By - April 04, 2022
When we think of global health, the challenges can seem overwhelming. At times we may even wonder, “How can I, as one person, make any difference?” Yet, the power of working on small teams at the local level, sharing commitments with colleagues in a different country, is enormous, and that is how effective and long-lasting changes occur. Connecting around common goals, building trust and friendship in the process, is transformative.
ASCP’s goals may seem lofty—providing patients everywhere with advanced diagnostic testing and treatment, providing international ASCP certification for laboratory professionals, and providing the best possible education for laboratory professionals and pathologists wherever they may live and work—yet we are meeting these goals step-by-step with the help of ASCP volunteers working on small teams. These experiences are often life-changing for the volunteers who serve.
I asked several volunteers to share some experiences and reflections:
Robert Brunner, BA, HT(ASCP), currently IHC/ISH Reagent Specialist at Leica Biosystems, worked for the National Health lab in Gaborone, Botswana, in August 2012. “The most meaningful part of the experience was realizing how eager the staff was to learn, as they were very engaged and receptive, and seeing their reactions when they could apply their learning to their work. Everyone, including the pathologist and management-level staff, were appreciative and excited to have us there. Another meaningful experience was visiting a local orphanage. We brought toys, coloring books and other items for the kids, who were happy and excited to see us. I grew as a person a great deal; to experience the culture and people of Botswana was a once in a life time experience. Working with the other great ASCP team members to develop curriculum was satisfying, all learning from each other.”
Jean Mitchell, BS, HT(ASCP), was part of an ASCP project in Botswana in August 2013. “I worked with a team of three others for a work-intensive 11 days teaching histology laboratory skills to a group of technicians at the National Health Laboratory in Gaborone, Botswana, customizing instructions to meet their needs. The chief pathologist reported that the technicians expressed happiness to have had the privilege to train with experienced histotechnologists, and that their attitude toward histology had changed once they learned the specific principles behind what they were doing. It was an overall rewarding experience.”
Patricia Ellinger, MSEd, MLS(ASCP)CMSBBCM, St. Cloud State University MLS program, has volunteered with the ASCP Global Health initiative. “In all five countries where I worked, I was impressed by the dedication of local faculty to travel to our two-week workshops. One faculty member in Tanzania traveled 13 hours on a bus on bad roads. While in Nigeria during the initial Boko Haram kidnapping and bombing, faculty members from eight MLS programs around the country had traveled to Abuja for our workshop. They told us how grateful they were that we had not cancelled our workshop, as other organizations had cancelled similar events. While we were there, one campus was bombed, and seven students (not MLS) were killed. I was impressed with how compassionate the other faculty members were in consoling and comforting people from that campus. Over the years, I have been glad to keep in contact with various faculty members we worked with, and pleased to hear how they have incorporated the training. It has been great to see some of them present papers at ASCP Annual Meetings, sharing how they have upgraded their programs.”
Dana Razzano, MD, third year Pathology Resident at the New York Medical College stated that, “ASCP has been supporting my endeavors in global health in every step of my career since medical school, when I realized that pathology and laboratory diagnostics were the cornerstone for patient care. Sadly, at numerous interviews for residency, when I expressed exuberance for potential contributions of pathology to global health, my comments were met by looks of confusion and doubt. Fortunately, around the same time, ASCP created the Center for Global Health—this served as my ‘proof of concept’ and a firm validation of my career goals. Since then, I’ve benefitted from many ways that ASCP works to engage members in their work worldwide. At the 2016 Annual Meeting, I heard keynote speaker Dr. Paul Farmer addressing the urgent need for improving global pathology services. The following year I met Dr. Dan Milner, Chief Medical Officer for ASCP’s Center for Global Health, who was kind enough to spend time offering me valuable career advice. Later, I had a blast participating in the ASCP Global Health Ideation Challenge, and, most recently, I served in Addis Ababa, Ethiopia as one of the inaugural ASCP Global Health Trainee Fellows, a deeply rewarding experience. All of these remarkable opportunities were available due to ASCP’s commitment to both global health and to their members.”
Dr. Priya Kumar, Hematopathology Fellow at Memorial Sloan Kettering Cancer Center, first volunteered in Cusco, Peru, on an ASCP Resident Subspecialty Grant. “I observed implementation of an initiative to decrease the cervical cancer burden for women in Andes Mountain villages and Cusco. With limited resources they created an infrastructure to collect Pap smear samples, and then process them, screen them and diagnose them centrally before reporting the results, without electronic medical records or an LIS system. Using a telepathology system (real-time/dynamic) they had weekly conferences. Later, as a board certified pathologist and ASCP Global Fellow, I visited the pathology department at KCMC in Moshi, Tanzania, where they had just implemented a whole slide imaging scanner and telepathology system in collaboration with ASCP and Duke Pathology. It was especially eye-opening when I previewed a lymph node case and wrote down “reactive vs. neoplastic process, need flow/IHC for a definitive diagnosis.” I hadn’t realized that the patient receiving this diagnosis was paying out of pocket for this biopsy. Realizing that patients did not get their money’s worth without a definitive diagnosis altered my perspective and approach. I began thinking about innovative ways to make diagnoses, to create alternative protocols/decision trees/implementation efforts for that specific site. And I gained insight into more effective ways to use resources in the U.S.”
Jaime Singh, MD, currently Chief Resident at Virginia Commonwealth University, worked in Dar es Salaam, Tanzania, as an ASCP Global Fellow. “It was very enlightening to see the gap between the strong theoretical and book knowledge of the pathology residents there and the practical aspects of grossing surgical specimens. The pathology faculty are so few in number, and so busy with patient care, that residents receive very little direct gross pathology instruction. I put together a gross template and handbook for how to approach the most common specimens encountered and gave several workshops, such as on gynecological oncology cases and thyroids. I became very close with one resident; we had good dialogues and developed trust and affection for each other.”
Jennifer Kasten, MD, MSc, Assistant Professor of Pathology and Cardiology, Cincinnati Children’s Hospital: “As ASCP Global Health Trainee Fellow I worked on quality issues in Uganda, at Makerere University Hospital in Kampala alongside a longtime visionary friend of ASCP, Dr. Robert Lukande. We worked like fiends toward a singular goal: Formally instituting laboratory policies and procedures and improving the physical space with enough low-cost (ie, free) solutions to progress upwards on the WHO SLPTA checklist to become the first 1-star histopathology laboratory in the region. I conducted the first quality audit of the department after digitizing their last two years’ worth of cases, and presented that data to the faculty. When I showed off the new features of the digitized case records—now one can search by patient name and obtain a pathology history! One can search by diagnosis (i.e., “prostate cancer”) and calculate how many cases of a given entity the department was seeing! We could do real cancer epidemiology at Makerere for the first time—it was as if an electric spark flew through the conference room. It could be the model of any business school external consultant case study in “local buy-in.” As a team, we realized that “quality” in anatomic pathology does not mean shiny and expensive, and it does not mean blindly duplicating whatever laboratories do in the US or Europe. Quality is mental, and it’s a professional commitment to patient care and accurate results. ASCP’s commitment to global health is real, genuine, deep and top-notch. To be involved is the highest privilege.”
Rex Famintangco MS, MLS(ASCP)CM QLCCM, Adjunct Faculty MLS program at Western Nebraska Community College, will never forget his first ASCP Global Health volunteer assignment in Georgetown, Guyana in 2014 and 2015. “Guyana will be forever near and dear to my heart. I was assigned to the National Public Health Laboratory (NPHL)
to mentor a Quality Management System (QMS), to perform an internal audit in preparation for ISO 15189 accreditation, to identify and help fill gaps, and to improve the quality of laboratory services and patient care. ASCP Global Health was a chance to impart my knowledge, to share my voice and my two hands, and to learn from colleagues there. During my initial three-week visit in 2014, I was able to experience their daily struggles from lack of resources. I also met the Ministry of Health Deputy alongside with the NPHL Director and CDC-Guyana Director to discuss the audit findings and the importance of management support for successful QMS implementation. When invited for a second follow-up visit in 2014, I saw significant improvements, ultimately a win for patients.
The most impactful visit was when I returned a year later in 2015. Upon arrival, I immediately noticed the difference from my prior visit, encountering empty and quiet hallways, compared to the busy activity before. Half of the workforce was gone, the laboratory was struggling to keep up with workload, and the QMS accreditation progress had slowed down. I learned that staff salaries had been previously supported by US government aid, which had ended. I asked a department head what motivated her to continue, given their situation. She responded ‘I owe this to my people. Who would do the CD4/CD8 testing for our country to diagnose HIV infection and progression if I leave?’ It moved me and earned my highest respect that these individuals continued working without compensation, from dedication and commitment to serve their country and patients. I became more understanding, compassionate, and empathetic, aware of the power of my time and hard work to benefit patients, thankful for the many blessings we have back home. Fully immersing myself into alternative ways of thinking and speaking changed the way that I think about life.”
Karen Brown, MS, MASCP, MLS (ASCP)CM, Adjunct Faculty at University of Utah, says, “In Durban in 2008, an unexpected result of our phlebotomy training sessions was interaction among MTs and nurses (who often perform phlebotomy in South Africa). Each group had the chance to talk about their challenges related to patient care and phlebotomy, to develop mutual understanding and respect for each other’s issues. This struck me as a global issue, one that we encounter in U.S. laboratory and health care facilities. However, perhaps the most rewarding experience of all occurred in East London in 2008. As a summary activity from our week of phlebotomy training, I asked each participant, going around the room in a round-robin fashion, to state something new they had learned during the week to take back with them to their facilities. Each of the 20 phlebotomists (primarily nurses) stated something new, so there were 20 separate, newly learned items: no repeats or overlaps in their responses! I found this an incredibly powerful and amazing reflection of how worthwhile and valuable our work was. In Guyana in 2009, prior to the advanced hematology training, during a hospital laboratory tour in Georgetown, an MT requested my help interpreting a peripheral blood smear in the hematology department. She thought the patient might have CLL but had no one to review the slide to confirm her suspicion. There was only one pathologist, who was overwhelmed with samples in the grossing room and not available to help with any “clinical” issues. This same MT later participated in our training sessions. I felt we really helped to improve the quality of work these professionals could provide. Blood cells are the same across the globe; only the names are in a different language. Students are the same too, with the same apprehensions as students in the U.S.”
For Von Samedi, MD, Associate Professor of Pathology at University of New Mexico, “My very first ASCP volunteer assignment was in 2010 in Haiti in the aftermath of the earthquake. I was a fourth-year pathology resident eager to go back to my home country to help in whatever ways I could. I was on a team with four board certified pathologists tasked to support the country’s main laboratory, which was markedly crippled after the earthquake both in terms of infrastructure and staffing, due to lives lost. We conducted a needs assessment and helped implement appropriate solutions. What was most meaningful to me were: 1) The realization that I could contribute in global health efforts as a pathologist and that ASCP was going to be the organization to be part of; 2) The indescribable feeling of giving back, of helping others in need, not just behind the microscope; and 3) ASCP was kind enough to allow me to visit the destroyed house where I grew up and to visit my elementary and secondary school, which, too, had sustained severe damage. This initial volunteer experience solidified in my mind that ASCP is a force for good in global health.”
Perhaps Linda Cherepow, BS HT(ASCP)HTL, summarizes the rewards of global work best: “It was the first time that I actually felt that I gave back to my profession. It was the first time that I had to troubleshoot everything, from designing a lab space, to keeping equipment running, to cleaning the lab each day. It allowed me to appreciate the value of my training and how much I can do to help patients with my histology training and skills.”
Emeritus Professor of Pathology at the University of Washington