Improving access to pathology in low resource settings

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Published: 10 Oct 2017
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Dr Abeer Shaaban - University of Birmingham, Birmingham, UK

Dr Shaaban speaks with ecancer at the Royal Society of Medicine meeting on cancer control about the essential role of pathology in disease control for low and middle income countries.

To address the need for adequate staffing and training alongside technical provisions, Dr Shaaban notes the utility of online training courses, including her own breast cancer pathology update course.

She also highlights the collaborative focus of the meeting, and the many stakeholders working together to provide training and personnel where needed.

Dr Shabaan notes the collaborative opportunities on offer by the International Committee of the Royal College of Pathologists, The Pathological Society of GB and Ireland, The International Academy of Pathology and The Association of Clinical Pathology.

I thought it was a very interesting discussion. I started with an overview of the role of pathology in managing patients in developing countries and why pathology is important. So in order to treat a patient and manage a patient appropriately we need the correct diagnosis and that’s where pathology comes to assess whether at first their tumour is benign or malignant, whether it needs to be taken out or not, what type, how aggressive it is, the nodal status and so on, all the prognostic parameters that tell us how to manage the patient and what’s the likelihood for this patient to survive. There was an overview as well of the resources in these countries and how little pathology is supported there. The number of pathologists is low and there are four countries, for example, in sub-Saharan Africa with no pathology at all. So this was really eye-opening.

Then we talked about some experiences from the pathologists in the UK helping out pathologists in Africa, particularly in Nigeria and Egypt, and developing a multidisciplinary approach for management of breast cancer.

How has your personal experience shaped your views?

Having graduated and worked in Egypt I was aware of some of the issues that are facing the health professionals there and patients there. Whilst there are really good pockets of knowledge in Egypt there was this lack of multidisciplinary approach so teams did not work together that much. We know that for best cancer management we need all teams - surgeons, oncologists, pathologists, radiologists – to come together and discuss patients and plan management. So that’s how we worked with the breast and gastrointestinal team in Mansoura University and developed some training and teaching on the multidisciplinary approach. We were very lucky to get people involved and particularly not only pathologists, we got surgeons, oncologists, radiologists, trainees and they are taking things forwards there.

How does this overlap into your own work?

We provide regular teaching for the breast pathologists in the UK and we try also to support the pathologists in low income countries. So we did a similar distant module teaching for breast pathology to colleagues in Nigeria, including trainees and senior pathologists. This included digital slides and slide seminars and lectures and this has worked very well.

How would you rate the balance of distant learning or in-person support?

They can work together and they are very complementary. Distant teaching has many advantages in that obviously the cost is reduced so taking a panel of colleagues from the UK to another country is very expensive. It also has the advantage of having the material available for reuse and also for people to access it and go back to it as long as they have internet access. There are several advantages for having this, however in some other countries sometimes the best approach is to do the face-to-face discussion at least once and then follow it on with distant teaching, particularly when you want to get people together and discuss issues and to develop the multidisciplinary approach.

Any further thoughts?

We should try to come together and work as teams. The International Committee of the Royal College of Pathologists is very active and they have several projects available and they are looking for volunteers to develop some work over in Africa and in other countries. There are also several pathology societies that can support and fund any work that you have that you would like to deliver as long as you have the right team and the right resources like the Pathological Society of Great Britain and Ireland, the British division of the International Academy of Pathology, the Association of Clinical Pathologists. In addition some colleagues just volunteer and go out there using their own time and their own resources and try to make a difference.