Dermatology in Sudan
Mahmoud A. Ahmed
Sudananese Journal of Dermatology 2004;2(1):2-5
Modern medical services were first introduced to the Sudan at the beginning of the twentieth century by the occupying powers- Egypt and Britain. The first hospital-Khartoum hospital- was opened in the year 1908, followed by other hospitals in the big cities: Medani, Atbara, Elobeid and Port Sudan. A program for training of paramedical staff was quickly put in place to provide nurses and medical assistants. As for doctors the then Medical Department had to rely on expatriates. Those were available from Egypt, Britain and Syria.
In 1924 the Kitchner School of Medicine was opened in Khartoum to train Sudanese doctors and the first patch graduated by the year 1928. The main emphasis at the time was on public health measures to combat endemic diseases. Curative medicine had to go through a slow pace.
Hospitals were prepared to deal with cases of internal medicine, surgery and obstetrical cases. Those were the threedepartments to prevail for a long time to come. Of the special departments only ophthalmology received an early attention and a single eye hospital was established in Khartoum in .This state of affairs continued into the early sixties when after independence expansion in the medical services and schools was gradually followed by introduction of sub-specialties. The initial step was an important decision made by the Ministry of Health to appoint four senior physicians instead of one with the aim of creating special departments for: cardiology, gastroentrology, tropical medicine and dermatology. The post for senior dermatologist went to Dr Wasfi who worked until then as a general physician with an MRCP degree. He was then sent to the London Institute of Dermatology to get training in the subject. On his return Dr Wasfi did not devote himself completely to Dermatology. He continued to practice as a general physician and dermatology became just a special interest to him. However he could be credited by establishing the first dermatological referred clinic and by opening a small ward for skin cases in Khartoum hospital. About the same time Professor Morgan (a British) from the school of medicine in Khartoum University and whose specialty was tropical Medicine developed an interest in dermatology accessing it from leprosy. However for both Dr Wasfi and Professor Morgan skin diseases remained but an integral part of internal Medicine and never developed into an independent medical science. With this being the official stand about dermatology Dr. Mohamed Ali Ahmed a dermatologist trained in Cairo and the London Institute of Dermatology, but with no degree in Internal Medicine had to accept the post of a medical officer with special duties- dermatology .
This was a stark example of the prevailing concept at the time that a dermatologist must be a physician first and a dermatologist second. Nonetheless Dr Mohamed Ali could fight his way and go into the records as the first Sudanese dermatologist. Furthermore he established the first proper independent department of dermatology in Khartoum North Hospital. By the early seventies and with increasing number of dermatologist trained in the different European countries and Egypt joining the Ministry of Health, Dermatology came to be recognized as an independent specialty and no longer was it necessary to have a degree of Medicine first. An independent registry started both in the Sudanese Medical Council and the Ministry of Health for Dermatologists. The first senior dermatologist for the Ministry of Health was Dr Abdelrahim Hussien a dermatologist trained in Western Germany, and who could be credited with the establishment of Khartoum Skin Hospital, the first of its kind in the Sudan.
It is difficult to point to a precise date at which proper dermatological services were available for the population. From the very beginning Medical assistants and general practioners had at their disposal such skin preparations as sulphur, mercuricand zinc ointments. Those were dispensed to patients with such conditions as skin infections and leg ulcers. Tar preparations were used to treat fungal infections such as tinea capitis. Needless to say that specific diagnosis was not made at the time and treatment was decided on the experience of the prescriber. Only after the start of the referred clinic in Khartoum by Dr Wasfi that specific diagnosis of diseases were made and records of the patients kept. From this time on dermatological departments manned by dermatologists were gradually to spread all over the country in the main hospitals, specialized dermatological services are now available in 15 towns. Ready dermatological and cosmetic preparations gradually flooded the market from the main pharmaceutical producers in Europe and USA making the job easier for the dermatologists and bringing them abreast with new therapies. The laboratory side was and still remains a week link. From the very start there was good cooperation with the general pathology laboratory which was run by general pathologist and who helped with the pathological diagnosis of skin diseases. Only recently some of the pathologists have turned into dermatopathologists. Sophisticated laboratory diagnostic methods used in dermatology such antibodies detection, immuno-florescence are still lacking.
Undergraduate education of skin diseases unfortunately does not carry the weight it deserves. In the oldest and most renowned school of Medicine (Faculty of Medicine U of K) dermatology is still taught as a part of internal medicine. Only twenty hours in the final year are devoted to the subject in the form of clinical sessions. However in the more recent Universities more attention is paid to the subject and skeleton departments are found in almost every one of them. However much remains tobe wished in this aspect such as more trained teachers definite curriculae and appropriate teaching materials and literature. Regardless of the poor quality of undergraduate education of dermatology the Sudanese Specializations Medical Board set up in 1996 has deemed it necessary to set a two years course in Dermatology. Four patches has already graduated with a membership degree. A year before the Council Juba University started an MD course of Dermatology and managed to graduate three patches already. It is expected that the growing interest of students and doctors alike in the subject coupled with the increasing awareness of the populations for dermatological services will help promote and diversify dermatological science in the future.
As early as the fifties research work in dermatology from Sudan appeared in the international medical literature. The first work in onchocerciasis, which is endemic in some parts of the country was undertaken by Professor Hamad Satti and published in Journals of Tropical Medicine. Later research on Leishmaniasis was undertaken by Professor Ahmed Mohamed Elhassan, a renouned pathologists who published a large number of articles on the various aspects of the disease. On the mycological front Professor Elsheikh Mahgoub and Professor Samia Ahmed Gomaa devoted large efforts on the research of madura which is endemic in some parts of the Sudan.
Their work is widely published in the international literature. Although both of them are not dermatologists by education their work cannot be separated from the history of dermatological research. The late Dr Wasfi together with the author have also done research in vitiligo in the 198ies which also fond its way to the international literature. The MD of Juba University requires the candidates to write a thesis in partial fulfillment of awarding the degree. It is hoped that research in the subject will attract the new generations of dermatologists and the future will see more of it.
The Dermatology Association
The Sudanese Association of Dermatologists started in the early seventies as a branch of the Physician society>By the late eighties an independent association was set up under the leadership of Dr Wasfi. The activities of the association included clinical meetings, social evenings and a biannual conference on the local level with some guests invited from abroad mainly England and Egypt. The association soon became a member of the Pan-Arab Dermatological Association and hosted the Pan-Arab conference of Dermatology in1996. A new office was elected to the association last year. Among the plans is the publication of a dermatological journal. Plans are also made to forge relations with international scientific bodies working in the field of dermatology.
Dermatology in the Sudan had a long infancy but in recent years with the growth of departments in several universities and with the expansion of health services over the country together with the rising awareness among the increasingly sophisticated community for cosmeological and dermatological care it is hoped that dermatology will grow out of its infancy and acquire its rightful place in the field of medical sciences.