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Global Health Initiatives: A Dermatologist's Perspective · The Science of Skin

• 0:00
  SPEAKER_00: This episode is sponsored by Lily, a medicine company.
• 0:09
  SPEAKER_01: Hello and welcome to the Science to Skin Podcast.
• 0:12
  SPEAKER_01: My name is Dr.
• 0:12
  SPEAKER_01: Ted Lane.
• 0:13
  SPEAKER_01: I am a dermatologist in Austin and your host for today.
• 0:17
  SPEAKER_01: But enough about me because we have just an amazing guest, Dr.
• 0:21
  SPEAKER_01: Scott Drew.
• 0:22
  SPEAKER_01: Scott is the uh owner and the principal investigator at Dermatology Associates of Mid-Ohio, where he practices dermatology, he sees research patients.
• 0:34
  SPEAKER_01: He's also heavily involved in the National Psoricis Foundation, right, Scott?
• 0:38
  SPEAKER_01: You're on the advisory board of that.
• 0:39
  SPEAKER_01: Congratulations.
• 0:40
  SPEAKER_01: He was recently uh uh introduced into the NOAA Worcester Society, which is an amazing society for uh for dermatologists recognizing excellence and in care and how much Scott has given to our specialty.
• 0:55
  SPEAKER_01: So uh I am just so honored to have Scott on the podcast.
• 0:59
  SPEAKER_01: And and while Scott, we could talk all about your clinical acumen and and everything you have done for the specialty, both in terms of research and and your your contributions medically.
• 1:10
  SPEAKER_01: Uh I what I'd like to focus on today is your philanthropy, if that's okay.
• 1:14
  SPEAKER_02: Oh, that'd be great.
• 1:15
  SPEAKER_02: Thanks, Ted.
• 1:15
  SPEAKER_02: And thanks for that great introduction.
• 1:17
  SPEAKER_02: I appreciate it.
• 1:17
  SPEAKER_01: Yeah, my pleasure.
• 1:19
  SPEAKER_01: Well, if I also should say that Scott and I are friends.
• 1:22
  SPEAKER_01: And so uh we we may play around a little bit on the podcast just because we we like each other immensely.
• 1:28
  SPEAKER_01: Um Scott, so so let's talk about power of a nickel and what it is and how you got started in it.
• 1:35
  SPEAKER_02: Sure.
• 1:36
  SPEAKER_02: Um so power of a nickel is a is a 501c3 that uh was founded by a friend of mine, a fellow alum of my alma mater, who was dean of the Oklahoma uh State University School of Medicine, and one day called me and said, Hey, have you ever been to Africa?
• 1:57
  SPEAKER_02: And uh he goes, I'm running a medical trip there, and whenever we go, the biggest need we have is dermatologists, and we never have one, and we need one.
• 2:07
  SPEAKER_02: Well, you want to come.
• 2:08
  SPEAKER_02: And I thought, why in the world would I do that?
• 2:12
  SPEAKER_02: And um, and so he gave me some details, and I literally said, Well, when is this trip planned for?
• 2:19
  SPEAKER_02: And he said, uh, two weeks from Thursday.
• 2:23
  SPEAKER_02: I went, Oh.
• 2:24
  SPEAKER_02: Uh I asked my wife and I said, Well, let's let's go.
• 2:29
  SPEAKER_02: So we went, and that was about 40 trips ago, and um, and we've been going ever since.
• 2:35
  SPEAKER_02: So Power for Nickel has a unique mission.
• 2:38
  SPEAKER_02: It's threefold.
• 2:39
  SPEAKER_02: It is to provide health care to the underserved, it is to bring U.S.
• 2:43
  SPEAKER_02: medical students to the non-industrialized world, ostensibly to teach young up-and-comers that medicine is first eyes, ears, hands, and sometimes nose, before it's PET scans and CAT scans and pony service ultrasounds.
• 3:01
  SPEAKER_02: And then thirdly, uh, it is to give U.S.
• 3:06
  SPEAKER_02: medical providers an opportunity to interface with providers in different places so we can exchange medical, intellectual, and cultural differences because how we treat disease X here is different than how we treat it there, not only because medical knowledge, but also cultural issues and uh mores and just a whole different scenario.
• 3:30
  SPEAKER_02: So this group again started over 40 years ago, and um it brings uh dermatologists and other specialties, mainly other specialties, to every continent of the world except Antarctica.
• 3:44
  SPEAKER_01: Wow.
• 3:45
  SPEAKER_01: And so when you go, Scott, are you it sounds like you're with multiple other specialists that go?
• 3:49
  SPEAKER_01: You're not on a derm-only trip, you're with multiple other specialists.
• 3:53
  SPEAKER_02: Um, so mostly, yes.
• 3:56
  SPEAKER_02: So the our group typically is a primary care group that has uh will augment with an orthopedic surgeon or an ENT surgeon or a dermatologist.
• 4:09
  SPEAKER_02: Um, but over the course of my career doing this, I have been on little subgroups where we have taken just derms or derms and uh ophthalmologists.
• 4:23
  SPEAKER_02: But typically it's a multi-specialty group.
• 4:26
  SPEAKER_02: But why I like it so much is we have young people with us, like students and residents, and um almost always, I would say 85% of the people that we see at least have one visit with Durham because it's you know, there's so many diseases that are mitigated by lack of education, lack of clean water, um, lack of um uh all you know, just some of the basic things we have.
• 4:50
  SPEAKER_02: So Durham is a is always the most popular place.
• 4:55
  SPEAKER_01: Scott, do if a Durham isn't interested in going and joining you on one of these trips, do they need to do like a tropical disease fellowship?
• 5:03
  SPEAKER_01: Is there anything like extra uh education that they need?
• 5:08
  SPEAKER_02: Um, so you have to educate your heart first, I would think.
• 5:11
  SPEAKER_02: Um, so it's funny to say that because when I first uh went, I thought I'd scour uh the the the medical literature.
• 5:21
  SPEAKER_02: And so the the front lecture slide I have when I give a lecture about this is a picture of the um Sub-Saharan Africa Dermatology Dermatology textbook, which is 11 pages.
• 5:32
  SPEAKER_02: So it doesn't take you long to become fully on board with that.
• 5:36
  SPEAKER_02: So the answer is no.
• 5:38
  SPEAKER_02: Um uh it really you have to be open-minded and prepared.
• 5:44
  SPEAKER_02: And I'll give an example of this, Ted.
• 5:46
  SPEAKER_02: Um, on the very first trip I went, um, we were given the the the pre-op work, but the biggest problem we had was itchy scalps.
• 5:54
  SPEAKER_02: And uh everyone there has itchy scalps, and I thought, wow, I'm brilliant, I'm fabulous, I can fix that problem.
• 6:01
  SPEAKER_02: And I called my friends from from the then company called Medicist, and I said, I need, you know, a thousand little sachets of nausea shampoo.
• 6:09
  SPEAKER_02: I got a bunch of people with subderm, and off we went.
• 6:11
  SPEAKER_02: And I got there, and I found out that water was a scarcity.
• 6:15
  SPEAKER_02: They didn't have they it was right on the Mara River, and uh, if you kept water around, the the mosquitoes would come and everyone would have malaria.
• 6:23
  SPEAKER_02: So it was both a scarcity and a curse.
• 6:26
  SPEAKER_02: And so rather than wash your hair with water, you'd wash it with mud.
• 6:32
  SPEAKER_02: Mud.
• 6:34
  SPEAKER_02: And to suggest that you wash it with water was a was a heresy because you had to save clean water for feeding children and then make sure there's no extra water so you wouldn't get malaria.
• 6:46
  SPEAKER_02: So all of a sudden I realized I was not as smart and brilliant as I thought I was.
• 6:50
  SPEAKER_02: So it is the the the beauty of these projects is they're both individual health, let me take care of the problem that you have, as well as public health problems, like there's no clean water, or when you wash your clothing, or wash um, or or or we'll use clothing example.
• 7:09
  SPEAKER_02: When you wash clothing, people tend to either lay it on a hedge or a tree, or on the ground where ectoparasites then crawl onto this to the clothing, and then the person puts it on, and the next thing you know they have babiasis, and uh for which there is no readily available treatment because they're busy worrying about food and water, not ectoparasites.
• 7:33
  SPEAKER_01: Right.
• 7:33
  SPEAKER_02: Yep.
• 7:33
  SPEAKER_02: So the quick answer question is no.
• 7:36
  SPEAKER_02: You don't need really any preparation from a medical perspective.
• 7:40
  SPEAKER_02: Um, but what you do have to prepare for is the cultural change.
• 7:46
  SPEAKER_02: And, you know, in our daily practices, we see the sign on the door, the chart in the door, and it says Mrs.
• 7:51
  SPEAKER_02: Jones is in today for a rational torso, and you already start to think.
• 7:56
  SPEAKER_02: And so I was uh in a Malawi with four of my very dear friends who were who are all this was a Durham only trip, and um uh we were sitting around at the end of the day come comparing notes, and uh somebody said, Oh, I saw this lady with this uh really terrible uh itchy rash on her torso.
• 8:17
  SPEAKER_02: And I said, Oh, I had a lady that was so dehydrated she was barely, and someone else had a lady with a rash on her neck, and we got to chatting, and we realized we had an epidemic uh of these dehydrated, demented, dying, dermatitic patients who all had pellagra.
• 8:33
  SPEAKER_03: Oh my god.
• 8:34
  SPEAKER_02: Nobody's list.
• 8:36
  SPEAKER_02: Yeah, because we didn't see Pellagra.
• 8:38
  SPEAKER_02: Well, it turns out all of the fish uh in in Lake Malawi have schisto and all the cows have brusella.
• 8:46
  SPEAKER_02: So nobody eats fish or meat.
• 8:48
  SPEAKER_02: They all eat rice, corn, and paint chips.
• 8:52
  SPEAKER_02: And so, you know, the the the public health cure is let's bring a bowl of Wheaties once a month and you're fine.
• 9:01
  SPEAKER_02: But again, so you just have to be open-minded and um and it's fun to have these little mini grand rounds.
• 9:08
  SPEAKER_02: Now, having said that, we see a lot of acne, psoriasis, eczema, the normal stuff as well.
• 9:12
  SPEAKER_02: But you also see some things that you just you would not even be in your differential in you know in North America.
• 9:19
  SPEAKER_01: Uh I can imagine people listening to this would be interested in joining and can see the the benefit professionally, personally, just for your soul as well.
• 9:29
  SPEAKER_01: Uh what's it like when you when you join a trip like this?
• 9:31
  SPEAKER_01: I know there's some payment involved, right?
• 9:33
  SPEAKER_01: Like the you have to pay your way to do this, it's not it's not supported in any other way.
• 9:38
  SPEAKER_01: Yep.
• 9:38
  SPEAKER_02: Um so right.
• 9:40
  SPEAKER_02: We're pretty happy that we don't take any money from the government.
• 9:42
  SPEAKER_02: Uh, we're pretty pleased by that.
• 9:43
  SPEAKER_02: This is all self-funded.
• 9:45
  SPEAKER_02: And the good news is, uh, and and our medical students, um, they either can do it curricularly, like through their school, and then bundle it through the five through their uh student aid.
• 9:55
  SPEAKER_02: Um, and you know, a lot of people that go are like my age and older.
• 10:00
  SPEAKER_02: And so there's we have a little foundation that helps that kind of thing as well.
• 10:04
  SPEAKER_02: Um, there's really no uh requirement like sweat equity or anything like that.
• 10:13
  SPEAKER_02: Um, and we encourage people like to look at our website, powervanickle.org.
• 10:18
  SPEAKER_02: But um we do usually have, you know, people typically don't say let's go in a week.
• 10:24
  SPEAKER_02: They think, oh, I'm going.
• 10:26
  SPEAKER_02: It's not like let's go to Boston or let's go to Ireland.
• 10:28
  SPEAKER_02: You gotta, you know, you gotta get a yellow fever shot, etc.
• 10:32
  SPEAKER_02: So we talk about um having three or four hour, hour and a half webinars uh with the whole group, A, so everybody kind of knows everybody's face, that kind of thing.
• 10:43
  SPEAKER_02: We talk about some custom things, like it's a good idea if you're going to a third world or a non-industrialized country to not have a t-shirt that says, wow, the Philadelphia Eagles are the best, and boy, we're the best people in the world, that that kind of thing, have unbranded stuff.
• 10:58
  SPEAKER_02: Um, we talk about like the biggest question we get, the first question is always safety.
• 11:03
  SPEAKER_02: Is it safe to go there?
• 11:05
  SPEAKER_02: And I, you know, I live in a small town in Ohio, and I tell people I feel safer in Uganda than I do in some places in my little town.
• 11:11
  SPEAKER_02: Um, so we talk about safety.
• 11:14
  SPEAKER_02: Uh, we talk about the group, just like you've gone scuba diving, you gotta have a buddy, you don't just wander around, you know, by yourself.
• 11:21
  SPEAKER_02: Uh, we talk about what volunteer volunteer sort of supplies one can bring, and uh uh again, a little about the just the cultural mores.
• 11:32
  SPEAKER_02: For example, there are very little uh medical records that a hospital keeps.
• 11:39
  SPEAKER_02: And many patients have never seen a doctor.
• 11:43
  SPEAKER_02: Never.
• 11:44
  SPEAKER_02: So, like a patient walks into a room in Austin, Texas, or in Marin, Ohio, you say, Hi, what can I do for you?
• 11:49
  SPEAKER_02: And they say, Oh, my left foot hurts, or I have an itchy rash on my left ear.
• 11:52
  SPEAKER_02: And there people just don't have any idea what you can do for them, and they don't understand the dynamic of what a doctor visits like.
• 12:04
  SPEAKER_02: And you say, Well, what medicines have you used?
• 12:07
  SPEAKER_02: Well, a leaf of that tree or the salve that my grandmother made, or so it's a whole different thing, and it requires a lot of listening.
• 12:16
  SPEAKER_02: And we always partner with um local in-country healthcare providers because they just do things differently than we do, and we have to listen to them because they uh for example, in the Kipsigi tribe in Kenya, hair, your scalp hair, is part of your marital gift to your spouse.
• 12:39
  SPEAKER_02: So you would no more show your scalp to a stranger than you would walk in naked to your son's baseball game.
• 12:47
  SPEAKER_02: Like this is just not a thing.
• 12:49
  SPEAKER_02: Well, of course, you don't know that until Scotty Drew walks in and says, Oh, what's wrong with their hair and rips the hat off, right?
• 12:55
  SPEAKER_02: And so you have to you have to have someone help guide you through this process.
• 13:00
  SPEAKER_02: So it's quite, it's quite educational for you individually to see um how different things are done because we think, oh, you've got psoriasis, what's your BSA?
• 13:10
  SPEAKER_02: Do you have any joint pain?
• 13:11
  SPEAKER_02: How are we going to approach the way we're gonna holistically attack this systemic problem?
• 13:16
  SPEAKER_02: And that's not the way everyone thinks about healthcare.
• 13:21
  SPEAKER_02: Not to mention the resources you and I have um are just logarithmically more than what many people have.
• 13:31
  SPEAKER_02: I'll give an example.
• 13:32
  SPEAKER_02: We had a uh we were in um uh uh Uganda at a at a rural clinic where they thought there was an epidemic of some MRSA type of infection that all these kids were getting.
• 13:47
  SPEAKER_02: Yet when you walked in the room, you saw all these bullish kids sitting on mom's lap and no one else had this rash except these like 20 kids.
• 13:57
  SPEAKER_02: And I think most first-year Durham residents would have recognized linear IJ bullish dermatosis pretty quickly.
• 14:03
  SPEAKER_02: Um, and having been on a myriad of antibiotics, but they had indigenously and were imported in from other places.
• 14:11
  SPEAKER_02: And so we said, well, it's gonna be pretty easy.
• 14:13
  SPEAKER_02: You know, you and I would do a DIF and an HE, and then we do G6PD, and then off would be well, not only is there no needle to numb a biopsy site, there's no three-punch, there's no formalin, there's nobody to read the slide, there's no blood test for the G6PD, and by the way, there's no dapsone.
• 14:36
  SPEAKER_02: So, like, okay, what are we gonna do?
• 14:38
  SPEAKER_02: And the beauty of the organization is when you get there, our organization takes care of the licensing.
• 14:44
  SPEAKER_02: So you have a license to practice in Malawi, Uganda, Syria, wherever we happen to be.
• 14:49
  SPEAKER_02: And then the Department of Tourism and uh Health is sends an attache, so you're you always have someone there.
• 14:57
  SPEAKER_02: And after about two days, we had a little mini lab and we had G6PDs, and by the time we left, everybody that could be on DAPS, because who's who is G6PD deficient, but a bunch of young um uh type five, type six Fitzpatrick kids.
• 15:13
  SPEAKER_02: So all of a sudden we have the things that are now available to us, uh, which makes me extrapolate.
• 15:19
  SPEAKER_02: The first time, my very first trip to Kenya, we walked into the lab uh and they had a finger stick and they had three things.
• 15:28
  SPEAKER_02: They had uh a hemoglobin, they had a Brusella titer and an HIV titer.
• 15:33
  SPEAKER_02: Not Brucella, I'm sorry, typhus.
• 15:36
  SPEAKER_02: HIV, uh hematocrit, and typhus was all they had.
• 15:39
  SPEAKER_02: And I had to stop and look look up typhus.
• 15:42
  SPEAKER_02: I said, is that is that typo?
• 15:43
  SPEAKER_02: No, that's not that's separate.
• 15:45
  SPEAKER_02: What what?
• 15:46
  SPEAKER_02: And I thought, typhus?
• 15:48
  SPEAKER_02: And in my lecture, one of my introductory lectures, I have a picture of like six kids, and they're all running around the playground with IVs in their head getting medicine for their for their typhus.
• 16:01
  SPEAKER_02: I thought, wow, just just crazy.
• 16:05
  SPEAKER_01: Crazy, yeah.
• 16:07
  SPEAKER_01: It really makes you think about the entire breadth of your dermatology knowledge.
• 16:11
  SPEAKER_01: I think in clinic, a lot of us see you know the zebras every once in a while, but otherwise, we're pretty much on the straight and narrow in what we see.
• 16:18
  SPEAKER_02: Well, uh, and you know what's what's crazy, Ted?
• 16:21
  SPEAKER_02: In sub-Saharan Africa, the the pediatric transmission of HIV is like next to Nero.
• 16:27
  SPEAKER_02: Pepfar has uh ensured that you can be in the deepest, darkest part of Africa, and the drone will still drop off heart therapy.
• 16:38
  SPEAKER_02: Um, however, adult transmitters of HIV is still pretty significant, you know, upwards of 30% in some places.
• 16:46
  SPEAKER_02: Um, and so you got so say you're below the equator, so your risk of HIV is about 30%, your risk of malaria is about 99%, and your risk of tuberculosis is about 60%, and 3 million people die every year of syphilis.
• 17:04
  SPEAKER_02: So, how about you have psoriasis?
• 17:07
  unknown: Right.
• 17:07
  SPEAKER_02: Because you know, three, four, five percent of people have psoriasis, and you've got all those other comorbidities, so you don't have a single functioning T cell.
• 17:14
  SPEAKER_02: So, what normally you and I would think of what psoriasis looks like big, thick plaques, elbows, knees, scalp, maybe inverse, none of that applies.
• 17:23
  SPEAKER_02: You've got some other manifestation genotypically, which is represented by what these not functioning T cells look like or or present.
• 17:34
  SPEAKER_02: Like, could that be psoriasis?
• 17:36
  SPEAKER_02: Well, there's no lab because you can't biopsy that.
• 17:39
  SPEAKER_02: You just have to, and then if you if you do treat it and they do have TB or they do have um malaria or hep C or whatever else, you're not gonna give them the things that we have if you could get them.
• 17:51
  SPEAKER_02: Um and so I write when I when I'm there and people are, you know, once once you get their malaria under control, and I'm serious, malaria, 100% of people have malaria.
• 18:04
  SPEAKER_02: Um, and so once you get all this under control and you're ready to start psoriasis therapy, um I write more methotrexate there and when I'm there for a week than I write in five years back in the States.
• 18:18
  SPEAKER_01: And then someone will take over care.
• 18:20
  SPEAKER_01: Is that the idea?
• 18:21
  SPEAKER_02: Oh, yes.
• 18:22
  SPEAKER_02: Oh, we haven't talked about that yet.
• 18:23
  SPEAKER_02: So, you know, I sometimes struggle with this because there is absolute value, in my opinion, in the relief of human suffering.
• 18:33
  SPEAKER_02: Um and, you know, uh the story I have a patient that I saw in Nicaragua who had this giant squame.
• 18:41
  SPEAKER_02: Anyone see my lecture seen this picture?
• 18:42
  SPEAKER_02: It's like this big on his chest, and he was told to come back, you know, go to the local clinic, and he got an appointment in a year.
• 18:48
  SPEAKER_02: And so we scrambled together and took care of this thing, and and you know, it was quite an ordeal, and he was fine.
• 18:56
  SPEAKER_02: And that's good.
• 18:57
  SPEAKER_02: And we impacted this guy's life.
• 18:59
  SPEAKER_02: But is that worth bringing 30 people?
• 19:02
  SPEAKER_02: You know, how do you where do you make that balance?
• 19:05
  SPEAKER_03: Right.
• 19:05
  SPEAKER_02: So I would have to say one thing I'm proud of is we really never go anywhere, A, where we're not invited, uh, and B, we have the opportunity to do some sort of continuity of caring metric.
• 19:17
  SPEAKER_02: So when a Durham comes, or an internist or a pediatrician or whomever, uh, like we do partner um with uh Geissinger, they bring a pediatric residency group with them every year, and we partner with Michigan State and WVSOM, and they bring cohorts of people.
• 19:32
  SPEAKER_02: So everybody signs up to do a Zoom shift, if you will.
• 19:37
  SPEAKER_02: And then part of working with um Indigenous healthcare providers is that um, you know, most of them are left with a pretty robust dose of Scott Drew teaching, which is sometimes like a big fire hose.
• 19:51
  SPEAKER_02: And um, and then with the benefit of um of WhatsApp, um uh I got a text last night, which I'm pretty sure was just garden variety nomular eczema, but my differential was oh, do they have syphilis?
• 20:04
  SPEAKER_02: They have dot that.
• 20:06
  SPEAKER_02: So we like to provide some continuity of care um and the establishment of um not EMR, just MR.
• 20:13
  SPEAKER_03: Okay.
• 20:13
  SPEAKER_02: And what's interesting is there the medical records are the property of the patient.
• 20:20
  SPEAKER_03: Uh-huh.
• 20:20
  SPEAKER_02: And uh so the patient keeps it, and it has become a sort of um social stratification.
• 20:30
  SPEAKER_02: I have been to the doctor.
• 20:34
  SPEAKER_02: And we kind of laugh because you know, in this day and age of physician rating and keeping people patients happy.
• 20:42
  SPEAKER_02: Can you imagine telling your patient, bring your records back and forth all the time?
• 20:46
  SPEAKER_02: You know, they've they they they can't remember what dose of medicine they're on, much less uh what you know, bring your records back and forth with.
• 20:52
  SPEAKER_02: So um we like to think that we are providing um some degree of teaching both to the patient and to the community that which works we're serving, so that we can go back.
• 21:05
  SPEAKER_02: And and Ted, I'll tell you the first time I went to Kenya, we practiced in a tent.
• 21:09
  SPEAKER_02: And that was, I can't remember how long ago that was.
• 21:12
  SPEAKER_02: And now, um, and this again started with a with a pharmaceutical company, Medicist, um, you know, way back when.
• 21:19
  SPEAKER_02: Uh, now we have like eight buildings, and you can actually deliver a baby, you can have your gallbladder out, you can have um many surgical procedures done there.
• 21:29
  SPEAKER_02: And there's also now a school where you can become a nurse, a teacher, a hotel person that keeps the village populated with its best and brightest.
• 21:38
  SPEAKER_02: Yeah.
• 21:38
  SPEAKER_02: Because, like in uh uh in um Narak, Kenya, if you want to become a doctor or a nurse, you have to go to Nairobi.
• 21:47
  SPEAKER_02: And then when you get done, you go back to Niraq, where there's nothing but you know, a s uh a wooden mall of cl of stores.
• 21:55
  SPEAKER_02: No, you're gonna s you're gonna you've probably met someone, you're gonna stay in Nairobi, and all of a sudden The rock is no better off having sent you there.
• 22:02
  SPEAKER_02: So we'd like to be able to keep to make the village uh have at least a microeconomy, if not an economy, so that um um uh people can get, you know, not have to take an ox and cart seven hours into a into a major hub to get health care.
• 22:25
  SPEAKER_00: This episode is sponsored by Lily, a medicine company.
• 22:34
  SPEAKER_01: When uh Scott, and again, remedial questions for me, but when when physicians you you bring this group, are there what are the living quarters like for them?
• 22:42
  SPEAKER_02: Ah, okay.
• 22:43
  SPEAKER_02: So no one trip is the same.
• 22:47
  SPEAKER_03: Okay.
• 22:47
  SPEAKER_02: Um, so if we go to Peru, um, you know, it's a five-hour flight from Atlanta, no time change.
• 22:57
  SPEAKER_02: So you go and you take a week off of work, and there's no no jet lag, and it's like a week.
• 23:04
  SPEAKER_02: It's and you stay at a double tree, and you go to a little clinic on the shores of the Amazon, and the people come in by boat from a village, and when the evening's over, you go back to the Double Tree, you go get a massage at the spa, and life is great.
• 23:20
  SPEAKER_02: When you go to Malawi, it's not the same.
• 23:25
  SPEAKER_02: Um, now we do have people that scout, and um, and we have like I've done many RR trips to go and see, like just three or four of us ago and see if it's um sustainable because we have to have proper proper transportation, safe food, safe lodging.
• 23:40
  SPEAKER_02: We always have armed security guards.
• 23:42
  SPEAKER_02: It was kind of weird.
• 23:43
  SPEAKER_02: The first time I went, the guy opened my soda with the tip of his AK-47.
• 23:46
  SPEAKER_02: I was like, okay.
• 23:49
  SPEAKER_02: Um, that's a little different.
• 23:52
  SPEAKER_02: Um when we now we go to uh Thintran out of Harvard um invited me oh many, many years ago to go with her to her laser clinic in Vietnam.
• 24:04
  SPEAKER_02: And um, and there, oh Ted, it's it's it's so sad.
• 24:08
  SPEAKER_02: There's a pretty high proportion of kids with um vascular malformations of the face and uh higher than Cambodia or Laos or Myanmar, but it's nobody seems to know why.
• 24:20
  SPEAKER_02: Well, it turns out that these the parents take their kids to the local shaman and put them in the warm water bubbling hot springs to sue them.
• 24:30
  SPEAKER_02: Well, it turns out they're not they're they're tritiated phosphorus, P32, and these a third of the kids die of uh of uh uh lip retricular malignancies.
• 24:41
  SPEAKER_02: So what we do is we try to convince them don't just walk 10 feet to your local hot pot, walk seven hours to our laser clinic where we can blast the heck out of your face where it hurts like crazy, and do it every month and have to walk forever.
• 24:56
  SPEAKER_02: It's quite quite something.
• 24:58
  SPEAKER_02: Yeah.
• 24:58
  SPEAKER_02: But when you go there, we stay in Saigon, which is a city of I don't know, 20 million people, and we stay in a high rise, and you can eat sushi all day, and it's it's like a vacation.
• 25:10
  SPEAKER_02: And then every day you take a bus 40 minutes out of the ring road to a to a village would be an upgrade.
• 25:20
  SPEAKER_02: And um, but I tell you the people are thrilled to see you.
• 25:23
  SPEAKER_02: Um what's fascinating, my wife happens to be blonde, and every you know, we always have a few people in the trip who are blonde, and indigenous people will come up and like touch their hair.
• 25:36
  SPEAKER_02: They've never seen a color like that before.
• 25:38
  SPEAKER_02: These are people who don't have internet, right?
• 25:39
  SPEAKER_02: So it's like very, very, very different.
• 25:42
  SPEAKER_02: And um and it is uh just a cultural awakening.
• 25:51
  SPEAKER_02: I don't think we've ever had accommodations that weren't good.
• 25:58
  SPEAKER_02: Um we've had one stars.
• 26:03
  SPEAKER_02: Um the more rural you are, the more likely you are seeing some really weird stuff.
• 26:09
  SPEAKER_02: And the more the more likely you are not to have a fillet the night that you eat.
• 26:14
  SPEAKER_01: Right.
• 26:15
  SPEAKER_02: And uh so in Peru, uh we we we eat well.
• 26:20
  SPEAKER_02: Uh we had a we had a clinic uh at the Syrian Turkish border during the um diaspora of Syrians uh in the war, just I don't know, five, six years ago.
• 26:33
  SPEAKER_02: Um, and we had a lot of box lunches there.
• 26:36
  SPEAKER_02: I always tell people to bring uh enough calories to get you through a meal.
• 26:40
  SPEAKER_02: So one time some young uh medical student brought tuna packets with them, which was a very bad idea.
• 26:47
  SPEAKER_02: I'm like, no, bring pot tarts or MMs.
• 26:50
  SPEAKER_02: Don't bring tuna fish.
• 26:52
  SPEAKER_02: Um, but we go out of our way to make sure that people um their needs are met.
• 26:58
  SPEAKER_02: But Ted, you know, we have to be honest and graphic with people.
• 27:02
  SPEAKER_02: When you're in Uganda, you uh there's no running water, there's no plumbing to the places we go.
• 27:08
  SPEAKER_02: We may get there at eight in the morning and not late till five at night.
• 27:11
  SPEAKER_02: So we tell people very candidly, take care of all your personal needs before you leave the hotel, because the last thing you want to do is be in an outhouse where there is no water, no soap, no paper, no nothing.
• 27:25
  SPEAKER_02: And um, so these trips are not for the faint of heart, but I also think if you can get through residency in med school and past the Durham boards, it's doable.
• 27:36
  SPEAKER_01: Gotcha, gotcha.
• 27:37
  SPEAKER_01: Uh uh one more question, Scott, about the supplies, because I may have missed this.
• 27:41
  SPEAKER_01: Did you are is any are there people that go responsible for bringing their own supplies?
• 27:46
  SPEAKER_02: No, no, no, no, no.
• 27:47
  SPEAKER_02: We provide everything.
• 27:48
  SPEAKER_02: Um, so the only what you have to do is um, and this is kind of funny, uh, most people end up leaving much of what they bring there.
• 27:57
  SPEAKER_02: Yes.
• 27:58
  SPEAKER_02: You know, I probably have, I don't know, a hundred pair of scrubs.
• 28:03
  SPEAKER_02: And whenever I go, I leave them because people are there.
• 28:07
  SPEAKER_02: You know, I I I went to a little boy who was there, uh we were in um uh Malawi and he had a Michael Jordan shirt on.
• 28:14
  SPEAKER_02: And I'm like, oh, do you like Michael Jordan?
• 28:16
  SPEAKER_02: And he's like, who's Michael Jordan?
• 28:18
  SPEAKER_02: Like, well, the shirt you have on.
• 28:20
  SPEAKER_02: And so like every t-shirt that says uh Kansas Day Chiefs Super Bowl champion 2025, because they didn't win, all those shirts go to Africa.
• 28:32
  SPEAKER_02: And so they it's it's for them, it's warm clothing, you know, or nice what, you know.
• 28:37
  SPEAKER_02: Um so we again we've been around long enough that we have uh enough money to buy medicines.
• 28:45
  SPEAKER_02: Now, not by logics and not Jack's, sure, but uh medicines.
• 28:50
  SPEAKER_02: Um and we have gauze, we have surgical supplies, we have injectables, we have syringes, we have um uh it's it's funny.
• 29:00
  SPEAKER_02: We we learned um uh on my first trip back, I had uh co-opted my germ path to read my biopsies.
• 29:10
  SPEAKER_02: And when I got to customs, they want to know why I had 50 jars of human flesh coming back into the country, right?
• 29:16
  SPEAKER_02: Like you can imagine that conversation.
• 29:20
  SPEAKER_02: So we now have uh all the paperwork that's assigned, and when you get there, you know, they you're you're you're welcome to like royalty.
• 29:28
  SPEAKER_02: Um and so you don't now uh I will say we bring um like a radiologist brings this is maybe different than when you and I were in medical school, Ted.
• 29:39
  SPEAKER_02: These kids come now, they they get these little pocket-held ultrasounds in their uh when they're in first year of medical school.
• 29:46
  SPEAKER_02: And you know, you and I might not ever cut off a midline cyst.
• 29:50
  SPEAKER_02: Well, these kids they whip out the ultrasound and they wave it around and they say, well, see, Dr.
• 29:54
  SPEAKER_02: Joe, I'm like, I don't know what I'm looking at.
• 29:56
  SPEAKER_02: Uh and they say, well, there's no connection between the cord.
• 29:58
  SPEAKER_02: I'm like, oh, I I have no idea.
• 30:01
  SPEAKER_02: So some special spring nuanced things, and we typically ask people if they're in Durham, oh, if you have if you can bring a case of acetophil or a case of cereb or a case of Neutrogena, because uh cleansers and moisturizers, I mean, everybody's got a topic or matitis because nobody has any red vegetables or green vegetables or yellow vegetables in their diet.
• 30:22
  SPEAKER_02: Everyone's got malnourishment.
• 30:23
  SPEAKER_02: So whatever you can do to get that skin barrier back to where it's supposed to be.
• 30:27
  SPEAKER_02: But in um in terms of asking people to fund the mission, I would say no.
• 30:35
  SPEAKER_02: Let me say this is again sort of a weird nuance.
• 30:38
  SPEAKER_02: I I don't make people not say it, but sometimes if you use the word mission, it tends to denote a religious connotation to it.
• 30:49
  SPEAKER_02: And we welcome any religion.
• 30:52
  SPEAKER_02: I don't care what.
• 30:54
  SPEAKER_02: Um, and and I don't want to think that if someone is not participating in a particular religion, they're not welcome.
• 31:01
  SPEAKER_02: We take all comers, and um now I will say in Africa, you will go to places where 100% of people are in a certain religion.
• 31:09
  SPEAKER_02: If you're going, now uh we don't ever go to you know Mozambique, but if you were if you go to a place, you're pretty sure it's the people there are going to be of one particular sect um or faith culture.
• 31:22
  SPEAKER_02: Um, but we again we never go any place where we're not invited, and we never bring 50 people to a place where a team of four or five have not been to to see what's going on.
• 31:33
  SPEAKER_02: And you know, uh we in Durham, particularly the past 10, 15 years, like to remind us that so many of our diseases are multi-system.
• 31:44
  SPEAKER_02: You know, we used to think of psoriasis as a skin disease, and now we know, or AD is a better example.
• 31:48
  SPEAKER_02: It's a multi- so we like to have our trips with at least some input to other disease states.
• 31:54
  SPEAKER_02: And when we think of chlamydia here, we think of that that's our disease, but over there, it's an ophthalmologic disease.
• 32:01
  SPEAKER_02: Um, and when's the last time you and I ever thought of chlamydia and the eye?
• 32:04
  SPEAKER_02: That's just not the way it is there.
• 32:06
  SPEAKER_02: So um, so the the supply team is a good idea, but I will also tell you there's some things that people really feel good about donating time and stuff.
• 32:19
  SPEAKER_02: So little things like stickers.
• 32:22
  SPEAKER_02: So if we're gonna deworm a community and you've got 4,000 little kids, you gotta you gotta keep the wormed kids separate from the deworm kids.
• 32:33
  SPEAKER_02: And ask a bunch of four-year-olds to stay in line.
• 32:36
  SPEAKER_02: Good luck with that.
• 32:37
  SPEAKER_02: So kids will uh nurses will bring stickers to once you get your worming medicine, you get a sticker.
• 32:44
  SPEAKER_02: So if a kid's got a sticker, you don't give them more worm medicine.
• 32:47
  SPEAKER_02: So all sorts of little um tricks of the trade.
• 32:53
  SPEAKER_02: Yes, and then inexpensive stuff.
• 32:55
  SPEAKER_02: Yeah, yeah, yeah.
• 32:56
  SPEAKER_02: But the organization's been around long enough where um we have a bench of medicine.
• 33:00
  SPEAKER_02: We actually have a warehouse now, and um, once you've had a uh our our recidivism rate is about zero.
• 33:08
  SPEAKER_02: So everybody who goes, even if they can't go back again, you know, they donate, they send a friend.
• 33:14
  SPEAKER_02: Um, and even if you're not in healthcare, um we bring engineers because you know, if you're in a community that's impoverished, you dig a well.
• 33:22
  SPEAKER_02: Once you get a well, then you can throw a plant.
• 33:25
  SPEAKER_02: And once you get enough food, you can get a cow.
• 33:27
  SPEAKER_02: Once you get a cow, you get a pig.
• 33:30
  SPEAKER_02: And then all of a sudden you have a microeconomy and you start a micro bank.
• 33:34
  SPEAKER_02: So we we try to bring a diverse group of people.
• 33:38
  SPEAKER_02: Um, and every now and then it's pretty helpful when you have a sp a group of dermatologists who are never shy on ego, um, are get get the get an earful from the local engineer, the teacher, or even the lawyer, like, oh, yeah, we could do that.
• 33:57
  SPEAKER_02: So it really is a multi-discipline, multi-team approach um to the to the problem.
• 34:02
  SPEAKER_01: Scott, thank you so much.
• 34:03
  SPEAKER_01: I mean, I've I I've had all these questions after kind of I I've known what you've been doing for a while, but I've always had these questions.
• 34:10
  SPEAKER_01: I could have just asked you, I suppose, but this is a great way for not only me to learn more about it as as I consider joining, but also from many others.
• 34:18
  SPEAKER_01: And obviously what you do is so important and so necessary around the world.
• 34:22
  SPEAKER_01: So thank you for what you do.
• 34:24
  SPEAKER_01: Thank you for sharing with us.
• 34:26
  SPEAKER_01: Uh, I I think this is really an incredible initiative that that you started many years ago.
• 34:32
  SPEAKER_01: Um, and the organization sounds like it's it's flourishing and helping so many people.
• 34:36
  SPEAKER_02: Well, so we have uh a couple of fun things hanging up uh coming up.
• 34:39
  SPEAKER_02: Uh SinTron and I are going back to uh Uganda, uh going back to Vietnam in January.
• 34:44
  SPEAKER_02: Okay.
• 34:44
  SPEAKER_02: And then with 2026, January 2026.
• 34:47
  SPEAKER_02: Yep, yep.
• 34:47
  SPEAKER_02: I'm sorry, yeah, 26th.
• 34:48
  SPEAKER_02: Uh Jody Flanders and I are leading a team to Peru in March of 26.
• 34:54
  SPEAKER_02: And then Tom Sarah and I are doing a trip to Uganda July 16th.
• 35:01
  SPEAKER_02: And then um we are still working out the details of Kenya in November of 26.
• 35:10
  SPEAKER_02: And then, but our group, they they run a trip every month somewhere.
• 35:13
  SPEAKER_02: I don't I obviously call it all of them, but um uh and we like to we always welcome new places, but we kind of like going to old places.
• 35:22
  SPEAKER_02: Uh we like we like I like continuity of care.
• 35:27
  SPEAKER_02: I like seeing the same doctors and nurses and patients um over time.
• 35:33
  SPEAKER_02: Powervanickel.org is our website, and um um it uh I I've never said I've never had someone say to me, Wow, I wish I hadn't done that.
• 35:45
  SPEAKER_02: Um everybody enjoys um that opportunity.
• 35:49
  SPEAKER_01: Perfect.
• 35:50
  SPEAKER_01: Well, you've been listening to the Science of Skin podcast.
• 35:53
  SPEAKER_01: My name is Dr.
• 35:54
  SPEAKER_01: Ted Lane, I'm your host.
• 35:55
  SPEAKER_01: Of course, our our wonderful guest has been Dr.
• 35:57
  SPEAKER_01: Scott Drew.
• 35:58
  SPEAKER_01: He's a dermatologist in Ohio and obviously a leader in philanthropy and dermatology as well.
• 36:04
  SPEAKER_01: Dr.
• 36:04
  SPEAKER_01: Drew, again, thank you so much for being with us.
• 36:07
  SPEAKER_01: Uh, if if you like today's episode, please give us a five-star rating, give us uh subscribe as well, let your friends know that we've we found that our podcast is growing because of word of mouth.
• 36:17
  SPEAKER_01: So if you could let your colleagues know, you'll get to hear this great content like we had today from Dr.
• 36:21
  SPEAKER_01: Drew.
• 36:22
  SPEAKER_01: Uh, thank you again for listening and uh have a wonderful Christmas.
• 36:27
  SPEAKER_01: And of course, I hope your 2026 is amazing as well.
• 36:30
  SPEAKER_01: Take care.
• 36:35
  SPEAKER_00: This episode is sponsored by Lily, a medicine company.