Histopathology services for developing countries.
Authors: M S Hutt, H Spencer
Journal: BMJ (1982)

In most developing countries, particularly those in the tropics with a predominantly rural population, the provision of diagnos? tic  services lags behind the development of clinical resources. During the past 30 years many schemes have been devised to provide adequate and appropriate laboratory services for the different needs of rural dispensaries and health centres, small district hospitals, and regional hospitals. Appropriate technology is vital to such plans, and the World Health Organisation and other individuals have produced several valuable manuals to this end. For most of these countries, however, diagnostic histopathology services are centred on the capital or other large cities, usually in the medical school. Worthy attempts to establish histological work in small hospitals usually fail after a period of initial enthusiasm. The paucity of trained pathologists in regions such as sub? sanaran Africa was emphasised to one of the authors (MSRH) when, in his second year as  of  (1963) at Makerere University, Uganda, he received a document from an international organisation asking for a list of pathologists with specialty training in oncology in Uganda. A generous estimate disclosed that within the whole area south of Sahara, but includ? ing Ethiopia, and north of the Zambezi river, there were then 12 fully qualified pathologists. With the development of medical schools in Africa and in other parts of the tropical world, more departments of  were established, most of which began to provide services to all government and mission hospitals in the  In Uganda the biopsy rates increased from 3400 in 1962 to over 12 000 in 1970, a large part of this increase being due to the reception of more specimens from up country. Nevertheless, in many areas services are still seriously deficient. In such circumstances a postal service to a large centre outside the country may be valuable on a temporary basis,1 and several of our colleagues in Britain continue to service mission hospitals in the tropics. In 1966 Dr J Borgstein, the senior government surgeon, approached Professor George Cunningham at the Royal College of Surgeons in London to see whether he would provide a temporary postal histopathology service to Malawi, as the only histopathologist in Malawi was leaving. In 1968, on Professor Cunningham's appointment to a chair in the United States, the service was taken over by one of us (HS) in the department of morbid anatomy, St Thomas's Hospital Medical School. About this time arrangements were being made for Professor Hurt to be appointed professor of geographical pathology in the school (1970), an appointment supported by the Wellcome Trust. All diagnostic  for Malawi has been done in the department at St Thomas's since that time. During the past 12 years a constant service has also been provided for mission hospitals in eastern Zaire, the Ivory Coast, and Sierra Leone. Specimens have also been received on a less regular basis from Cambodia, Fiji, the Comoro Islands, and the Yemen. In under? taking this work for developing countries we have had three objectives.