Stories From the Field:

KENYA

Global Health Dermatology in Kisumu, Kenya

Terry Farsani, MD, a resident in Dermatology at MGH, was granted a Center for Global Health Travel Award  to spend two weeks in Kenya to evaluate the burden of vulvar disease and disorders in HIV infected women.

I traveled to the FACES (Family AIDS Care and Education Services) Clinic in Kisumu, Kenya, with a travel grant from the MGH Center for Global Health.

As a Dermatologist working in women’s health issues and Global Health Dermatology, I focus on vulvar dermatoses as well as general dermatology. Vulvar dermatoses cause discomfort, disfigurement, and increased anxiety in females, and very often, women are reluctant to discuss vulvar issues. In addition, limited training leads to improper diagnosis and treatment of these disorders.

As part of our work with vulvar disorders, we sought out to determine the burden of vulvar disease in HIV-infected women and possible correlation among vulvar disease and cervical dysplasia as well as CD4 count. We also aimed to improve capacity of clinicians in Kisumu to diagnose and treat patients with vulvar dermatoses and to assess patient willingness to discuss vulvar issues.  Our long term goal includes the development of educational modules for the clinicians.

We were able to assess 170 patients in total and determine the prevalence of vulvar dermatoses in HIV infected women. It was interesting to discover that few women discuss their vulvar issues, and that even when asked about vulvar symptoms or rash, many with visible disease denied signs or symptoms. This emphasizes the importance of discussing and treating these disorders with patients.

By supporting clinicians like myself, the MGH Center for Global Health is supporting research and care in some of the poorest settings worldwide and for that I am very grateful.