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Implementation of an Ultraviolet Phototherapy Service at a National Referral Hospital in Western Kenya: Reflections on Challenges and Lessons Learned
- Source :
- Dermatology and therapy, vol 10, iss 1, Dermatology and Therapy, Dermatology and Therapy, Vol 10, Iss 1, Pp 107-117 (2019)
- Publication Year :
- 2020
- Publisher :
- eScholarship, University of California, 2020.
-
Abstract
- Introduction In order to manage skin conditions at a national referral hospital level in Kenya, specialized dermatology services, such as dermatologic surgery, dermatopathology, phototherapy, and sub-specialty care, should be offered, as is typically available in referral hospitals around the world. A Kenyan patient with prurigo nodularis, whose severe itch remitted after phototherapy treatment at the University of California, San Francisco (UCSF), inspired the development of a phototherapy service at Academic Model Providing Access to Healthcare (AMPATH), a partnership in Western Kenya between Moi Teaching and Referral Hospital, Moi University College of Health Sciences, and a consortium of North American academic medical centers. Methods Initial project funds were raised through a crowdfunding campaign and fundraising events. A new narrowband ultraviolet B phototherapy unit and replacement bulbs were donated and air shipped to Eldoret, Kenya. A team of dermatologists and phototherapy nurses from UCSF conducted a 2-day training session. US-based dermatologists affiliated with AMPATH provide ongoing support through regular communication and on-site visits. Results Early in implementation, challenges faced included training clinical staff with limited experience in phototherapy and improving communication between nurses and clinicians. More recent challenges include frequent rotation of specialty clinic nurses in the dermatology clinic, adaptation of phototherapy guidelines to balance patient volume with service delivery capacity, and training assessment of disease activity in darkly pigmented skin. Conclusion Strategies that have been helpful in addressing implementation challenges include: increasing on-site and remote training opportunities for clinicians and nurses, developing a tiered payment schema, educating patients to combat misconceptions about phototherapy, dynamic phototherapy referral guidelines to accommodate service delivery capacity, and prioritizing the engagement of a multidisciplinary team.
- Subjects :
- Kenya
Referral
Service delivery framework
education
Clinical Sciences
Specialty
MEDLINE
8.1 Organisation and delivery of services
Dermatology
7.3 Management and decision making
030207 dermatology & venereal diseases
03 medical and health sciences
0302 clinical medicine
Clinical Research
Health care
Ultraviolet light
lcsh:Dermatology
Medicine
Dermatologic surgery
Original Research
Low- and middle-income countries
and middle-income countries
business.industry
lcsh:RL1-803
Phototherapy
Health Services
medicine.disease
Resource-limited settings
3. Good health
Low
030220 oncology & carcinogenesis
Africa
Medical emergency
Patient Safety
business
UVB
Subjects
Details
- Database :
- OpenAIRE
- Journal :
- Dermatology and therapy, vol 10, iss 1, Dermatology and Therapy, Dermatology and Therapy, Vol 10, Iss 1, Pp 107-117 (2019)
- Accession number :
- edsair.doi.dedup.....cd3a3dc48bc554d044b245442c4a4059