in all schools of medical training in Tanzania was ignored until recently, and even now workers at all levels of health care know little or no dermatology. Most nurses do not know nor were they taught the basic principles of caring for patients with skin conditions. In Tanzania the teachers in the medical training schools and in the University do not know much dermatology themselves. Furthermore, teaching facilities —
INTERNATIONAL JOURNAL OF DERMATOLOGY
682
November 1976
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