Against all odds, a histology lab in rural Ghana

The race was on. Final preparations for the July 2022 mission trip to build the laboratory had already been made, and the shipping container was being prepared to be sent to Ghana. We had a few weeks to obtain another processor and embedding center or the mission trip would be unsuccessful. Luckily, we did so—from Labcorp and Springfield Memorial.

However, the instrumentation that was now ready to be shipped would be useless without the chemicals and reagents needed for processing, staining, and grossing. We spoke with several vendors in Ghana and found many to be unreliable; they also asked for more money than the published price. After much consternation, we were able to find an appropriate vendor.

In July 2022 the volunteer IHDN team arrived in Ghana to set up the histopathology laboratory in a newly constructed pathology building. We were a seven-member volunteer group: me; Dr. Agamah and his wife, June; Muriel Washington; internal medicine resident Robert Kropp; nurse Ernestine Moore; and high school student Nikita Nagendra. We also recruited a local histotechnologist to learn the operations and recruit others.

Here, too, we found ourselves in another race. Ghana customs didn’t release the shipping container of equipment until nearly one week after we arrived, and by that time only four days were left before our departure to the United States. First the chemicals and reagents needed for the processor had to be set up. Twenty-gallon jugs of 100 percent ethanol and 37.5 percent formaldehyde were diluted into the necessary components.

The processor was started but the paraffin wax was not heating in all chambers. No amount of troubleshooting could solve the problem. Washington orchestrated a workaround: Tissue dehydration and clearing would be done automatically, but the infiltration of paraffin would have to be done manually. The paraffin blocks would need to be inserted and ejected into the chambers at the appropriate time.

The embedding station was also started but the wax was not dispensing and the cold plate portion would not freeze. Wax had to be retrieved directly from the wax chamber and put into a warm kettle and ice trays were used in place of the cold plate. The microtome, heating block, and staining areas were set up and ready for a trial run.

When we arrived the next morning, the processor and embedding station had turned off owing to a power interruption. It took hours to restart the system and melt the wax. But very late on the same day, we were able to process placental tissue (as a trial); embed, cut, and stain the tissue; and generate a slide acceptable for histologic analysis.

Over the next two days, I grossed in several thyroids, a breast biopsy, and a soft tissue lesion. Although some processes were manual, the slides generated were of acceptable quality. I was able to interpret these slides and generate an official pathology report for the surgeon. We left for the U.S. the next day.

Great challenges remain. Only a handful of trained histotechnologists are in Ghana and most prefer to work in cities like Accra. We also need pathologists to gross in complex specimens, which is a challenge given the limited number of pathologists in Ghana. By fostering partnerships with public and private entities, IHDN is hoping to recruit the appropriate talent.

With so few pathologists in the country, expert and timely consultation is also difficult. The organization is raising funds for a digital scanner so volunteer pathologists worldwide can interpret cases.

Despite the obstacles, we are hopeful this nascent laboratory will one day burgeon into a busy one that provides vital diagnoses to the underserved. We are thankful to all who worked hard to support this effort. We hope this laboratory will help reduce some of the barriers people in the rural areas of southeast Ghana face in obtaining histopathological diagnosis of their tumors.

Dr. Nagendra is medical director, Center for Esoteric Testing and Atlantic Regional Laboratories, and medical director, Atlantic Division, Labcorp, Burlington, NC.