Large teledermatology project in a remote island in Eastern Indonesia

A teledermatology project on a remote Indonesian island resulted in numerous benefits for local health workers and patients. Diagnostic accuracy, satisfaction, and confidence of local healthcare workers improved, whereas out-of-pocket costs and travel time for patients were reduced. “Teledermatology offers sustainable and scalable opportunities, strengthening local ownership and capacity,” concluded the authors of the project.

“Indonesia is a large archipelagic country, and dermatological conditions are mostly managed by frontline healthcare workers,” outlined Dr Marlous Grijsen (University of Oxford, UK) [1]. “Many of these healthcare workers don’t have expertise in diagnosing and treating skin diseases.” Dr Grijsen and colleagues chose the Indonesian island Sumba to assess the efficacy and applicability of their teledermatology tool aimed at supporting local healthcare workers with clinical decision-making. The remote island has around 800,000 inhabitants. Marlous Grijsen and her team collaborate with the Sumba Foundation, a local NGO that supports 5 primary health clinics on the island. There is no dermatologist available on the island. Of the 40,000 patients who visit the clinics each year, 10–15% have skin-related complaints. “The main goals of our project are to improve access to quality skincare and develop a better understanding of the needs of the community.”

Dr Grijsen and co-investigators used a store-and-forward platform as a method to deliver teledermatology. Local healthcare workers were trained in diagnosing and managing common skin diseases, including simple diagnostic skills such as a skin scraping or slit skin smear.

Of the 307 cases that thus far have been analysed over a period of 2  years, skin infections and infestations were the most commonly observed skin diseases (52.8%), followed by eczematous conditions (27.7%). Importantly, 17% of the cases were attributable to neglected tropical skin diseases, such as leprosy, scabies, and snake bites. Dr Grijsen mentioned that the diagnostic agreement between the healthcare workers and a trained dermatologist in terms of Kappa value increased from 0.45 in months 1–6 to 0.76 in months 19–24.

Finally, Dr Grijsen summarised some other accomplishments that the project has achieved to date: “Over 10,000 patients with skin diseases have benefitted from this project. The diagnostic accuracy of the local healthcare workers increased significantly over time and 95% of the consultations could be resolved on-site without the need for referral to a specialist. Healthcare workers demonstrated high satisfaction and improved confidence in skin-related clinical decision-making, according to a survey. Finally, patient travels, healthcare consumption, and out-of-pocket costs were reduced,” added Dr Grijsen.

1. Grijsen M, et al. Improving access to skin care through teledermatology in a remote island in Eastern Indonesia. Session Teledermatology, WCD 2023, 3–8 July, Singapore, Singapore.