Capacity-building Visit to Lebanon - 2023
Project title: Capacity-building visit to Lebanon
Partners: IFD-ILDS, MedGlobal, Salama the Lebanese Association for Family Health, American University of Beirut.
Funders: ILDS-IFD - https://www.ilds.org/what-we-do/partnerships-and-networks/migrant-health-dermatology-working-group/
Description:
In May 2023 the Migrant Health Dermatology Working Group (MHDWG) of the International Foundation of Dermatology, which is the humanitarian arm of the International League of Dermatological Societies (IILDS) and holds “official relations” status with the WHO, partnered with NGO Bridges2Health&Rights, an NGO working on sexual health, skin health and sexualized violence, to carry out a capacity-building mission in Lebanon.
The initial field project allowed a preliminary assessment of the healthcare needs of the local population and a technology assessment to determine whether a teledermatology service could be used in this setting. The mission supported capacity building through training and mentorship to develop and strengthen the skills, resources, and processes in place in the region. Furthermore, it allowed a preliminary appraisal of health-related issues with a particular focus on women’s sexual and reproductive health and rights (SRHR).
The context:
Lebanon is experiencing its most devastating social, economic, and financial catastrophe in decades. The financial crisis that started in October 2019, further exacerbated by the impact of Covid-19 and the Port of Beirut explosion in August 2020, had a disastrous impact on the country, with more than half of the population likely living below the poverty line. This is further compounded by the ongoing conflict in neighbouring war-torn Syria. According to the UN, Lebanon hosts the highest number of refugees per capita worldwide, especially in the Bekaa Valley. Approximately one in five people living in Lebanon is considered displaced and of the estimated 1.5 million Syrian refugees, most are in the Bekaa Valley and 90% live in extreme poverty. Half of surveyed Syrian refugees are unable to access all their needed medication. The overcrowding and poor sanitation of refugee camps make their population particularly vulnerable to health problems, and skin conditions accounted for 41% of health complaints of Syrian refugees in Lebanon, including leishmaniasis, scabies, cholera, and skin infections. These infectious conditions constitute a significant public health concern as they can easily be transmitted and may necessitate systemic treatment to prevent complications such as deep tissue infections and glomerulonephritis, which carry significant morbidity and mortality. However, there is a lack of dermatology care provision with many dermatologists having fled Lebanon as well as a lack of medications. The need for dermatology clinical and educational support has been highlighted in multiple United Nations High Commissioner for Refugees (UNHCR) reports. Health care workers are seeing a large number of dermatoses and specialist dermatology input is needed to help establish diagnoses and treatment given limited resources.
Objectives of May 2023 Mission:
Overarching goal:
-To improve access to skin and STIs care for displaced Syrian communities and under-served local populations in the Bekaa Valley and Beirut.
Objectives:
-To determine the top ten skin conditions in the displaced Syrian and local population.
-To sensitize local healthcare professionals with relevant expertise in the country who can participate in ongoing activities.
-To train and up-skill local healthcare workers to diagnose and treat common skin conditions.
-To identify a local trusted champion to employ sustainable interventions.
-To use a teledermatology platform to support and supervise the local trusted champion for asynchronous consultations of complex dermatological cases.
-To refer complex cases to AUB Dermatology Department for investigations, treatment and follow up.
Results of the mission :
-150 dermatologists of the Lebanese Dermatology Society were reached and attended lectures on migrants’ skin and sexual health at their Annual Meeting.
-12 local clinical staff members of NGO Salama, including two urologists, two gynecologists, two general practitioners, two pediatricians, two midwives, and two social workers, attended a training session on sexual health/STIs. We also provided shadowing and training opportunities to gynaecologists and dermatologists employed with our partner NGOs.
-417 patients benefitted from dermatological consultations over one week across seven clinic sites in the Bekaa Valley (field assessment –short dermatology mission).
-In total 498 skin conditions were identified, the most common being eczema/dermatitis (21.9%), acne (13.7%), fungal infection (8.4%), psoriasis (5.6%), melasma (3.2%) viral warts (2.8%). We identified several undetected genodermatoses.
-284 women, primarily Syrian nationals, accessed the dermatological clinic over one week. Most women had refugee status (60%) and had lived in Lebanon for over 5 years (64%). Out of the women who were asked if they had ever done a smear test, 86% responded that they had not, and in most cases were unaware of cervical cancer screening.
-Two senior dermatology residents interested in carrying out medical outreach activities in the Bekaa valley from the Department of Dermatology at the American University of Beirut were assigned. Both joined some of the clinics and gained field experience from international experts.
-A local champion was also identified during the field mission who continues to visit the partner clinic sites weekly to deliver dermato-venereology care.