Increasing the number of pathologists practicing in underdeveloped countries will allow accurate diagnoses that will save lives. Improving the existing laboratories will improve turnaround times for speedier treatment of the diseases, and the ability to send cases out for consultation.
Projected 2020 Projects
This year, Path of Logic will continue to teach of anatomic tissue dissections with histologic correlation on-site in Uganda. In addition, a series of instructional videos of the most complicated tissues will be given to the laboratory to assist as they approach these uncommon and complicated cases.
Path of Logic hopes to find a solution that will address the ventilation short comings in the surgical dissection room of the laboratory. Likely this will be finding a small ventilation hood that will pull formalin particles out of the air while the residents are working with tissue.
The electronic reporting system introduced in 2019 will be updated to meet any new needs. Training on using diagnosis codes will also be a focus. Lastly, the system will be expanded offer a recording/reporting system for the mortuary.
Path of Logic strives to continue supporting the residents by providing stipends for living expenses. Progression in treating cancer, starts with the diagnosis. Pathology residents are unpaid. Funds will encourage new residents to enter the field of pathology, and allow the current residents to focus on the highly complicated field of pathology, feeding the forward movement of cancer diagnostics by starting at the roots in education.
Path of Logic will continue working on building community relationships through its partnership with Mpowerd Inc to distribute solar powered lights to children in primary schools.
In 2019 Path of Logic worked with two computer software consultants to build a free computer program that could accession the cases, track them, generate a pathology report, and give a report of turn-around-time. In addition, we also hope that this will eventually result in increased funding for pathology services in Uganda. Right now, the money allocated from the Ugandan Ministry of Health is allocated to medical issues such as HIV, malaria, and cancer treatment – but none for diagnostics. The Department of Education allows some funds for Pathology, but only about 30% of what is needed. Part of the reason why is that until now, there has been no way to quantify the number of cancer cases. With our program, we will be able to generate that data to show real numbers when lobbying for increased funds.
Hands-on dissection instruction is important when learning anatomic pathology protocols and gaining an understanding of the tissue sections needed to provide a complete diagnosis. In 2019, most of the focus was with the two first-year residents covering the basics of tissue dissections with routine surgical specimens.
In 2018, Path of Logic tackled fixation issues, and focused on teaching and providing tools to ensure proper fixation protocols and ratios were followed. Currently, the formalin in those containers is discarded in the sink at the medical school.
Formalin is a known human carcinogen, and proper waste management is crucial to protecting water. Path of Logic introduced a formalin recycler to the laboratory to increase the life of formalin used for tissue processing, while also reducing the amount of chemical improperly disposed of.
For the second year, Path of Logic provided living expense stipends to the four residents. In a country where pathology residents are unpaid, many have second jobs on the weekends to support their families. The stipends lessen the financial burden to allow focus to their roles at MUST.
Dr. Mitala, Dr. Raymond, Dr. Sharif, and Dr. Tobias
For the second time, Path of Logic teamed up with Mpowerd to distribute hundreds of solar lights to primary schools without electricity. To learn more about Mpowerd click here.
Teaching anatomic tissue dissections with histologic correlation. Proper dissection and selection of pathological tissue samples requires training that is lacking in UG. The residents use outdated books to direct them to dissection procedures. Path of Logic provided instruction on-site for all cases encountered during the January visit, as well as a presentation of proper tissue dissection techniques for breast, colon, and uterine tissues, with modifications made to accommodate resource issues.
New Pathology Textbooks. The current books used in the laboratory for the residents are outdated and damaged. Grossing manuals and current pathology literature will enhance the learning of anatomic pathology. Grossing manuals and surgical pathology books were provided for the residents to share and reference in the lab.
Correcting the issue inadequate fixation (preservation of tissue). Quality slides, which are required to make quality and accurate diagnoses, require properly preserved patient tissue. Path of Logic provided reusable vessels that the laboratory staff will transfer patient tissue to once it arrives, allowing the proper ratios of fixative to tissue. Proper fixation requires a 20:1 ratio of formaldehyde to tissue volume. In UG, patients provide their own vessels to store their tissue until dissection and processing occurs, which can wait up to a week in containers many times no larger than the tissue itself, which can leave the cells necrotic (non-diagnostic).
Correcting improperly mixed formaldehyde. Just as important as the volume ratio of fixative to the tissue, is the concentration of active fixative (formaldehyde) to water. In the US, we purchase formaldehyde already mixed with buffered water to the correct concentrations. In UG, formaldehyde is purchased as a powder and is estimated by the naked eye. Path of Logic purchased a hydrometer and conduct testing to provide a recipe that will be used in a consistent vessel for accurate and reproducible concentrations of proper fixation.
Stipends were provided to the four residents (physicians training in pathology). Progression in treating cancer, starts with the diagnosis. The Ugandan government encourages certain physician specialties by providing living expense stipends; pathology residents are unpaid. Funds will encourage new residents to enter the field of pathology, and allow the current residents to focus on the highly complicated field of pathology, feeding the forward movement of cancer diagnostics by starting at the roots in education.
Path of Logic teamed up with Mpowerd and distributed hundreds of solar lights to homes in rural communities without electricity.
January 13th – Feb 6th Anatomic pathology dissection instruction with histological correlation will be provided to 3 medical students with the Mbarara University of Science and Technology. Topics covered include:
– Breast dissection and tumor differentiation
– Colonic resections and cancer staging
– Uterine and cervical pathology
Instruction to histology staff related to small biopsy submission and standard of procedure improvements.
Efforts to organize the current and future tissue blocks and slides to improve turnaround times for cases is a side focus of the trip and will require local Ugandan assistance for building new filing storage containers.
In May of 2016, assistance was provided to the Justinien University Hospital in Cap Haitien, Haiti laboratory staff to establish a histology department lab and install new equipment under the EqualHealth organization. Microtomy and staining instruction, as well as laboratory safety education was a focus for producing quality pathology slides and blocks.
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