Spring break usually marks an opportunity for enjoying time off from our daily work.

For a group of UCLA medical students and three attending physicians, the 10-day break was an opportunity to extend primary medical care to people in need. In April, the group traveled to Haiti where they volunteered medical services to communities in and around the capital city of Port-au-Prince.

On the first day of clinic in a small church in the village of Mussotte, a 20-year-old woman presented with two years of swelling, redness and tenderness of her nails along with occasional drainage of pus. The group was unsure of the diagnosis and proper management for this condition and needed a dermatologist's recommendations.

While engaging in international medical outreach, clinicians encounter challenging medical problems that could benefit from a specialist's recommendations. Through collaboration with a store-and-forward teledermatology consultation service called Direct Dermatology, the volunteer group was able to provide rapid expert-based diagnosis and treatment of medical skin problems for patients who would otherwise not have access to a dermatologist.

The group sent a teledermatology consult, and within one day the patient was diagnosed with a curable condition called chronic paronychia and was given medication and treatment recommendations.

Third-year UCLA medical student, Lisa Altieri displays the bags of topical medications prescribed by Dr. Belinda Tan. The group of students and attending physicians from UCLA brought the medications with them from Los Angeles.

"It was satisfying to use teledermatology to provide quality dermatologic care to people who normally would not even have access to primary care," UCLA medical student Lisa Altieri said. "I loved learning from the consult on site and teaching my fellow colleagues."

Recent advancements in telecommunications have created opportunities to use teledermatology in resource-poor settings with little or no infrastructure. In Haiti, telecommunications are outpacing improvements in access to basic medical care.

For example, many patients who received care from the UCLA providers on this trip had never visited a physician before. In the village of Mussotte, the nearest pharmacy was 45 minutes by car and did not carry even the most basic medications like acetaminophen. However, Internet access was available even in the most remote villages via 4G cellular service, and also through free WiFi in Port-au-Prince.

On the team's trip to Haiti, 75 patients had dermatologic issues, and nine of these patients had challenging skin presentations that required expert consultation. Photographs of the dermatologic problems were taken with an 8-megapixel smartphone camera and then uploaded directly from the phone to Direct Dermatology's secure teledermatology Web-based portal.

"You don't need a computer. The mobile phone bandwidth in developing countries and a basic smartphone is all you need to bring medical expertise around the globe," said Dr. Belinda Tan, a dermatologist with Direct Dermatology.

From her office in Los Angeles, Tan accessed the photos and responded with diagnoses and treatment recommendations. In less than 24 hours, the medical team in Haiti received complete consult reports. Haitian translators transcribed the patient care instructions in Creole and included them in a bag with the recommended medication, to be sent back to the patient.

Professional educational resources for the on-site medical team were also included in the consultation and were shared with Haitian healthcare providers so that this would provide an educational feedback loop towards better sustainability.

Preliminary results from this project confirm the feasibility of a rural and urban store-and-forward teledermatology network using the currently available telecommunication infrastructure in Haiti.

Skin problems are common health issues presenting in survivors of natural disasters, due to overcrowding and sanitation issues. Skin findings can be the initial presenting sign in many severe infections or complex medical problems.

While larger telemedicine projects helped fill a gap in medical care after the earthquake struck Haiti in 2010, there are currently few, if any, teledermatology-specific projects. This pilot project was one of the first to be pursued in Haiti by a small grassroots group in collaboration with volunteer efforts from an established teledermatology group in the United States.

In this setting, teledermatology offers prompt expert diagnosis, treatment recommendations and education that enable improved skin care in distant communities lacking access to specialist care. Based on the success of the project, the group encourages similar sustainable partnerships between grassroots organizations and telemedicine services as a part of their international medical outreach.