ASCP Global Health Scholarship for Residents Opens Eyes to Pathology Needs in Low Resource Countries

Kelsey Hummel, DO, FASCP, received an ASCP Trainee Global Health Fellowship grant for pathology trainees in 2020-2021, which allowed her to work on a month-long research project assisting Dr. Elisée Hategekimana at the University Teaching Hospital of Butare (CHUB) in Rwanda. As the project took place during the COVID-19 pandemic, she conducted all her work virtually from the United States. 

“This experience helped me to develop a better understanding about how pathology is done in low resource communities around the world,” says Dr. Hummel, now a fellow in gynecologic pathology at the University of Michigan, in Ann Arbor, Mich. “I would encourage pathology residents and fellows to apply for this Trainee Global Health Fellowship to expand their understanding of healthcare systems outside of their current academic setting.” 

For her research project, Dr. Hummel and Dr. Elisée sought to broaden the capacity of diagnostic pathology at CHUB by introducing manual immunohistochemistry stains, or IHC, to the hospital. 

“We decided to expand on the research Dr. Elisée completed during his residency at the University Teaching Hospital of Kigali (CHUK), investigating the prevalence of gastric adenocarcinomas at CHUB that were positive for HER-2 by IHC. HER-2 is a protein that controls cell growth and repair and is often a target for chemotherapy drugs like trastuzamab (i.e., Herceptin). Since Dr. Elisée was familiar with the manual IHC process, it was easy to bring this project to CHUB in southern Rwanda,” explains Dr. Hummel.  

Through this experience, Dr. Hummel learned about the challenges of funding international projects. For example, purchasing research supplies in the U.S. and sending them to another country is exceptionally expensive.  Asking international collaborators to purchase materials online can also be difficult. In Dr. Hummel’s case, she found out Rwandans rarely use credit cards. Instead, they have an electronic payment system like Zelle called Mobile Money Rwanda, so they use cash or this app for most purchases. That meant that the typical reimbursement model used in the U.S. for academic purchases was not viable for this project. 

In addition, international medical research is subject to federal regulations. There were certain procedures that she needed to follow to meet U.S. requirements regarding anticorruption laws, including detailed paperwork outlining institutional approvals and project expenses. This was an eye-opening experience. 

“That is just one example of how the fellowship helped me,” she adds. As a resident at the Baylor College of Medicine in Houston, Texas, her ASCP fellowship experience encouraged her to continue her work with Dr. Elisée and CHUB, resulting in two additional research grants funded by the ASC Foundation and CAP Foundation. “For the CAP grant, we recently installed three low-cost 3D printed slide scanners to bring telepathology to CHUB, which the pathologists originally did not have. Now, we host a monthly educational conference reviewing challenging cases from Rwanda with U.S. sub-specialized pathologists to give the CHUB pathologists access to their expertise.”  

Reflecting on the lessons learned from the fellowship, she says the hands-on experience gave her a far greater appreciation for the complexity involved in developing global partnerships. “It is important to address and respect international colleagues as collaborators. They have a wealth of knowledge that will ultimately lead to any project’s success within their country.  My role is as a consultant, and essentially a guest. It’s important for me to really listen to what they say their hospital needs and then use my knowledge to support them.”   

Today, she is leading a new project to create a machine learning (ML) algorithm to triage cervical biopsies for pathologists using images from the previously mentioned 3D printed slide scanner (the OpenFlexure Microscope(OFM)).  The goal is that biopsies with cancer or high-grade precursor lesions will be flagged for expediated review so these patients can be treated more quickly. While artificial intelligence has been used similarly for analyzing still pictures and whole slide images for several types of pathology specimens, slide scanners are prohibitively expensive and frequently unobtainable in low-resource countries. Being able to utilize images from the OFM could help reduce delays in reviewing pathology specimens in places where there is a shortage of pathologists.  For reference, a cervical biopsy usually takes one to two days to receive a result.  But in these areas, it can be anywhere from three days to four weeks. As Pap smears and HPV testing are limited in these areas, cervical biopsy is frequently a screening and diagnostic specimen for cervical cancer precursor lesions. 

“Right now, we want to show that an algorithm can be made, and that it has a high enough sensitivity and specificity to distinguish between two categories: low risk for high grade squamous intraepithelial lesion (HSIL) and high-risk for HSIL,” Dr. Hummel says. “The diagnoses in the high-risk group are managed with immediate surgical treatment. That means identifying these patients in a timely manner is vital to ensure the cancer does not spread and result in limited treatment options.”  

She has started collecting specimens and is finalizing data user agreements to allow for collaboration across four other healthcare institutions. Currently, they plan to have a research paper ready for publication by August 2025.  

Next year also marks a milestone for Dr. Hummel’s career. After six years of training, she will begin work as a cytopathologist at the Veteran Health Administration (VHA). After having trained at a VHA hospital during residency, Dr. Hummel felt the ASCP Trainee Global Health Fellowship helped to prepare her for her new role.  

“I am very grateful for the experience that the ASCP fellowship gave me,” she says. “The skills I learned in the fellowship are applicable not only to international work, but within the U.S. as well. While the VHA is the largest integrated healthcare system in the U.S., the pathology services are not ubiquitous. This is a very similar situation to what I have seen in other countries. I want to work with laboratories and pathologists throughout the system to make healthcare at the VHA more equitable across the country for our veterans.”   

When asked if she has any advice for pathology trainees interested in global pathology, Dr. Hummel advises, “Apply for grants like the ASCP fellowship. Even if you don’t have a mentor at your teaching institution, this grant will help set you up with one. I would also recommend learning how to do research in implementation sciences. The University of California, San Francisco has a free Implementation Science short course that can help get you started. In my experience, most global health work is done through research funding. If you want to demonstrate that your project or healthcare change is impactful, learn how to measure it in a meaningful and statistically significant way. Lastly, if your program does not currently have global pathology opportunities, that does not mean you can’t create them yourself. Reach out to pathologists who work in the area of global health and look for ways to be involved.” 

ASCP recently awarded Dr. Aisha Mohamed, MD, PGY-2 pathology resident at the University of Minnesota Medical School with the ASCP Trainee Global Health Fellowship for the 2025-2026 academic year. During this fellowship, Dr. Mohamed will work directly with Dr. Alex Mremi, MD, PhD, Head of the Department of Pathology at the Kilimanjaro Christian Medical Center in Moshi, Tanzania on a prostate cancer project both through virtual and in-country support in Tanzania.