What are the challenges to telehealth in the third world?
A second large hurdle has been the lack of histology services at all of the hospitals. They have the capabilities to do basic blood work, but there are no histology labs to process tissue samples. We addressed that hurdle at one of the hospitals last November, but that is one hospital in a network that spans the continent.
What kinds of cases are you seeing?
We have seen a spectrum of cases from common entities, such as nummular dermatitis, to rare birds like leucoderma syphiliticum and suppurative keloids. It has been fascinating to see tropical dermatology and many HIV-associated disorders.
What are your most exciting accomplishments in this project?
Building a teledermatopathology lab in one of the poorest countries in the world for about $20,000 was a struggle, but ultimately an exciting success.
What have you learned about philanthropic work? What advice would you give to others who are seeking opportunities to do similar work? Are there any pitfalls to avoid?
The biggest piece of advice I can give is, go where the local people are also committed to the project. Sustainable change that lasts beyond the humanitarian trip requires that the local community is invested in the project. Just because the local community states that the service, project or equipment would help them, does not mean that they are currently invested in making that a reality today or this year. It may just mean that they intellectually affirm that it would of benefit if present. Or they may even just be being polite and don't think it is a useful or viable idea. Consider having a benchmark to gauge commitment, such as a consistent stream of consults. It may not be a lot, but it is consistent. There is an opportunity cost to time, trips and donations, so prioritize the places that tangibly show commitment, which may not be the place that has the most need.
I would say that anyone can help, but not with anything. Meeting the felt needs of the community, rather than what you as an outsider think is best, is most important. You have to build relationships, evidence humility, and show a long-term commitment before you find the area you are most useful. Despite some small successes that were personally thrilling to us, I think Ashley and I see ourselves at the very early part of this process. We are working and learning.
What would you do differently if you could start over?
I would ask the local doctors more often what they think they need and what their priorities are.
What are your plans and goals for the future?
Long-term we hope to use the Malamulo lab as a pilot that can be replicated at other hospitals in the network and built upon by other specialties; especially general surgical pathology. This could fundamentally change the healthcare that is available to so many of our fellow men. It will be a process, and I am sure we will make mistakes, but we decided that doing nothing or waiting until we had extensive personal experience treating African histoplasmosis or Buruli ulcers was worse.
We would like to expand these services to other specialties and to new locations, as many potential patients have no alternative. In the future, the ideal would be to lose many of our patients to local physicians as access to specialty training hopefully improves.
Dr. Hamstra practices dermatology and dermatopathology in Coeur d’Alene, Idaho and Spokane, Washington.
Dr. Ashley Hamstra
Dr. Morrell, a dermatology resident, will be a dermatopathology resident at the University of Massachusetts for 2017-2018.
Dr. Travis Morrell
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