Pathology Enhancing Services in
Lower and Middle Income
Countries (LMIC)
Milton Datta, on behalf of Dan Milner (ASCP)
Hospital Pathology Associates
University of Minnesota Medical School
Models of Pathology Care
• Laboratory
• Clinical Pathology – Laboratory testing
• Anatomic Pathology
• Surgical pathology
• Autopsy Pathology
• Community Hospital Model
• Administration by a single or small number of pathologists
• Reference Lab Model
• Separate Divisions with specialist pathologists
• Administrators
• Clinical pathologists
• Microbiology, Chemistry, Blood Bank, Hematology, Coagulation, Toxicology
• Anatomic Pathologists
• Gynecologic Pathology, Hematopathology, Dermatopathology, Head and Neck, Breast,
Gastrointestinal, Genitourinary, etc
Reference Lab Model
• Provides focused care with specialized expertise
• Advanced training (fellowship)
• Difficult to staff
• Need many pathologists with advanced training
• Most effective with large volume laboratories
• Large hospital
• Laboratory serves multiple hospitals
Reference Lab Example
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4 Metro Hospitals
13 Regional Community Hospitals
*** clinics
7,600,000 lab tests
80,000 surgical specimens
3,700 bone marrow biopsies
4,200 Fine needle aspirations
5,600 cytology specimens
71,400 PAP smears
75,000 square feet space
700 laboratory professionals
37 pathologists
Video Walk Through
American Society for Clinical Pathology
• Since 1922, world’s largest organization of pathologists
and laboratory professionals
• Education, certification, quality standards
• International certification 80 countries
• 2005; President’s Emergency Plan For AIDS Relief
(PEPFAR)
• ASCP developed testing capacity in countries affected by the
AIDS epidemic.
• ASCP volunteers and staff traveled to selected countries,
assessed the needs of each environment, and created training
programs for local technologists
• Labs testing for human immunodeficiency virus (HIV),
associated with treatment.
Key Components
• Leverage PEPFAR laboratories
• Currently support diagnostics for HIV, Malaria, TB
• Have infrastructure in place
• Collaboration capabilities and management assistance
• Specialty specific workflow
• Utilize existing technology
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Secure private medical records
Whole slide imaging technology
High speed Internet connections
Cloud storage
Supporters and Partners
Partners in Health
IBM Watson
The following government organizations
American Cancer Society
support this effort:
Institute for Health Metrics and EvaluationThe White House Office of Science and
Technology Policy
American Society for Microbiology
The National Security Council
Association of Public Health Laboratories
The National Institutes of Health
The African Strategies for Advancing
Pathology
The National Cancer Institute
Africa Society for Laboratory Medicine
Sakura Finetek
Roche Diagnostics
Pfizer
Omnyx, LLC/GE Healthcare
The Centers for Disease Control and
Prevention
Rwanda
• December 2016
• A memorandum of
understanding with the Minister
of Health of Rwanda
• Working with the Rwandan
Minister of Health
• First site in Butaro Rwanda
• Goal: cancer diagnosis and
treatment to clinicians in 47
different hospitals
Butaro, Rwanda
One Primary Pathologist
2,500 cases
75% covered by primary pathologist
Remaining can benefit from telepathology
consultation
Expand to 25,000 cases as regional
reference lab
Dr. Deo Ruhangaza serves as the pathologist
for the newly opened pathology laboratory
in Butaro, Rwanda. The laboratory opened
in October 2016 as part of the Partners
Initiative, led by ASCP.
Program Expansion
• Democratic Republic of Congo
• Biamba Marie Mutombo Hospital, Kinshasa
• ASCP Country Assessments
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Kenya
Uganda
Tanzania
Malawi
Ethiopia
• In March 2017, ASCP Dr. Milner and several Partners
Steering Committee members visited hospitals, met
with the Ministers of Health, and conducted country
assessments.
Tanzania and KCMC
Opportunities for ASCP
• ASCP
• Dan Milner, M.D.
• KCMC
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Gilleard Masenga, M.D
Sarah Urasa, M.D.
Furaha Serventi, M.D. Chief of Oncology
Balthazar Nyombi, M.D. Laboratory Director
Alex Mremi, M.D. Pathologist
Patrick Amsi, M.D. Pathologist
Pietor Slotwieg, M.D. Pathologist
• Duke-KCMC PEPFAR SITE
• John Bartlett, M.D.
• Duke - Pathology
• Jiaoti Huang, M.D.
• HPA – Minnesota
• Milt Datta, M.D.
Key Additional Needs
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High throughput tissue processor and slide stainer
Laboratory technicians trained in histology
Immunohistology autostainer
Refrigeration
Electrical backup
Reagents
• Antibodies
• Staining supplies
Preliminary Pathologist Participation List
• North Carolina
• Duke University
• Minnesota
• Hospital
Pathology
Associates
• HealthPartners
Specialties
Breast
Number of
Pathologists
4
Fellowship
trained
Yes
Faculty
Experience
Yes
Gastrointestinal
3
Yes
Yes
Gynecologic
4
Yes
Yes
Genitourinary
3
Yes
Yes
Hemepathology
2
Yes
No
Head and Neck
4
No
Yes
Dermatopathology
Soft Tissue
Lung
2
1
1
Yes
Yes
Yes
Yes
No
No