Episode 4: Global Dermatology, An AAD2022 Special

In this special episode of BJD Talks, we're at the American Academy of Dermatology Conference in Boston! Fittingly, we're discussing Global Health and Equity, and are lucky enough to have three great guests to share their important perspectives. Dr Esther Freeman, Dr Doriane Sabushimike and Dr Linda Oyesiku speak to Dr Jonny Guckian about the global implications of dermatology research and how to undertake more equitable scholarship.

Transcript

SPEAKER_04 0:18

Hi there, and welcome to BGD Talks, the official podcast of the British Journal of Dermatology. In this podcast, we look well beyond published studies and explore the real-world implications of dermatology research in an accessible way. This podcast is for anyone with an interest in skin health research. That's whether you're a dermatology professor, researcher, resident, patient, or simply a skin enthusiast. We hope you'll join us as we build on our world-leading research through friendly discussion. My name is Dr. Johnny Guccian, and I'm a dermatology reg in Leeds, the United Kingdom, as well as the BJD's Podcast Associate Editor. Together we'll dive into a huge range of issues, which are important to dermatology, including patient public involvement in research, artificial intelligence, and social media in dermatology scholarship. This is a really special episode of the BJD Talks, which, as you might already be able to tell, sounds a little bit different to normal. We're coming to you directly from the American Academy of Dermatology 2022 meeting in Boston. I can confirm that there is a lot of dermatology happening. It's been exciting to see that people do exist in real life, other than in the virtual world. This episode is really fitting for the AAD. Dermatology is a global endeavor, and the BJD is focused on patient outcomes the world over. So today we're going to explore global dermatology with a focus on global health and equity. How do dermatology outcomes vary across the world? What's the responsibility of a dermatology journal on this global scale? And what can you, the listener, do to improve outcomes in a way that's equitable globally? To answer these questions and more, I'm lucky enough to be joined by three amazing guests. First up, we have Dr. Esther Freeman, Global Health and COVID dermatologist, who's associate professor at Harvard, an epidemiologist, and chair of Glow Derm, the Global Alliance for Global Health Dermatology. Of course, she's also section editor of the Global Health and Equity Section here at the BJD. Hi, Esther.

SPEAKER_03 2:07

Hi.

SPEAKER_04 2:07

I'm also delighted to welcome Dr. Dorian Sabushimikek, dermatovenerologist trainee at the Regional Dermatology Training Centre at Moshi, Tanzania, and Secretary of the Glow Derm Training Committee. Great to meet you, Dorian. Great to meet you too. And finally, I have Dr. Linda Oyoshiku, incoming dermatology resident at the University of Washington with a special interest in pediatrics and skin of color, and Glowderm co-founder and former trainee representative. Fantastic to meet you, Linda.

SPEAKER_03 2:34

Nice to meet you too.

SPEAKER_04 2:35

So everybody, are you all enjoying your AAD?

SPEAKER_02 2:39

It's been a busy and crazy experience. We had the COVID symposium just this morning. We had our annual scientific meeting with the International Alliance for Global Health Dermatology just a few days ago where we announced our new mentorship program. We're really excited about it. But uh, you know, Dorian over here, I think maybe had the longest journey she went from Pittsburgh.

SPEAKER_00 2:57

Yeah, I flew uh 28 hours from Klimanjaro to uh Boston, and I'm really enjoying the AED. Uh I'm enjoying the lectures, um, also enjoying getting samples. We all are yeah, it's my first time here, and it's um I'm really enjoying it.

SPEAKER_04 3:16

Brilliant. It's great, it's great to be able to speak to you here.

SPEAKER_01 3:20

Yeah, I think the AED is an incredible experience as a young trainee. You get to learn so much, meet so many people, connect with your peers, meet mentors and rock stars in the field, um, between Gloderm, the Society of P Object Derology, and the Sort of Color Symposium all in one day. I think it was an amazing start to uh what has been a wonderful weekend.

SPEAKER_04 3:40

I think it was all a bit overwhelming at first having not done anything face to face for so long, and then suddenly a lot of real people standing in front of you who you maybe you spoke to virtually before.

SPEAKER_01 3:53

Yes. Exactly. And it's been so amazing to meet people that you thought you have already met because you've been talking to them virtually for two years or or longer, and only on social media or on Zoom, and to meet them and also feel like you know them so well because that connection has already been built.

SPEAKER_02 4:09

Um In fact, this is the first time in person that the three of us have met. Lynn and I have worked together in person for several years. To reunite have worked together virtually now for several years. This is the first time we're all in one place together, which is just a crap.

SPEAKER_04 4:22

That's amazing. Oh brilliant. It I I find it um fun to see that people aren't just heads. Um and and people are a lot taller than I than I realize in real life. Um so that that's always that's always fun. That was me when I saw Lynn the Bruce.

SPEAKER_00 4:36

I didn't know she was that tall.

SPEAKER_04 4:39

Um so let's talk about uh global health and dermatology. So global dermatology is of course a huge area. The world is a big place. Can you guys share with the listeners how you came to be involved with this area?

SPEAKER_02 4:52

Yeah, for me, I started out um with my training in actually I came into dermatit, it's also more than I was in global health, that I came into dermatology late. Um I did my PhD in infectious disease epidemiology and was based in four different sub-Saharan African countries, looking at the comparative HIV epidemic between uh different sub-Saharan African countries and eastern versus western Sub-Saharan Africa. And I actually found myself working in rural Lesotho, uh, just a small country entirely surrounded by South Africa. I was working with an organization, Paul, that Paul Farmers Organization for bringing intervetir biology therapy to Lesotho for the first time. Really remote neural, so that I originally dropped in my airplane and resupplied once a week. Um and then just kind of landed us in a field with medications that we needed. And what was so interesting, we had no access to lab tests at all. We were diagnosing people with HIV for the first time. And I found that the skin was really a window into people's soul because people were being in severely amino suppressed, and you could almost guess their CD4 count uh based on skin findings. And that was actually how I became interested in dermatology. So it's almost like I came from a blue hole background and then came into dermatology in a more unusual way.

SPEAKER_04 6:00

But I don't think that's difficult dermatology track. I think a lot of people have uh have interesting kind of journeys into dermatology. So it's why I love meeting people on this podcast and and hearing about hearing about uh their journeys. What about um what about you guys?

SPEAKER_01 6:13

Aaron Powell Ironically, I had a very similar entry into dermatology. I had studied international health and public health and went to graduate school public health before um going to medical school and then spent two years as a Peace Corps volunteer in Mozambique and working in a pediatric rehabilitation center for children who had malnutrition and with a pediatric VIP organization. And so I came sort of from a background in public health and interest in global health, not intending to go to medical school at all at the time, and then deciding that I was interested in in medical school. But I think I was so again struck by so much that I saw and with relationship to the skin and the presentation of multiple infectious diseases, um, diseases that are associated with malnutrition, and uh, of course, being in a region where there is so much uh so much need medically that there are also a lot of areas where I saw potential for impact. I thought I was gonna go into pediatric infectious disease actually, and and then came into dermatology when I realized so much of what I enjoyed or what I was interested in and what I did impacted by in my own personal life. I was in the field. I didn't know if I could connect them. I didn't think it was something that could happen. And so I was trying to figure out how to merge those worlds and eventually I think the path of finding mentorship led me to find a master and then to ultimately decide that I could do this as a career and sort of have it all.

SPEAKER_00 7:37

So my experience is a little bit uh sad because uh I'm from a country where we don't have dermatologists. We have only three dermatologists for an estimated population of 12 million. That's Burundi. Uh so I have always been interested by dermatology since I was young, because I suffered from a very severe uh eczema, and it was sad because uh I couldn't find someone to explain to my parents what I was suffering from and to treat me properly. So I used to say I want to become a doctor and to be a skin doctor. And when I got the good marks to join medical school uh in Burundi, I decided to go and do it in Rwanda. And when we were rotating um in the different departments when uh we rotated in the in dermatology, I was the only one who was interested. Other people were like, oh, this is disgusting. We prefer to go and stay in pediatrics or uh internal medicine. Mia used to stay there with uh the only dermatologist we had, and then she was, maybe you should join later when you finish your internship. If you are you find yourself still interested in dermatology, maybe you should join um um residency in dermatology. But unfortunately in Rwanda, they didn't have um residency in dermatology. So I searched and then found that the best, um, one of the best training centers was uh in Tanzania, which is also um a neighboring country of Burundi. So I went there the first year. I was a private student, so I didn't have any sponsor. Uh, but it was expensive for my family. So after finishing the first year, I wanted to drop because uh I couldn't um afford to continue the four years. And when I talked to the principal of the regional dermatology training center in Tanzania, Professor Mavura, uh, I told him, I think I'm going to suspend or to just drop uh and do uh continue uh to work as a GP. He said, no, I can't afford to lose you. Let's uh work on it, then look for someone to sponsor you. So he helped me to uh to look for a sponsorship. And I continued. And uh during that second year, that's where I met Professor Lovan Koza. Uh that was during uh Globosorasis uh Atlas uh visit in Tanzania. And uh she is even the one who introduced me to Glodem and to the trainee committee.

SPEAKER_04 9:57

Fantastic. Hearing about you guys being inspired by personal experience, being inspired by mentors, and being inspired by you know patients that that you see. It's interesting uh to hear that uh our motivations and our journeys are inspired by similar things kind of the world over no matter no matter where you've come from. So that's um kind of global commonalities is is really quite powerful. You've mentioned Gloderm quite a bit um already. Um let's let's get down to it and explain what Glowderm is um and the Glowderm Alliance. What do you get up to and why does it matter?

SPEAKER_02 10:27

Glowderm is the International Alliance for Global Health Dermatology. We're a relatively new organization, started about four years ago. And the idea was really to give a place for people, both trainees and practicing dermatologists who really have experience in global health dermatology, to come together, share best practice, share resources, and really think about how we can increase access to skin care, you know, worldwide. Um, and so from that organization, we've really grown. And what's been incredible is to see the Glowderm Trainee Committee in particular take off. And Dorian, who's one of our founders of the Glowderm Training Committee, I think can speak to that a little bit. But it's it's really been incredible to see treaties around the world. We really have treaties from truly global settings, come together. And they've actually started an international webinar series that provides free, incredibly high-level education. It's basically like imagine the world's best speakers for grand browns showing up and giving free lectures that are freely available online. You can go to gloderm.org and you can access our free content. And what's so cool about this is it matches a senior uh dermatologist with a topic expertise with a trainee from around the world who can present particular cases. So, you know, just incredible to watch the growth over the past few years.

SPEAKER_00 11:37

So the Glonum Trainee Committee is uh actually a group of dermatology trainees uh with uh some uh expert dermatologists. And what we do, we uh every month we do three uh webinars whereby we have case uh presentation by trainees, and uh followed by uh literature review and explanation by dermatologists. And uh at the end, the participants are allowed to ask questions to the speakers. So it's something that we have been doing uh now for almost two years. At the beginning, it was a little bit complicated. We had to create Zoom uh linked by ourselves and adding participants ourselves. Uh but since we joined the GLodum, uh they are helping us in a lot of things, uh advertising our webinars. And uh we are now um in our second uh academic year, and we have been having uh more than 200 participants. At the beginning it was only 70, around 70, uh 80, but now we are having more than 200 participants, and all the webinars are recorded and uploaded uh at the Glodem YouTube channel to allow those who miss them to review the recording and also uh for those who need to check or to revisit the the videos for the practice to do it. And uh, for example, myself, I've been doing it, like going back to the videos for my patients or to check some management of some conditions. So it's something that is very helpful because um in some areas where they don't have dermatologists, uh, there are some general practitioners who are seeing skin conditions who don't have any idea about how to treat them, who have been also joining. There's one uh from Burundi who actually texted me and told me that those webinars have been very helpful for him, though sometimes he struggled with the language because you know it's a French-speaking country. Uh, but he told me that he also used them for his patients. So it's something that has been very helpful for trainees in dermatology, but also those who are seeing skin conditions as GP.

SPEAKER_02 13:41

And I would say I'm just looking at some of our recent webinars, we literally look at who's coming to listen to these talks live, and it could be the middle of the night in some places, and you sign on, and there's someone from the Sudan, there's someone from Indonesia, there's someone from Australia, there's someone from, you know, from Israel, there is all across the world represented, you know, people from Brazil, uh, folks from Venezuela. And so just so amazing to really see the global community coming together. I think the second piece uh to just mention about Glowderm is our launch of our new mentorship program. And this is really aimed at um dermatologists, dermatologist trainees in low resource settings, particularly in low and lower middle income countries. Um, not so much to train in clinical skills, we're not uh clinical mentorship, but really to train people in leadership skills. So, for example, if you're someone like Dorian who's gonna go back to Burundi and be only the fourth dermatologist for 12 million people, I'm gonna guess that Dorian and Dorian's future is probably setting up an entire residency training program. We need to give Dorian the skills to succeed in.

SPEAKER_04 14:40

No pressure, Dorian.

SPEAKER_02 14:43

My practice thing's coming.

SPEAKER_04 14:45

So, I mean, we've we've talked about um global dermatology education, we've talked about uh mentorship, and we've talked about leadership. Um let's talk about research and scholarship, because this is uh ultimately a research and scholarship uh podcast. So are we doing enough as a dermatology research community for global health and equity? And how can publications better represent the global burden of disease?

SPEAKER_02 15:09

The short answer journey is no, we're not doing enough. I suspect it is which is why we're having this podcast. And you know, I have to say it was I was so thrilled when John Ingram, who's the editor-in-chief of the BJD, reached out to me to found this section on global health and equity because I said, yes. You know, finally the field of science realizes how important this is and that there is a big gap. And founding that section, I think, is really the first step to acknowledging the importance of this and having high quality research and high-quality reviews. All of us have worked together to try to um promote publications in global health and equity. And I remember I, you know, I turned in one paper that was looking at the importance of um and the ability for people to do skin biopsy worldwide. And the reviews I got back were we don't see why this is work. And it literally was like, you don't see why being able to do skin biopsy in a country other than other than the US or would be important. Like this is completely fundamental to our specialty. And I think that really, to me, seeing that kind of review lit the fire of like, we need to do better. We need to have people who are well versed in these issues and understand, you know, the importance of a global burden of disease, how we can match, you know, in the literature, high quality research in these areas.

SPEAKER_01 16:18

Yeah, I think it's so important that we give a space to multiple voices in this field and realize that there are people in so many different countries with experiences that we don't even know anything about because they haven't had an opportunity or a space to publish. Um, even something that could be as not as rigorous as a, you know, randomized control clinical trial, but is a very potent piece that has um can have tremendous impact on the field because you don't necessarily know space for your piece and where you could find it, um, and then whether or not it's that could actually have power to affect change. And I'm speaking a little bit from a personal experience with a piece I wrote um a couple of years ago that uh was published in the Pediatric Dermatology Journal on a plea for making brown bandages stick. And it sort of goes through the history of adhesive bandages and why we have come a hundred years of having this product and we haven't had a product that shows the the diversity of the world and the global population that now has, you know, been a hundred years of of struggling to find something like that. So I think it was a really interesting process to find a home for that piece. And I knew that I wanted to find a place where people could read it and enjoy it. But I also hoped that it could be given a stage so that maybe people could start asking these questions and probing things that they see in their day-to-day life that may not be inclusive in their clinical practice. And we have so much in medicine that is not equitable, and there's so much bias in medicine. And there have been a lot of papers to to bring this up. And um, it was really, really incredible to see that a piece like that could find a home and not only find a home, but could affect change in my future institution at the University of Washington.

SPEAKER_02 18:09

And this being humble, like so basically then how is I remember this so clearly, she's like, Why are all these band-aids pink? And I was like, I never thought about that before. I feel terrible for the fact that I never thought about that. So it's true. All of the band-aids we give out in Zenic are pink. It doesn't matter what you know your skin tone is like. And what's so amazing about this piece that Linda published about the need to amount band-aids of bandages that actually match your skin tone is that her future institution, she's not even there yet, has already changed their band-aid supply so that they have a diversity of bandages. She hasn't even arrived yet and they already did it. How cool is that?

SPEAKER_04 18:45

No pressure, Linda.

SPEAKER_01 18:49

But I think that one of the things I wanted to include in that piece as well was to say we need to start interrogating some of these things that are normative in our day-to-day life. And there are a number of things that, you know, could be spoken about in journals and be given a stage so people can can start to think about um how they can affect change on a on a grander scheme. I mean, a bandage is very minor in in the grand scheme of things. It's important and significant for a lot of people. However, I also wanted it to be a piece that allowed people to sort of break the glass on something that they may not have really truly seen before and opened their eyes to a lot of inequity in medicine.

SPEAKER_04 19:28

Aaron Powell I think we're somewhat conditioned sometimes within the research community and our with within our research work to think that you can only affect change with randomized controlled trials and very you know traditionally literature that's in the the the top tiers of the evidence-based medicine, apparently. But actually, when you consider what is the point of research, what is the point of scholarship? Well, it should be to affect change and to get people to reflect. And ultimately, that's how you improve outcomes by bringing about hopefully good change. And that doesn't need to be a uh a clinical trial to do that. Sometimes you need to amplify the right voices and the right ideas. So speaking of uh research, can you guys share with me an example of great research you've read, or indeed research you've undertaken, it's not leading at all, on global outcomes research and dermatology.

SPEAKER_00 20:17

Okay, I can share one example of um a research that we did with uh a group at that time I was um working with a group of um residents in oncology, but now they have graduated, they're a big oncologist in Rwanda. So we uh were working on uh uh feasibility of using a smartphone to detect skin cancers in uh patient uh people living with alpine. So they were just supposed to take pictures of any lesion that they seen uh on their skin and post on the application that we created. So uh as dermatologists we will like recommend if it needs a biopsy, if it needs uh to be excised, or if it needs to just get uh crime therapy or any other um management, or if we need uh also um like a consultation or um an opinion from oncologists. And it's really worked. And um people living with albinism in Tanzania were very, very happy because it was some of them, it was difficult to come to clinics or to uh reach where we're doing outreaches, because we're even when we go for outreaches, we don't go to all health facilities. We go to one point and then they have to all come up there. Uh so even those who are not having phones can use uh if a neighbor's phone or anybody in the family. And we found out it was really helpful for them.

SPEAKER_02 21:40

And I think to put it in context, because albinism is not necessarily around something I run into all the time in my day to day clinic, could you give us a little context story and for what you're seeing in terms of the burden of disease and uh the you know, kind of what the feeling is in terms of how much albinism you're seeing in Tanzania and why this is an important problem?

SPEAKER_00 21:57

We see um Nick Floyd's important. So if I said in my uh when I do clinics, every week I'll see more than signs, uh people leaving the uh clean. And most of the time they come to clinics because they already have involves and some of them uh need big surgeries and they are so depressed that they don't even want me to do anything if anything attack it's going to happen again. And um getting some protection in Africa is very also difficult. So um the good thing using those phones uh so they from far we don't have to come and also uh it's a way of communication because we were providing our um our our contact so they could call us and uh at any time and uh ask any questions. So it's something that uh was helpful and also helpful for us because uh it was even um making us uh doing um a a good job uh distance that we won't have to for all chip.

SPEAKER_01 23:03

One piece of research that I've been working on in the US has been on the impact of pseudophiliculitis barbae and the barbershop particularly, and trying to understand the knowledge, attitudes, practices about this condition. Um I was really interested in the fact that there are roughly, they say the incidence is about 83% of black men will deal with PSB, and it's not currently good black men, it's also women are included in that population. There are transgender individuals included in that population. And of course, we have this huge population that is going to see primarily their barber or their stylist for a condition. I wanted to know if there was any understanding of what dermatologists' role could be in that condition and treating that condition, improving the quality of life, those individuals. It was really wonderful to be able to use something that has been developed, the Skin Index Mini, to assess the quality of life impact on this condition and then understand how we can unite um or create collaboration between barbers and dermatologists so we can better serve a community that is underserved in most places. Um because so many people had no idea that a dermatologist condition, they were feeling that um they had no option. They felt like there was no treatment out there for them and for their condition. And while it is a difficult thing to treat, there's a lot that can be done. And so many people don't have the understanding of what dermatology includes necessarily. So we have such an interesting bias in what we as a field may put out into the world and what patients and the public may understand that we do. So I think it was really cool to to to do a study of the CJ. There's so much, so much potential for collaboration. So many arbors have no idea that there could be a dermatologist that can treat this condition or to help their clients uh improve the quality of life. And then there's so many individuals that have no idea that a dermatologist could treat this condition.

SPEAKER_04 25:02

So Can I narrowed out for a second with that? This study is when it sounds really interesting. I don't want to read it. Um how did you collect data for it?

SPEAKER_01 25:09

So we created a survey um and then we distributed on multiple platforms and social media to barbershop community groups online. We had about 4,000 respondents to the survey in a really short window of time. It was an incredible response to this because so many people as a mental dealer this issue, and so many barbers hit like a dead end as far as what they think you. It was really wonderful to go through the data and understand like there's a tremendous lead and a gap, and there's a cascade that has not been even remotely analyzed. There's a lot of studies on barbershops as a space for intervention for blood pressure, for um for diabetes management, but in a space where they're dealing with hair and scan, which is in the domain of dermatology itself. And they are basically our community health workers potentially. We need to create dialogue. Same for women with hair loss, we have to create dialogue. A lot of times people come to see a dermatologist when it's too late. Their stylist has helped them and done a lot of things to improve how they present themselves in the world, but had they come to the dermatologist sooner, they might had an intervention sooner that could have changed the rest of their life and the impact of your life.

SPEAKER_04 26:23

Wow, I mean, it's really sounds like an area of need.

SPEAKER_03 26:26

I wouldn't I wouldn't know where to start and trying to reach out to 4,000 farmers, but perhaps even if that was messy. Um Esther, what about you? What's your what's your favorite global documentary?

SPEAKER_02 26:37

Well, I have to say, I think my favorite right now is the new editorial that we just put out, John. I'm not gonna lie. Um, so uh we're very lucky at the BJD that I've recruited wonderful associate editors from around the globe that really have incredible expertise in global health and equity. Um, so for example, we have Valeska Padavese from Malta who does migrant health. Um, we have uh Paco Bravo from Peru, who's an expert in tropical dermatology. We have Anisa Mosem from South Africa, who's an expert in HIV dermatology. We have Arshana Singal from India, who's an expert in community dermatology. And we have Riayatsu from Japan and also the US, who's an expert in neglected tropical diseases. So, really an incredible team with a diverse set of expertise and a diverse set of geography. And we put together an editorial to introduce the section on global health and equity. And I think things that are really near and dear to my heart, actually, that we've talked about in the editorial, is around authorship. I think one thing that we don't think about enough and don't talk about enough is that it's really important that research is not coming from outside and being done on a group or to a group of people, but rather from within the community. And so we really talk about the importance of having someone within a community being involved, ideally from the very beginning with a research project, you know, to really be involved in conception and certainly in the analysis and the planning and the writing up. And so I think all too often, and and I'm guilty of this in my own past research of really not including people from the very beginning. So we talk about the role of authorship and authorship order, I think is really important to think about in global health and equity in particular.

SPEAKER_04 28:09

So just speaking about the new BJD section, it's not just global health, it's global health and equity. Um, Esther, how can we practice more equitable dermatology research?

SPEAKER_02 28:18

I think equity is so key in the future of dermatology research and the dermatology literature. I think we talked a little bit about authorship, which as I said is an issue near and dear to my heart, really making sure that research is coming from communities and rather than being done, you know, to or on communities. I think in particular, we think about the representation, the literature, it really does not match the global burden of skin disease. And I think far too often we have research coming out of the global north that is not necessarily either relevant or driven by priorities in the global south. So I think just super important to include more voices. And I think here at the BJD, we're really interested in not just including more research papers from these areas, but also how do we include, for example, higher quality reviewers with expertise in health equity and also in global health, I think is is really important. And so we we need to train our next batch of reviewers and listen, our next batch of editors. I will be absolutely delighted when I work myself out of a job. And I hope to be replaced by someone, you know, eventually uh who has, you know, really come through the system and um been involved in equity since very early on in their career. So I think uh, as I said, I would love to eventually uh work myself out of a job and replace myself with these wonderful trainees, for example, who are sitting right here next to me. They're they're the next generation there who really matters.

SPEAKER_04 29:33

Hopefully some of our listeners here listening will be even to patch. I love it. If you're interested in viewing, please get in touch. We're always desperate for review, it's the BJD, but so we mentioned the global north of the south.

SPEAKER_03 29:46

Um interesting points about that. How can we best empower a platform or celebrate dermatology research on order to be taken away from that global north? And importantly, how are we gonna know if that has succeeded? Big question.

SPEAKER_02 30:02

Yeah, I mean, I think if we think a little bit about the global burden of skin disease, you know, there are certainly conditions that I think are affecting worldwide. So for example, dermatitis and acne are right up there, you know, in the global north and global south. And there's some conditions, for example, like tinea, that are incredibly burdensome worldwide, but don't really make it top in the literature, uh, for example, in North America or Europe. So I think there's a balance that we want cutting edge, but we also want to really embrace the issues um that are relevant to people, you know, worldwide and not just living in the global north.

SPEAKER_00 30:37

I had an idea. What about um doing workshop in research, for example? Because there are some people in the low-income countries uh who are interested in research, but they don't have any idea on how to do research. So maybe the big journals could um like initiate or start doing workshops in some countries to get more interesting data, because uh they are very important, especially for the change. Because when the WHO, for example, is um, if I give an example of leprosy, for example, in Tanzania, we have been struggling getting medication for leprosy patients because it has been eradicated. So we usually send them to a TB program to get medication, and then they go and then find there is no medication, they'll tell them WHO is not sending medication for us because there's no data showing what is the incidence of leprosy, for example, in Tanzania for now. There are no data because there's no research that is being done, because there are few people who can do the research. Us who are, for example, in uh cities, we don't know what is happening in the villages where we have like medical officers who are working there, they could collect data and also publish about what is happening there, and that would be very, very helpful.

SPEAKER_01 31:49

One of the things with Gloderm and this particular issue that we hope to work on, and it's very hard to know. I think the answer to your question is it's hard to know when we have achieved that. But I think on the path to that, knowing that it is somewhere we want to be, um, Gloderm is really, really interested in being able to provide more professional development to people. Just like we have grand rounds for dealing with particular spoon issues, we have a potential to also have grand rounds on professional development issues, such as being a mentor, being a mentee, but also how to write a manuscript, how to obtain approval for your study, how to have methodology that is, you know, rigorous, and how to really be a researcher and to be a biostatistician and to lend assistance in in the sense that we can have a living library on how to be an academic.

SPEAKER_00 32:44

I think it should be more training on how to write good papers, because for example, some people would write paper to and they'll be refused to be published because they didn't write the way the journals want it to be written. So I think it would be good if the big journals are teaching how to write, because some people feel like uh uh they are being judged while they are not being taught how to write.

SPEAKER_04 33:05

Yeah, I think you've all made some really um fascinating points. Since especially that last point um about education or or even I wouldn't even necessarily always call it education because because uh sometimes I feel that in academic land we all speak a certain language and we're all part of the same club. And anybody who does speak that particular language isn't in the club and but they can't possibly be doing good. But actually they are. So it's it's about accessibility. So some of the points you guys have made have been really powerful in terms of better accessibility, um, improving engagement, and then ultimately we can measure that by seeing the quality of research that does develop and does come out of it and being more widespread of that across the blue. And I guess that's really what we're here for ultimately, is to make better quality research worldwide so as to better practition outcomes.

SPEAKER_02 33:55

I think, Johnny, one thing to you know to add is when people think about global health, they think international health. They think that means going across a border. And when we talk about global health and equity, we're really talking about under-resourced environments that are truly everywhere in the world. This might be literally down the street from you. And so sometimes students ask, you know, how can I get involved? And I say, look around. What are the issues facing your community? You don't need to get on a plane and fly somewhere to find an under-resourced environment. You know, for example, here in Boston, we have um persons experiencing homelessness and we have Boston healthcare for the homeless. Um, I also think about the indigenous communities uh worldwide and and even just you know, urban, you know, black communities and as well. And and Linda's not, you can't see Linda, but she's nodding her head. Um, but I think, you know, I just think that when we think about global health, I really think of it as global is local. And so, in terms of asking about how people can get involved, think about your own local communities and the issues you're facing. This doesn't need to be far away from where you are.

SPEAKER_04 34:52

So I think we've touched on so many different things and one of we have we have taken over the world and and we have improved uh and sort of like global health dermatology um academia uh in this uh hour-long session. So it's kind of so well done, team. Um and good luck to the BD BJD team editing this uh this podcast. Everybody behind this. We hope that some of the messages people that we have sent have come across. And you're having this conversation happening from the guys setting up the room behind us. And so that brings us to the end of uh today's special episode of BJD Talks. We've addressed issues which impact dermatology research on a global level and hopefully have inspired some listeners to broaden their horizons on encompasses sourcing Iequality research. Thank you so much for taking your time uh out of your AED meeting. We look forward to sharing our next episode of BJD Talks. Please do let us know if there's any hot topics in dermatology you think we should discuss. We're always really busy uh at the social media, so you can reach us via at brjdermatol on Twitter and at brjdermatology on Instagram, or by using the hashtag bjd.