For the Western-trained physician accustomed to the
high standard of living, long life expectancy, and predictable disease patterns
that are prominent in the developed world, practicing pathology in the
developing world, where the majority of the world's population lives poses
unique problems. As the sophistication of technology in our pathology
laboratories improves, our capacity to fine-tune diagnoses improves and
medicine becomes more individualized, the health care gap will undoubtedly
deepen, while the most basic pathology services are difficult to come by in
many impoverished countries. Many pathologists and health professionals have
been motivated to try to bridge the gap. In the United States and Canada, as
well as many other industrialized countries, there are a number of significant
efforts. However, the situation on the ground is frequently complicated, and
such initiatives may face obstacles ranging from educational and cultural to
economic and political in nature. Pathologists, who are highly trained to do
specialized and advanced studies on problems relating to the individual
patient, specific diseases, or pathobiology occurrences, may find this
particularly difficult. Our education does not adequately educate us to deal
with societal concerns such as those that confront the emerging nations.
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These difficulties are not limited to pathologists or even physicians. The developed world has long grappled with both the practical and theoretical sides of help, and significant progress has been made. In Africa alone, it is estimated that $2.3 trillion has been spent on various aid programs over the last five decades, and some contend that there is little to show for it.
Pathologists and physicians aren't the only ones who face obstacles. The developed world has long struggled with both the practical and theoretical aspects of assistance, with notable progress. Over the previous five decades, an estimated $2.3 trillion has been spent on various charity programs in Africa alone, and some argue that there is little to show for it. Economists, both in academia and for various international organizations, have spent a lot of time evaluating a mountain of economic data in order to figure out whether foreign aid helps, hinders, or has no effect. There is no agreement on whether a huge, centrally planned effort—a "big push"—is required, or whether the solution for poor countries will have to be found by imaginative people "on the ground," or "Searchers," as Easterly1 calls them. The notion of microcredit, which was proposed by Muhammad Yunus, laureate of the Nobel Peace Prize in 2006, is an example of the latter.
It is not our intention to take part in this debate. It is, therefore, prudent for any pathologist interested in working in underdeveloped nations to get acquainted with the concerns. The philosophical concepts are more than theoretically important since they assist one comprehend how one's efforts fit into a bigger picture of aid and provide a framework within which one would choose to contribute. In our own work, we've found that responding to local requirements through teaching, training, and collegial support is the most valuable contribution a Western-trained pathologist can offer in a low-resource situation, which will invariably have its own particular strengths.
Pathologists, in particular, are in short supply in the majority of poor countries. Many underdeveloped countries are covered by a small fraction of this, ranging from 0 to low single digits, despite average personnel in North America and Europe ranging from 14 to 40 per million people.
Uganda, for example, has 18 professional pathologists serving a population of 28 million people, while Tanzania has 15 pathologists serving a population of 38 million. Training is highly variable, and standardized programs are hard to come by. Because of the cost, training time is usually limited. This, along with economic incentives and labour market realities, results in an abnormally high rate of "brain drain" from poor to developed countries, as Western countries have historically relied significantly on foreign-trained physicians to meet their own personnel requirements.
It's crucial to figure out what kind of contribution to make, and it's not easy. We occasionally contribute used equipment or books without giving any thought to how effectively these well-intentioned presents meet genuine needs. Gifts are gladly accepted and usually treated with great respect for the donor, which may mean that a non-functional and outmoded piece of equipment is preserved in the restricted space that could have been utilized for active equipment on occasion. In most Western laboratories, a complex piece of equipment would not be installed without some sort of maintenance plan in place. Complex machinery, on the other hand, is frequently donated to nations with a tropical environment, where things break down even more frequently and where there may be no local knowledge for resolving the inevitable difficulties. Unfortunately, in some Western countries, this inefficient generosity is occasionally promoted by granting a tax benefit to the contributor. In other circumstances, giving equipment is a cheaper alternative to throwing it away, especially when there are environmental issues.
The University of Calgary is involved in a number of international consultancy projects. One such project, which focuses on undergraduate medical education and training of primary care physicians with public health expertise, was started at the request of Lao University of Health Sciences in Vientiane, People's Democratic Republic of Laos (formerly the Faculty of Medical Sciences, National University of Laos). J.W. and H.B. were also heavily involved in this initiative, assisting the pathologists in Vientiane. The difficulties they face are common in many poor countries. This country of 5 to 6 million people had only one pathologist before the start of the project.
Since then, another pathologist has come, and there are a few junior staff members in training, largely from the local area. Only the capital, Vientiane, has laboratories, and tissue processing facilities are scarce. These pathologists have the Herculean burden of providing clinical services as well as all pathology education for the country's single medical school undergraduate students. The stats, on the other hand, can be deceiving.
Only a small percentage of surgical specimens will be seen by a pathologist, and this is usually determined by the patient's financial situation. As a the result, healthcare statistics based on pathology data, such as cancer statistics are more of a rough approximation than an accurate picture of
reality.
Cervical cancer screening has had a significant impact on lowering the incidence of the disease in countries where it is used, but it is still, the most common cancer that kills women in nations where it is not used.
Cervical cancer screening, while basic, necessitates a level of training and an organization that may be difficult to attain in situations when resources and manpower are limited. This is undoubtedly an area where pathologists' skills and knowledge shine, and pathologists may make a significant contribution to public health. Human papillomavirus testing and cervical Papanicolaou smear screening are anticipated to be the most cost-effective screening programs, with human papillomavirus immunization preventing the disease in the long run. 7 A cost-effective treatment strategy would also be required, and long-term viability would necessitate local administrative and financial collaboration.
Fine-needle aspiration cytology has a lot of promise because
it is a low-cost and reliable diagnostic procedure in expert hands, making it
ideal for low-resource countries where histopathology laboratories aren't
available or open biopsy is problematic (Figure 2, A and B). The approach can
be taught by a consultant in a short amount of time, and the interpretation can
be aided via telepathology and local pathologists' continuing education
programs.
For obvious reasons, such as expense, cultural hurdles, and a
lack of both facilities and skilled workers, autopsies are not routinely
performed in underdeveloped nations. As a result, there is a lack of
trustworthy data that can only be obtained through autopsy and that could have
a considerable impact on health policy and spending. In most poor countries,
forensic pathology expertise and practice are similarly lacking. As a result,
the reason and method of death may not be probed as fully as intended. In this
case, pathologists' experience and input would be invaluable. Without autopsies
and forensic pathology, it is possible to "get away with murder" on
occasion; it is evident, then, that providing pathologic resources can have
far-reaching consequences that extend beyond public health to concerns of
social justice and law and order.
In many underdeveloped nations, zoonotic disease, food and
water contamination, and inadequate nutrition are all well-known problems.
Without a doubt, providing clean water and nutritious food, as well as
efficient waste disposal, will improve the developing world's dire health
statistics. Far greater knowledge of the complicated biochemical interplay
between wildlife, livestock, and human populations is also critical. Physicians
tend to approach their work in fragmented, rather than holistic, ways, and
collaboration between medical practitioners, veterinarians, and ecologists are
quite limited. The "One Health" approach, coined by the American
Medical Association and the American Veterinary Medical Association in a joint
communiqué, is a start toward identifying and addressing issues.
Chronic diseases are also becoming a rising concern in
emerging countries, according to the World Health Organization. 9 In the
underdeveloped world, cancer is an orphan disease with a diagnosis and
treatment system that is woefully inadequate. 10 It is estimated that over 1
million new cancer patients are diagnosed each year in Africa, with roughly 80%
of them being diagnosed at an advanced stage as a result of insufficient
patient information and a lack of accessible, inexpensive, and effective
treatment. This is an area where precise and fast pathologic diagnoses are
clearly required to offer patients and their families clear information on
which to base treatment decisions, even when therapy is currently unavailable.
Pathology services are, in general, basic in much of the
underdeveloped countries. Pathologists from wealthy countries can help
low-resource countries provide support for locally adapted services by
collaborating with local medical and government institutions. Time, expertise,
and collegiality are the most essential donations that can be offered, with
training as the major focus, selecting those areas where we believe our
contribution will have the biggest long-term benefit. It is critical that we
better educate ourselves about the issues of pathology in developing countries,
but it is maybe even more critical that we include this topic in our residents'
and students' curricula. The challenge depends upon us to take up the
challenge.
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Reference
pathology and digital pathology UCGconferences press releases and blogs
Medium: https://medium.com/@traviis.stork/digital-pathology-advantages-limitations-and-emerging-perspectives-57bce27ae3f2
Linked In: https://www.linkedin.com/pulse/digital-pathology-advantages-limitations-emerging-dr-travis-stork
Tumbler: https://breastcancerucgconferences.tumblr.com/post/679066526805016577/digital-pathology-advantages-limitations-and
Blogger: https://emiratespathologyucgconferences.blogspot.com/2022/03/digital-pathology-advantages.html
Reddit: https://www.reddit.com/user/BreastCancerUCGConf/comments/th10wu/digital_pathology_advantages_limitations_and/
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