Trinidad and Tobago, June 2011
DR. Kudakwashe Maloney M.D., Dermatologist and Clinical Fellow in Medicine at Beth Israel Deaconess Medical Center in Boston Massachusetts wanted to be sure that the problem she saw was real. If it was real she wanted to solve it.
Dr. Maloney, with deep passion for Trinidad, knows firsthand that Hansen’s Disease, also known as leprosy to those of us in the general population, is a real problem in the Caribbean nations. Early detection and prompt treatment halt disease progression and radically reduce the danger of infecting others. Dr. Maloney and others believe that many of the people in close contact with Hansen’s Disease patients are likely to also have the disease, undetected and incubating.
Early symptoms of Hansen’s Disease are skin lesions, which to the eyes of trained dermatologists are unmistakable. These same lesions are most times simply passed over, if noticed at all, by the rest of us. Maloney decided that she could determine if there are large numbers of undiagnosed Hansen’s Disease sufferers by looking at large numbers of people in the at-risk population, people in close contact with known patients. Maloney also needed a way to have other dermatologists examine the patient cases and images, have those organized in some web-accessible way. That’s where ClickMedix came into play.
Maloney’s idea was to engage the network of social workers who were already visiting the community and caring for the sick. They would gather the relevant health information, including photos of skin lesions on smart phones equipped with ClickMedix software, and using Trinidad’s existing cellular infrastructure, transmit these cases to the Internet for remote diagnosis by her and her colleagues in the US. Maloney reached out to Ting Shih, ClickMedix Founder, to explore how mobile smartphones can help her. Together, Maloney and Shih tailored ClickMedix ClickDerm teledermatology application, focusing precisely on detecting Hansen’s disease. Special attention was paid to photographing lesions. When the system was ready, Maloney made a visit to Trinidad to equip and train the first social worker.
The ClickMedix ClickDerm app was easily downloaded and installed onto a 5 megapixel Motorola Android phone that was available locally in Trinidad. Time was spent making sure that the social worker knew how to take the best possible photos adjusting for sufficient lighting. Photos taken in shadows or a dimly lighted room are insufficient for visual diagnostic use. The social worker learned to take high quality photos and to enter text input using the smart phone keyboard. The Trinidad phone company had no difficulty supporting the device; one that was commonly used and, from their point of view, simply doing the kinds of things that phones do.
Hansen’s Disease detection rates vastly increased, by more than an order of magnitude, which extrapolates to yearly numbers detection rising from 3 cases per year to 60 cases per year for a single social worker. The implication is obvious. One social worker in one small community can bring early diagnosis and therefore effective treatment to more than 50 people a year who otherwise would have slipped through the public health safety net only to later on deal with leprosy in an advanced stage while contributing to the spread of Hansen’s Disease within their community.
This was a pilot, only a brief pilot with a highly motivated dermatologist present to make sure that things went right. However, a longer-term study is underway. Collection and transmission of patient data is entirely in the hands of local social workers. If the study produces results comparable to the early pilot Dr. Maloney conducted, she will have proved her point, provided treatment regimen to these patients even from afar, and already be addressing the prevalent problem of Hansen’s Disease in the Carribean, while sitting at her home in Massachusetts.