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Deeper than the surface
Liz Clarke. Sunday Tribune News, 7 March 2004. Republished courtesy of Independent Newspapers (Pty) Ltd
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[On the eve of International Women's Day, Liz Clarke spoke to a doctor who is committed to unravelling the intricate workings of the skin and taking her knowledge to the rural heartlands of KwaZulu-Natal.]
Skin conditions, whether mild or serious, are the body's way of alerting the onlooker that medical disturbances may be happening within. But a blister, an oozing lesion, a swath of red bumps or a gaping abscess is something most of us would rather not look at. Dr Ncoza Dlova, one of the few black dermatologists on the African continent, is only too happy to oblige.
So much so that she is busy compiling possibly the world's first clinical atlas on skin problems relating to HIV/AIDS in the African population. "You might ask why we have to differentiate between the different skin colours," she said, as we paged through some tough-to-look-at photographs at the Nelson R Mandela School of Medicine, where she consults and lectures. "We have literature on the HIV-related skin conditions for the European community, but a black skin does not always react in the same way, and we may not be making the best prognosis."
This week saw the amiable doctor, with a ready smile even at dawn, board a tiny plane at Durban International Airport bound for Manguzi Hospital on the outskirts of Empangeni in Zululand, where several patients were anxiously waiting to see her at the hospital's dermatology clinic.
She had already been warned that a number of cases would require her expert attention, including a young mother with extensive Kaposi's Sarcoma, a disease once rare, but now frequently seen in those with advanced HIV/AIDS, when the immune cell count is low. A child with an unusual rash across his back would also need her expert eye, as well as a mother with shingles.
It was a tough day. Up at five, seeing to her family which includes her doctor husband, Themba Mabaso, and eight-year-old son, Wakithi, and then a dash to the airport to catch the 7 a.m. flight organised by the Red Cross Air Mercy Service's Flying Doctor and Health Outreach service. "I believe it's the right thing to do," she says, as the ground slips away from beneath us. "Our colleagues at rural hospitals often work under difficult conditions. They really need to be able to share knowledge. It's my hobby-horse, but that's what I urge doctors and health-workers to do. There's a voluntary air service available - get out there and help."
Born in a remote village in the Eastern Cape near King William's Town, Dlova began her journey of investigation in 2001, with other dermatologists, to identify skin conditions associated with HIV-positive people. Now a seasoned flyer after having logged nearly 100 flying hours, she is used to all types of weather and flying conditions. "Sometimes cows and goats wander across the runway which makes it difficult to land, and one time we were on our way to Tugela Ferry when an almighty storm struck us. I've never been so happy to touch ground."
But this week it was the turn of the patients and hospital staff at Manguzi to be relieved. Also on the list for consultation was a serious case of ring-worm, thought to be exaggerated by HIV, and several cases of seborrhoeic dermatitis, possibly HIV-related, which involved rashes of the scalp, nasal area, back of the ears, underneath the breasts and in the groin area. It was clear from the caseload that the dermatology run would have to be made again soon. "The reason we are seeing so many AIDS-related skin cases," said Dlova, "is because of the high numbers of full-blown AIDS patients in this country. Because of anti-retrovirals, you are not seeing these cases in Europe or America, which is why it is important for our doctors to have a ready reference."
Dlova hopes to have the skin atlas she is compiling with Dr Anisa Mosam, also at the Medical School, ready for desktop reference use in a few months' time. Alongside each condition will be a suggested treatment regimen. Meanwhile, she has established a "dermatology hotline" through which she encourages local dermatologists throughout KZN to be on call for specific rural hospitals.
She has also started an e-mail link whereby remote hospitals can send in photographs of patients' skin conditions for her to identify. One step further, she now has a live telemedicine link with Port Shepstone Hospital, where she "sits in" on clinic days, examining patients and discussing treatment issues with staff.
"We have come a long way in six years," she says. "But there is still so much more that could be done. I see the looks of appreciation on people's faces in those far-out places, the smiles on the patients' faces when their skin problems have been attended to and the enthusiasm and willingness to learn by the doctors."
It was dusk by the time the plane touched down again. It would be dark by the time she got home. "No matter", she says. "It's all worth it." |
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