- Upgrading and standardizing laboratory practices and procedures
- Introducing appropriate new technologies
- Providing advanced training and continued education for laboratory personnel
- Training an Eritrean medical practitioner to become a specialist in clinical and anatomic pathology.
We have accomplished most of the objectives set forth for improving the clinical laboratory system in Eritrea. Through corporate and private donations and acquisitions with grant proceeds, the Clinical Health Laboratory (CHL) in Asmara and many of the laboratories in the outlying hospitals are now equipped with up-to-date equipment that are appropriate for their needs. Reagents and methodologies for most chemistry tests have been standardized.
After learning from Dr. Victor Lee at Pathologists Overseas that one of the two pathologists in Bhutan would soon be retiring, the Los Angeles Society of Pathologists sponsored the remaining physician for 15 months of advanced training at Los Angeles-USC Medical Center with the goal of increasing his expertise and enabling him to introduce new technologies in his home country.
Dr. Lee and Dr. Jack Ladenson also began consultations with the Bhutan Ministry of Health on issues of laboratory improvement, quality assurance and manpower development. They entered into an agreement with the Secretary of the Ministry of Health to implement a laboratory information system (donated by CompProMed) and to assist with short term support for the pathology and clinical laboratories.
Pathologists Overseas arranged rotations for internal medicine residents and medical students in Bhutan, and supported the development of continuing education for physicians and nurses in chronic disease management, nutrition, diabetes and dialysis. We also initiated upgrade training in Radiology, and continued annual training sessions for cytotechnologists.
The purpose of this project was to establish a laboratory in Madagascar capable of providing affordable histopathology diagnostic services for Malagasy patients, and to train one or more Malagasy physician(s) in this medical specialty. The ultimate goal was to establish a financially sustainable histopathology service administered and staffed by Malagasy physicians and personnel.
To achieve the project goal, objectives were divided into four general areas:
- Establish a functional histology laboratory to process pathology specimens in a cost-effective manner.
- Provide diagnostic histopathology services immediately.
- Build up a referral base and increase the specimen volume to a financially sustainable level.
- Train two to four Malagasy physicians in the medical specialty of Pathology so that they can take over the professional diagnosis function of this laboratory.
We later determined that histotechologist training was an issue, and addressed that as well.
The Madagascar project has matured into a locally staffed and administered histopathology laboratory. At the conclusion of our formal involvement supported by the USAID grant in November 2002, we turned over the service to Dr. Rakouth and Dr. Lalao, and in 2003 the SALFA AnaPath Laboratory received official accreditation as a histopathology laboratory. Dr. Frank Kiel, the Project Director, returned each year through 2007 and was working with regional pathologists to organize the first Western Indian Ocean Pathologists Meeting to be held in Madagascar.
HAITI / DOMINICAN REPUBLIC
During a site visit to Haiti in 2012, Dr. Ladenson and Dr. Riley from Pathologists Overseas found that Hospital Bernard Mevs/Project Medishare in Port Au Prince - the only hospital in post-earthquake Haiti that was able to care for critically ill adults and pediatrics - needed to be able to measure blood gases to monitor ventilated patients. After blood gas capability was installed (thanks to a generous donation from Nova), Dr. Riley assisted with the installation of an automated chemistry analyzer and set up basic coagulation testing.
In 2013, Dr. Riley made a site visit to a clinic in Jimani, Dominican Republic. Jimani is very close to the Haitian border and the clinic there serves both Haitian and Dominican people. At the time of the site visit there was no lab in the clinic so a Pathologists Overseas project was initiated. Volunteers, including Dr. Riley and residents from the Washington University School of Medicine Department of Pathology and the St. Louis Children's Hospital Pharmacy Residency Program, worked with local Dominican Lab Techs and a physician to establish the necessary capabilities. Donations from Heart to Heart International and Opti Medical made much of this possible. Work there continues, and ongoing volunteer support is needed.
During 2014, Dr. Riley began another project in Haiti, this time with Washington University faculty working in Cap Haitian in northern Haiti. Working with Washington University Brown School of Social Work and the faculty of Universite Publique de Nord du Cap Haitien (UPNCH), Pathologists Overseas was instrumental in the initiation of the first Public Health degree program in Haiti.
Pathologists Overseas' initial visit to Malawi was in November 2010. Dr. Tim Amukele and Dr. Jack H. Ladenson visited the hospital facilities and people involved in pathology and clinical laboratory services at Queen Elizabeth Central Hospital (QECH) and the University of Malawi College of Medicine in Blantyre, Mzuzu Central Hospital in Mzuzu, the Biomedical Sciences Program at Mzuzu University, Edwedemi Hospital Laboratory in Mzuzu, Kamuza Central Hospital, and the Community Health Sciences Unit in Lilongwe.
Pathologist Overseas programs at the QECH laboratories are focused in two areas: Establishing a Quality Assurance (QA) training and monitoring system, and helping to set up a Laboratory Information System. One of the mainstays of the QA program is External Quality Assurance. This is a system where results on outside blinded specimens are used to compare an individual laboratory’s performance to its peer laboratories. Starting in 2012, we arranged for two samples a month from the Royal College of Pathologists of Australasia (RCPA) to be sent to the Hematology and Chemistry laboratories at QECH as a way to help monitor the laboratories’ performance. That program continues.
The Laboratory Information System (LIS) was donated by Jeff Fisher of CompProMed and initiated by Robert Tuggey who spent 2 separate one-month periods in Blantyre establishing the workflow system for the LIS as well as installing the LIS and interfacing the Hematology and Chemistry analyzers. In 2013 Pathologists Overseas sent volunteers to refine the use of the LIS and its interface with some of the instruments, and to conduct staff training. All of the objectives were met, and the LIS has been in use since that time.