Revolutionary new medical capability passes test during SA09 

In a part of the world where modern medicine is simply a dream for most, two U.S. military doctors stepped up to the plate, bringing not only basic clinical care, but access to the specialized world of dermatology.
For a brief window of time, the Beninese village of Sinende had access to a globe-spanning, highly trained, all-volunteer network of skilled American doctors.

“Derms are limited assets,” said Air Force Maj. Craig Miller, a dermatologist with the 459th Expeditionary Aerospace Medicine Squadron, and Pittsford, N.Y., native. “So I’ve constructed the first Portable Teledermatology System - as far as I know.  This technology is great at distributing specialty care, whether in the public health arena or in military care.”

Miller and Maj. Ari Fisher, also a dermatologist with the 459th EMDS, used the system to diagnose and prescribe treatment in three rural villages throughout the area surrounding Bembereke, Benin.
Miller’s PTDS consists of a portable microscope, a digital camera, computer and a satellite system. The camera, computer and satellite can all be charged by a compact, 50-watt solar-panel. The entire system fits compactly into two small hard-shelled cases and one computer bag.

“I picked up the pieces over the internet,” Miller added.  “This system is simple, complete and self-sustaining. It’s easily deployable, and a rugged, robust system. It works.”

Miller, a reserve Airman, first conceived the idea of creating such a system while deployed to Landsthul Regional Medical Center, Germany, during the early days of Operation Iraqi Freedom. 

In 2003, said Miller, no dermatologists were forward deployed. An average of seven service members each day were airlifted from the combat zone due to misdiagnosed skin issues, taking valuable flight space that could have been used by the combat wounded. Ninety-percent of the cases he saw in Germany, Miller added, didn’t need to be there. And typically at least two weeks passed before the service member could be reattached to his or her unit.

Cost savings and unit readiness on his mind, Miller devised a portable system on his own dime, adding pieces over time and deploying it for the first time during Exercise SHARED ACCORD 09, a 15-day, scheduled, bilateral U.S.-Benin exercise.
When a patient arrives on scene in the field, said Fisher, an Albany, N.Y., native, a culture is taken from the irritated site, along with a digital photo. Any questions not answered on-site by a physical examination or test under the microscope, are forwarded through the portable system to a central networking hub, where volunteer dermatologists in nearly every time zone provide input. A typical turnaround time for any question submitted to the inbox is about one hour, noted Fisher.

Often, when a patient describes common symptoms like a rash or respiratory infection, the fastest way to accurately determine its source and seriousness is with a microscope, said Miller.

“Small-pox versus chicken-pox,” said Miller. “A quick little microscope test can tell the difference.”

The teledermatology networking system, a brainchild of Army Lt. Col. Hon Pak, has been in place for some time, said Miller. However, until now, the system was used mainly for connectivity between military bases and stateside hospitals.

In a deployed or field environment, or on such occasions when a dermatologist is not present, the PTDS can be used by general practitioners, nurses, and doctors’ assistance to quickly and accurately diagnose the issue, said Fisher.

“It’s helpful to them,” said Miller. “And such a system allows us to perfect our technology for use when we actually need to use it – for example, after a bio-terrorism attack.  [Dermatology] is one of the most telltale signs of bioterrorism.”

Miller and Fisher were tasked specifically with dermatology care provision during SHARED ACCORD. However, “The first Marine phrase we learned was Semper Gumby (Always Flexible),” said Fisher. “And that’s been needed here.”

Clinic attendees were asked to define their main ailment, and Miller and Fisher found that skin irritations that would be high priority for care in the United States came in a low third or fourth for the Beninese villagers—far behind eye problems, dental issues or respiratory illnesses.

“Fungal infections or scalp irritations are standard – they’re acceptable here,” said Fisher. “Back home we’d require three to six months of treatment for the type of ailments we’re seeing.”
Miller’s ultimate wish, he said, is that the PTDS be used in deployed environments by any branch of service.

“It would provide instant consult by a centrally deployed dermatologist,” he noted.

SHARED ACCORD is aimed at conducting small unit infantry and staff training with the Beninese military.  The exercise is focused on non-lethal weapons training; individual and crew served weapons proficiency and small unit training tactics, techniques and procedures as well as company and battalion level staff training.  Additionally, the exercise will involve various medical related humanitarian assistance efforts for the local population to include veterinary care.