April 2008
Feature Story

Ed Finkel

Yet again, pathologists come to the rescue of a hospital in Africa that badly needs their services.

Since its founding 17 years ago, Pathologists Overseas has sent a succession of pathologists to Madagascar, Kenya, Eritrea, Nepal, Bhutan, Peru, El Salvador, and Santa Lucia for varying periods to shore up pathology services in those countries.

This year the organization adds Ghana, in West Africa, to the list. This newest initiative came at the urging of retired Utah pathologist Thomas Coppin, MD, who traveled there last year to study the need and recently spent a month, from mid-January to mid-February, working at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana. Dr. Coppin was the first of at least 16 American and Canadian pathologists who will travel there this year. The organization’s aim is to have two volunteer pathologists at KATH at any one time in overlapping, monthlong stints. KATH’s laboratory has modern equipment, trained technicians, and the ability to perform all stains except immunohistochemistry, Dr. Coppin says, but hasn’t had an anatomic pathologist for at least three years. “How long this has gone on, I don’t know exactly,” he says. “There are some screwy things—having a laboratory that’s fully functioning, but producing slides for no one. It’s crazy. They’ve had some intermittent help—a pathologist came down from Norway for a month—but it doesn’t last.” A limited number of cases for immunohistochemistry are sent to Norway, but it can take up to a month for results to be returned.

Pathologists Overseas plans to spend three years in Ghana, which would require 72 rotations, and a key part of the project will involve training residents, some of whom are graduates of the Kwame Nkrumah University of Science and Technology School of Medicine in Kumasi. The university’s school of medicine takes 120 top students per year, straight out of high school, into its six-year program. KATH is the medical school’s teaching hospital.

Those interested in pathology are generally sent outside the country for training and don’t return, and Ghana has only six trained pathologists, all working in the capital of Accra, the country’s largest city. Accra is more cosmopolitan than Kumasi, Dr. Coppin says, which might explain why the pathologists choose to live and work there.

The volunteer pathologists will teach residents using dual-headed microscopes with the hopes of building a cadre during the three years that will be self-sustaining once Pathologists Overseas completes its work. Technologists at KATH have been cutting tissue samples and staining them. The pathology project volunteers will now share their expertise as they help the residents examine slides.

“The [residents] I met were very bright. I’m hoping they can be on their own in two to three years. I’ve told them that’s all it [the U.S. effort] would last. You can’t go on forever; at some point they have to take over for themselves,” he says. Dr. Coppin says two residents are being trained now in Norway and the hope is that they will return.

By mid-February, the volunteer pathologists had cleared a backlog of 300 cases from 2007 and handled 230 that were brought in in January. The cases are varied, Dr. Coppin says, with some rare cases seen only in conferences or study sets or “once or twice in a lifetime of practice” at home. In one month, they saw, on a regular basis, a large number of various sarcomas, varieties of ameloblastoma, schistosomiasis, an alveolar soft part sarcoma, advanced carcinomas from multiple organs, poorly differentiated or undifferentiated carcinomas, high-grade lymphomas, and thyroid and salivary gland tumors.

The daily work schedule is such that ample time can be spent with the residents, who need regular instruction in proper grossing practices, Dr. Coppin says. They are “bright in clinical medicine but sorely lacking in basic histology,” he adds.

Within a short time, the pathology volunteers will be working in a new German-built anatomic pathology laboratory contained in a large regional morgue on the campus of the 1,100-bed teaching hospital. The building is completed but hasn’t opened, Dr. Coppin says; it’s awaiting a dedication ceremony with high governmental officials. (Performing autopsies is not part of the pathology project.)

The anatomic pathology lab is located in a separate wing of the new building, which has outside walls of mosaic tile, a stainless-steel trimmed interior, and air-conditioning throughout. “It [the building] compares with the best I’ve seen,” says Dr. Coppin, who in his career has moved into two new hospitals and laboratories. The still-unfinished gross room is expected to have three stations with sinks and hoods, and the histology lab has “plenty of room” but inadequate ventilation and bench space. Dr. Coppin asked that both be added, which will delay the move of histology into the new building. “We can help if we are firm in directing what is needed for the future and altering what is installed,” he says.

Dr. Coppin envisions volunteers serving the first through the end of a month, or mid-month to mid-month, so that all who volunteer will have a housemate and work partner to give them the lay of the land professionally and in day-to-day living.

The Ghana project will be the most ambitious for Pathologists Overseas since the Sept. 11, 2001 terrorist attacks, after which finding volunteers to spend time in developing countries became far more difficult, says Heinz Hoenecke, MD, founder of Pathologists Overseas. Even now, recruits don’t seem to be as eager. “There’s still some hesitancy about going overseas. But it’s picking up.” Still, “It’s only about two percent [of pathologists] who are interested in this sort of thing.” Those who do go find it’s rewarding and interesting and that the cost is reasonable, he says.

Aside from the cost of leaving one’s practice for a month, Dr. Hoenecke estimates airfare and other expenses would be less than $2,000. These other expenses include paying for the vaccines, anti-malarial drugs, visas, and tours to see places in Ghana. Most expenses are tax-deductible (Pathologists Overseas is a registered 501-c-3). The hospital will furnish food for project participants.

Pathologists Overseas found more than 90 pathologists to travel to Kenya over a four-year period and between 60 and 70 who went to Madagascar in just over three years.

Recruitment difficulty aside, the Ghana project will be easier overall because the laboratory is already in place, whereas for past projects Pathologists Overseas had to raise money for equipment and supplies. “I’m optimistic about this one,” Dr. Hoenecke says. “I say to people, ‘You have to be altruistic, you have to have some spirit of adventure, you have to be adaptable, and most of all, you have to be available.’”