August 9 - Pathology Central

We spent the day at the epicenter of pathology services in Uganda with the people that make it all happen. It was a day of sharing the vision of EKYAALO and collaborating with the pathology department at Mulago National Referral Hospital/Uganda Cancer Institute and the National Health Laboratory and Diagnostic Services (NHLDS).

We started the morning with a quick breakfast and words of advice to the graduate team before heading to Mulago Hospital's pathology laboratory, located above the morgue. Something I didn't realize before my first visit to Uganda was how much of a pull autopsy-related duties are on the pathologists in East Africa. This is something one of our collaborators in Kenya shed more light on. More about that in a future post...

After arriving in the Pathology department, we met with the team that we had been working with for the last few months - made up of cytotechnologists and pathologists. The day's agenda started with a prayer and introductory words from pathologist, Dr. Veronica and then Kim Hwang and I shared the vision, technical progress, and plan for the future IRB-related work to the group. There was a period for comments from the attendees where there was valuable input for us to incorporate in our development plans. Dr. Veronica then took the stage again to discuss the context of our with and alignment with Uganda's Pathology Improvement Plan. It was great for us to validate the fit of our work with the country's agenda.

Presenting EKYAALO

Noting feedback from attendees

During the day, we gained technical and organizational insights from the group:

TECHNICAL:

• Four suggested buckets for ultimate cytologic diagnosis:

1. non diagnostic

2. benign

3. atypical

4. suspicious

5. malignant

• All of the diagnoses determined by the EKYAALO app should be reviewed by a pathologist

• Ultimately, it would be good for the tool to be able to guide the pathologist to look at the suspicious area on a slide

• Some potential pitfalls and concerns were also shared during the day:

  • Cost

  • Internet needs

  • Patient and data security

VALIDATION AND INFORMATION THAT BOOSTS OUR WORK:

"The PIs have shared this project with the Ministry of Health and and everyone is excited"

• NHLDS’s pathology program is really interested in boosting QC and quality is a goal for them. A component of rapid on-site evaluation (ROSE) in our work is strongly supported

"Patients would be happier if we could ensure that the quality and adequacy of their sample is ensured the first time"

ORGANIZATIONAL CONTEXT:

• The Ugandan Ministry of Health is rolling out a plan to deploy cytotechnologists at the district level in Uganda. This is important because cytotechs can be our ideal user and who we could design our tool for.

• If you're unfamiliar with Cytotechnologists, here is a little bit about them:

  • Cytotechnologists have 3 years of training in a University program

  • They are knowledgeable about pathology lab procedures (FNA sample acquisition, smear creation, determining sample adequacy)

  • They are familiar with anatomy and can palpate to find and isolate lesions

  • They usually operate in centers where they can work alongside pathologists and help build the capacity of pathology services in the country

"Cytotechnologists are the arms of the pathologists for places they cannot reach"

We spent the rest of the day preparing for the IRB study with a few dry-runs of the protocol with the team.

Thank you to the whole team for a productive day of work!

The NHLDS, Mulago, and JHU team