Pathology Overcomes Boundaries – Interactive Microscope System Facilitates Training of Pathologists in Developing Countries


"The lack of pathological examinations is one of the most pressing issues of medical care in developing countries." Dr. Roberto Monaco, pathologist in Neaples, knows the disastrous consequences from his own experience. He is a member of the board of the Italian NGO "Patologi oltre Frontiera" ("Pathologists beyond the Borders") and campaigns in this capacity for the implementation of pathological examinations as the basis for diagnosis and therapy even in the poorest countries. According to the WHO, cancer is already a dramatically increasing problem in developing countries. Early detection could drastically reduce mortality rates.

"Patologi oltre Frontiera" was founded in 1998. Its latest project focuses on Nigeria, where breast and cervical cancer are two of the most frequent fatal female cancers. In 80 percent of cases, tumors are not detected until a very advanced stage when the chances of recovery are slim. This is because there are hardly any histo- and cytopathological facilities, and  awareness for the importance of preventive medicine is almost non-existent. "In Nigeria we now have the rare opportunity to pull together with all those involved," Monaco reports. "As well as the non-profit Italian organization 'SOSolidarietà', the church, local authorities and the Nigerian government are supporting our project, which entails comprehensive smear test screening of women in Imo state. Monaco is particularly pleased that the state has agreed to fund the project, so that the women do not have to pay for the check-up. In a country where each health care procedure costs money, this is a key factor contributing to the success of the project.

The local government of Imo, a state with a population of 4.5 million, has already launched a campaign to advertize the project and to sensitize women for the importance of screening. The representatives of the region’s religious communities have taken on the difficult task of contacting the women and persuading them to have the gynecological examinations. The exam centers were built and staffed by SOSolidarietà and the Federal Medical Centre. Roberto Monaco and Patologi oltre Frontiera were responsible for procuring the technical equipment, such as the Leica IMS500 HD interactive microscope system and a Leica Autostainer XL, and also for training eight young people as cytoscreeners. In a course lasting only five months, the challenge was to teach them to be able to confidently detect and diagnose a smear specimen. "The Leica IMS500 HD is the ideal instrument for our courses as most of the participants are beginners," Roberto Monaco sums up. "We can discuss microscope images without each student having to look through a microscope and adjust the viewing tubes." Instead, the students have a small monitor on their desk for viewing their specimens and discussing them with each other. If necessary, one of the images can be displayed on all the monitors or on the main monitor of the teacher for group discussion. Monaco: "With the Leica IMS500 HD we can provide practically oriented and interactive training that enables all the students to participate fully. The Leica IMS500 HD will be used in our projects in other countries in future, too."

In his search for voluntary course tutors, Roberto Monaco was pleasantly surprised: a large number of pathologists from all over Europe responded to his Internet appeal, so that the course in Nigeria had an international team of teaching staff from Italy, Croatia, Spain, Ireland and the USA. "It was extremely encouraging for me to see how many people all over the world want to help and get involved," says the pathologist. "It’s also an important step toward raising awareness of the problem of cancer in the developing countries and finding even more supporters."

So what is it that motivates Dr. Monaco? "I’m extremely lucky to have had a good education and I’ve accumulated a wealth of in-depth knowledge. I would like to pass on this knowledge. I would like it to bear fruit and benefit others who have not had the same chances. And 'Patologi oltre Frontiera' gives me a wonderful opportunity to do so."

The organization really has initiated numerous trailblazing projects with lasting success. The central hospital of Tanzania, one of the organization’s first project countries, for instance, now runs a large histopathological department that carries out roughly 5,000 exams a year. A team of oncologists is currently being set up. Telepathology also plays a significant role in the work of the voluntary medical staff: In places where there are no pathologists or pathologists with only very basic training, the microscope images can be sent via the Internet to experts in Italy for assessment and diagnosis. Telepathology has already been used with great success in Zambia, Palestine and Uganda. It enables a diagnosis to be made in real time – for instance during surgery – and serve as the basis for successful therapy. So Roberto Monaco can rightly say that: "Each case of cancer we can prevent or cure with our activities amply rewards us for all the effort."

This project is supported and funded by the Waldesian Church of Italy

Pathologists beyond the borders NGO

Patologi Oltre Frontiera is a group of Italian pathologists. This NGO association was initiated by members of the Committee of the International activities of SIAPEC (Società Italiana di Anatomia Patologica e Citologica Diagnostica – the Italian Society of Anatomic Pathology and Diagnostic Cytopathology).

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