Teledermatology in Tijuana, Mexico

RESIDENT CORNER Teledermatology in Tijuana, Mexico Megan Brown, MD The Health Frontiers in Tijuana (HFiT) clinic is deportees, indigent patients, and recently Haitian a binational partnership between the University immigrants.1 We established teledermatology ser- of California, San Diego School of Medicine vices under the faculty leadership of Casey Carlos, (San Diego, California); the Universidad Autónoma MD, who was awarded a SkinCare for Developing de Baja California School of Medicine (Tijuana, Countries grant from the American Academy of Mexico); and Desayunador Salesiano Padre Dermatology incopy April 2015 to address the need for Chava, a community grassroots organization in teledermatology support for the clinic.2 Tijuana, Mexico. Health Frontiers in Tijuana pro- Over the last 2 years, we have worked closely vides accessible quality health care for the under- with 2 medical students from the University served in Tijuana’s Zona Norte. This article is a of California,not San Diego—Nicole Herrick, BS, and narrative meant to share my clinical experience as Nicole DeMartinis, BA—to apply for the grant a dermatology resident who worked with HFiT to and create a system whereby volunteer residents establish teledermatology services at this clinic. and faculty consultants at the University of California, Cutis. 2016;98:E20-E21.DoSan Diego, can provide teledermatology services on a weekly basis to support the HFiT staff as they see patients with dermatologic conditions. Initially, we he Health Frontiers in Tijuana (HFiT) clinic purchased touch screen tablets to use the Africa is a binational partnership between the Teledermatology Project (africa.telederm.org) web- TUniversity of California, San Diego School of based program. The clinic was already functioning Medicine (San Diego, California); the Universidad with electronic medical records with volunteers who Autónoma de Baja California School of Medicine carried tablets and scribed for the providers as they (Tijuana, Mexico); and CUTISDesayunador Salesiano saw patients. We felt this method would be a great Padre Chava, a community grassroots organization way to incorporate teledermatology into the clinic, in Tijuana, Mexico. Health Frontiers in Tijuana and it functioned moderately well for several weeks provides accessible quality health care for the under- but was very labor intensive on our part, as we fre- served in Tijuana’s Zona Norte.1 This article is a quently had to travel to Tijuana to retrain rotating narrative meant to share my clinical experience as clinic volunteers on how to use the program. Often, a dermatology resident who worked with HFiT to the Internet connection was slow, which made pull- establish teledermatology services at this clinic. ing up the Africa Teledermatology Project website difficult, and photographs also would take too long Teledermatology in Tijuana to upload in the middle of a busy clinic. The patient population served by the HFiT clinic We are now exploring how to use a more simple includes substance users, sex workers, the homeless, email format to send the teledermatology consulta- tions while still being compliant with the Health Insurance Portability and Accountability Act. We Dr. Brown is from the Department of Dermatology, University of currently use secure university email accounts. California, San Diego. The author reports no conflict of interest. Although we are still working out the details, this Correspondence: Megan Brown, MD, 8899 University Center Ln, email-based method seems to work well. It has been Ste 350, San Diego, CA 92122 ([email protected]). a simple solution to accommodate a slow Internet E20 CUTIS® WWW.CUTIS.COM Copyright Cutis 2016. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. Resident Corner connection and many rotating volunteers without train primary care providers at HFiT on performing requiring additional training. The email format also simple skin biopsies and managing basic derma- allows the photographs to be saved in draft messages, tologic conditions. Through our support of these even if the Internet connection times out. providers, we are creating a sustainable partnership Once the teledermatology consultation is sent, that is mutually beneficial to the patients in Tijuana the medical students and I review them and then get as well as the medical students and residents in the an attending physician’s input on our proposed work- United States. It is highly rewarding to all those ing diagnosis and plan. We work to have this process involved with this project, and I am excited to see complete within several days to return the answered what challenges this next year will bring as we wel- consultation to the requesting provider. come many new patients from Haiti into the HFiT patient population. Final Thoughts The HFiT providers have shared a lot of positive REFERENCES verbal feedback about this project. One frequent 1. About Health Frontiers in Tijuana. University of comment is how helpful it is to have access to a California, San Diego School of Medicine website. dermatologist for challenging cases. We also have https://meded.ucsd.edu/index.cfm/groups/hfit/about/. heard many times that this project has inspired Accessed November 29, 2016. medical students and volunteers to expand their 2. SkinCare for developing countries. American Academy knowledge of dermatology. We are continuing to of Dermatology website. https://www.aad.org/members form new collaborative relationships with physi- /awards/skincare-for-developing-countries#undefined. cians in Tijuana. We will soon have the ability to Accessed Novembercopy 29, 2016. not Do CUTIS WWW.CUTIS.COM VOLUME 98, DECEMBER 2016 E21 Copyright Cutis 2016. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher..

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