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Imagine running an Anatomic Pathology laboratory with a dedicated but limited staff who are afraid to travel to work, who do so with intermittent electricity and internet, and often without essential reagents needed for their job.  U.S. Laboratories wouldn’t even try, yet that is how Hôpital Universitaire de Mirebalais (HUM) in Haiti still functions despite the most desperate circumstances imaginable. 

Significant political unrest in Haiti is causing problems to all major infrastructure, threatening safety, and impacting the ability to get supplies to the laboratory. Pathologists and other medical professionals are threatened by violence and targeted for kidnapping, and safe transportation of both people and materials is uncertain. 

It’s not for lack of trying—these dedicated laboratory professionals work hard against the odds every day to serve their patients, but the lack of essential laboratory equipment, reagents and staffing severely hampers their ability to provide cancer diagnoses and effective treatment to patients in need. And it begs the question: What can be done to support Haiti’s laboratories?  

A bare bones laboratory 

The situation in the laboratory is dire in Haiti, according to Marie Djenane José, MD, Head of Pathology at HUM in Haiti. She is one of five pathologists in the entire country serving a population of 12 million. 

Other challenges, Dr. José writes by email, include, “The difficulty of keeping staff motivated, the impact of institutional shortcomings on the pathology department causing delays in the supply of inputs, water and electricity, and the lack of resources to hire more staff.” 

Challenges to overcome

In addition to shortages of both equipment and staff, power outages are common, which has a significant impact on refrigeration and the operation of equipment within the laboratory. Plus, safety and security are a real concern due to the political chaos and gang activity in the country, Dr. José explains. 

“During this crisis crippling many activities in the country and in HUM, we spent several months without one of our main dyes, hematoxylin, for example,” Dr. José says.  

“Strategically, we had to approve a triage of specimens, prioritize oncology cases, especially breast. A special turnover (a security-protected transport service) is established for the staff to reduce the costs of travel and the risk of insecurity on national roads,” she says. 

A partnership 

HUM laboratory professionals rely upon a collaboration with Brigham and Women’s Hospital in Boston, which has a long-standing collaboration with Zanmi Lasante, as part of the Global Health Delivery Partnership, to read and analyze slides, under the leadership of Dr. Jane E. Brock, MBBS, PhD, former chief of Breast Pathology at Brigham and Women’s. 

Dr. Brock reads the breast specimens and triages the rest of the cases to a team of other volunteer U.S. pathologists supporting the Haiti pathology department and Haiti pathologists.  

“All of the quality controls, which are absolutely standard practice in any accredited laboratory around the world, just are not in place,” Dr. Brock says. “The lab is dealing with all the quality challenges imaginable, specimen mislabeling, poor tissue fixation, poor processing, difficulty with quality microtomy and tissue staining, and challenges scanning the slides and uploading them to the cloud for pathologist review.” 

This can lead to situations like specimen mix ups, cross-contamination of tissues, and other issues. Despite these odds, they are still diagnosing Haitian patients, and one of the diagnoses that turns up often is breast cancer. 

Of course, there are still major barriers to treatment after diagnosis, but patients make dangerous journeys to seek treatment even amidst the turmoil.  A Haitian oncology team offers chemotherapy and surgery, offering life-prolonging treatments to some of the poorest and most socially vulnerable cancer patients in the world.  

Workarounds 

Dr. Rebecca Henderson, MD, PhD, who volunteered on the ground in Haiti for several years, praises Dr. José for her commitment on behalf of her patients, calling her an “amazing, dynamic pathologist” and explains one of the solutions they devised to the huge backlog of tissue samples awaiting diagnosis that were sitting in formalin for many months. 

“One of the things that we did was to start a prioritization of actual cancer biopsies where we know with reasonable degree of clinical certainty that the patient has cancer. Those we fast track. If everything is working perfectly, which it is not right now, we can get a turnaround time down to three or four weeks,” Dr. Henderson says. 

Currently, wait times can be six to eight months and beyond, she says, largely due to material shortages. 

“With the help of ASCP we have set up an amazing telepathology service that reads many of our cancer cases at a distance. We always need more volunteers. But right now, we are out of everything.” 

The greatest needs 

In addition to trained laboratory professionals and pathologists to handle the volume of work in the laboratory, the pathology laboratory at HUM needs equipment—a tissue processor, a functional H&E staining machine, and it will shortly need a new, larger-capacity slide scanner to handle the unmet needs, according to Dr. José. Reagents are always in short supply and donations are always needed and welcome. 

“We need volunteer pathology experts for the telepathology service,” Dr. Brock explains. “But it’s not as easy as you might think. As an ‘expert’ pathologist in the U.S. offering diagnostic support in these circumstances, you need to understand you will receive limited clinical history, the diagnostic slides may be sub-optimal, no additional immunohistochemistry may be available for many weeks to confirm or refute your diagnosis, and there are very limited treatment options available for the patient, and yet they desperately need you to provide a helpful diagnosis to triage the patient. You have to be willing and able to do this to support the service.”  

Once they are gone, Henderson says, “Cancer diagnosis and treatment at the hospital will grind to a halt.” 

The outcome without support 

Dr. José is grateful for all the support she does get, but she is very clear about the realities of her situation. While she feels that they are doing their best, she writes that without further help, “That [best] is likely to no longer [to be] sufficient without the human and financial resources needed to maintain the laboratory in a socio-cultural context highly unstable politics.” 

How you can help 

The best way to directly support the Haiti HUM pathology laboratory currently is through cash donations to the ASCP Foundation.