Whither dermatology. Thoughts generated after holding a dermatology clinic on Baffin Island.

In February 1998, I spent 3 days at the regional hospital at Iqaluit (Figure 1) on Baffin Island, 2578 km north of New York, NY (Figure 2). Two thirds of the patients here were Inuit, many having been flown in from outposts hundreds of miles away where daily continuing care was provided by nurses, with only occasional visits by physicians. One third of the patients had moderate to severe atopic dermatitis, displaying a great variety of morphological patterns. One tenth had alopecia areata totalis or universalis. About one half could not speak English, and there was no patient information literature available in their language; many believed that I was going to cure them. The challenges that the management of these conditions presented in this population were formidable; the hands-on effort required to care for these patients in a straight-forward and honest manner was great. By the end of several 12-hour days, with a noon break each day to give an in-service lecture, I felt exhausted but satisfied.