Establishing a Pathology Service in Northern Uganda

An accurate diagnosis helps to prevent unnecessary or incorrect and potentially harmful treatment and therefore, ensures better use of resources. But, the turnaround time to make a diagnosis and the accuracy of diagnosis is still unsatisfactory in institutions in Africa such as St. Mary’s Hospital Lacor in Gulu, Uganda. These factors have a profound impact on patient management and outcomes. Also without an accurate diagnosis, effective patient management cannot be implemented and meaningful research cannot be conducted.
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Tiziano, Loredana (Pathology Oltre Frontiera) with Lawrence and Michael struggling with immunostaining

Since 2008, the Italian non-governmental organization, Pathology Oltre Frontiera (APOF) has been actively helping to establish a histopathological diagnostic service at St. Mary’s Hospital Lacor. The hospital is located about 6 kilometers west of Gulu town in northern Uganda. It is a private, non-profit, Catholic based institution that was founded in 1959 by the Comboni Missionaries. Since its foundation, it has been continuously and steadily developing. The hospital provides all of the major components of the Uganda Minimum Health Care Package. It offers inpatient, outpatient and community-based services. The hospital has adequate facilities and infrastructure. It has electricity and water that is constantly available. The hospital has 580 well-trained staff members, including 35 doctors and 200 nurses and medical officers.

The Hospital receives patients mainly from the Gulu District, but also from other parts of northern Uganda and Sudan. It can accommodate 600 inpatients plus their attendants and sees on average 500 patients on an out-patient basis daily. At least 100 patients are admitted to the hospital every day. The majority of these admissions (about 60%) are children below six years of age.

Diagnostic services have been ensured by the continuous presence of volunteer pathologists from Italy and two local technologists. The pathologists from APOF will continue to remain at the hospital until the Medical Officer, who is presently undergoing training at the Mulago Hospital to become a specialist in pathology, can work autonomously.

The availability of a pathology service makes it possible for St. Mary’s Hospital to participate in the INCTR study on Burkitt lymphoma (BL). Their ability to participate in the study is important because in this region, BL is one of the most common childhood cancers.

The laboratory is equipped with automated embedding and staining units as well as a microtome. Not only basic stains such as H&E are performed, but also PAS, Giemsa, Ziehl-Neelsen e Papanicolau for vaginal smears and cytology are as well. Basic immunostaining is also possible. Most of the running costs are paid for by the hospital as are the salaries of the laboratory staff. INCTR pays for part of costs associated with the antibodies used in lymphoma diagnostics.

In the year 2010, there were 1,052 cytology and 1,930 histology examinations performed. Approximately half of the cytology examinations were of vaginal smears for women attending antenatal and AIDS clinics in order to screen for cervical cancer.

An integral part of the APOF program is to raise awareness among all of the medical and nursing staff of the new pathology service. The laboratory is also “twinned” with specialized centers in Italy, mainly the Department of Pathology at the University of Siena in order to receive scientific “on line” help. Dr. Lorenzo Leoncini is responsible for the APOF project in Lacor. He is also the Director of INCTR’s Pathology Program and a member of INCTR’s Governing Council.

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