Navigating COVID-19: an update from Nigeria

This month’s update is from the Nigerian Association of Dermatologists (NAD), awarded a DermLink grant in 2020 to undertake their End Advanced Skin Cancer Scourge in Albinos Project (EASCAP). As part of this, Dr Nkechi Anne Enechukwu and her team provided dermatological care and skin cancer prevention training to Persons with Albinism in Anambra State, Nigeria. 

Persons with Albinism and their families were invited to attend community-based workshops on skin cancer and sun safety. Persons with Albinism received flyers, leaflets, and sun protection materials during these workshops, including sunscreen, hats, and clothing. Through this, they were able to learn about the early signs of skin cancer and how to protect themselves and their loved ones. 

During these workshops, attendees also received free skin checks and follow up treatment as many presented signs of skin cancer. With the onset of the COVID-19 pandemic, Dr Enechukwu had to suspend community-based clinics and workshops. In place of this, they developed radio and text message-based awareness material. Despite these challenges, they continued to provide free skin checks and treatment for Persons with Albinism but on a one-to-one basis. 

Following treatment, patients were monitored and advised through WhatsApp and online consultations. They also received fluorouracil creams and soaps and sun protection packages of sunscreen, hats, and clothing. As a result, they were able to reduce the number of mortality and disabilities from advanced skin cancers in Persons with Albinism within a year. Considering this, the NAD will continue its SunSmart campaign to ensure that this trend continues. 

In total, 73 Persons with Albinism were reached. Of this, 32 patients had excisional biopsies. Dr Enechukwu and her team collected 199 skin biopsies, where over 50% were malignant or premalignant, and 17% were not. The remaining biopsies are awaiting processing. As such, the results have not yet been confirmed. The data collected from this project was also utilised for training 60 dermatologists about the early detection of skin cancers in Persons with Albinism and the role of Dermoscopy in evaluating Persons with Albinism.

The project was a great success. Nonetheless, there were challenges. Therefore, Dr Enechukwu notes the lessons learnt were as follows: 

• “Prepare for all eventualities: The pandemic disrupted the initial plans and led to a major shift from a community visit for the skin evaluation to a hospital-based skin evaluation. We had also planned large group meetings, but this was modified due to the pandemic.
• Collaboration is key- the moment some of the state stakeholders of the albinism association came on board, Persons with Albinism at the grassroots who could not afford transportation fares were able to attend the clinics.
• Involve Persons with Albinism. We had to employ a Person with Albinism as an assistant and it made collaboration easier.”