Dermatologist navigates six-month medical mission trip

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Lt. Cmdr. Jane Scribner, MD, (center) examines a boy with eczematous dermatitis, who was held by his mother in Colon, Panama.

When Lt. Cmdr. Jane Scribner, MD, went aboard the U.S. Navy Ship Comfort in April 2015, it was the start of her six-month journey to provide dermatologic medical and surgical care to individuals living in 11 underprivileged countries in the Caribbean, Central America, and South America.

Dr. Scribner shared the challenges and successes she encountered while deployed with 1,200 shipmates during her July 28 presentation, “Tales From the Fleet: The Role of Dermatology in Military Humanitarian Missions Around the World” (B007).

“Aside from the challenges of everyone being away from family and leaving your dermatology practice behind for several months, the trip was physically demanding. We carried in our gear and set up temporary medical sites in 11 countries, where we cared for patients for about 12 days in each country,” said Dr. Scribner, who at the time was stationed at the Captain James A. Lovell Federal Health Care Center in North Chicago and is now a dermatologist at the Walla Walla Clinic in Washington state.

The ship carried both civilian and military medical personnel, including 35 surgeons. At each stop, a large number of volunteer nurse practitioners and primary care and internal medicine physicians had screened waiting patients.

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Dr. Scribner talks about her mission during the AAD 2016 Summer Meeting.

“It was a little bit like working in a multispecialty clinic because the medical team ashore would see the patients first and then determine which patients had dermatologic needs,” Dr. Scibner said.

Medical teams treated patients in Belize, Colombia, Dominica, the Dominican Republic, El Salvador, Guatemala, Honduras, Haiti, Jamaica, Nicaragua, and Panama. Seven countries did not have piers in which to dock, so team members had to wake at 4 a.m. to wait in line, board and pack small boats, and travel to shore to begin work by 8 a.m. Because they had to pare down their medical supplies, Dr. Scribner looked to dentists on the mission for some equipment. “After all, they had similar surgical supplies,” she said.

Patient follow-up, the number of patients, and types of cases posed additional challenges.

“A lot of what we do in dermatology is to biopsy, culture, and get ancillary tests to guide our diagnosis and treatment. We had a pathology lab on the ship, and, although the lab did a beautiful job, they took three or four days to complete the processing and had limited stains,” Dr. Scribner said. “If you’re in a country for 11 days, what can you do with those results, and if you biopsy a patient on the last day of a mission in a country, what do you do with that result? We did a lot of presumptive treatment.”

Of the 1,000 patients examined each day, she saw about 40 dermatology patients a day — about 2,700 total patients.

“That’s significant for a humanitarian mission, and it’s emotionally challenging to see patients who are so desperate and so poor, and to face how we can or cannot help them,” Dr. Scribner said.

For example, Nicaragua brought cases of xeroderma pigmentosum and cutaneous tuberculosis. In Haiti, infectious diseases were a challenge. Seeing pigmentary disorders in the tropics, where adequate access to protective clothing is not available, also was troubling.

“It was hard to see because we couldn’t really do anything to help them, and some were incredibly young children,” Dr. Scribner said.

Because her trip occurred prior to the Zika virus outbreak, safety came in the form of the military’s preparedness by spraying to prevent mosquitoes, distributing uniforms treated with permethrin and insect repellent, and controlling diet to prevent gastrointestinal issues.

Among the shipboard medical personnel were volunteers with Project Hope, the Registered Nurse Response Network, the Latter Day Saints Charities, and Operation Smile.

“This mission shows how we can work with an international community to aid the poorest of the poor,” Dr. Scribner said. “We reached out in other ways by providing lectures to local health care providers, which have very limited resources, and they were excited to have lectures on the basics by a dermatologist. Getting to participate in such a way was exciting.”

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