1. 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

2. 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

3. 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

4. Reference Lab Example 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

5. Video Walk Through

6. 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.

11. 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
Secure private medical records
Whole slide imaging technology
High speed Internet connections
Cloud storage

12. Supporters and Partners
Partners in Health American Cancer Society Institute for Health Metrics and Evaluation American Society for Microbiology Association of Public Health Laboratories The African Strategies for Advancing Pathology Africa Society for Laboratory Medicine Sakura Finetek Roche Diagnostics Pfizer Omnyx, LLC/GE Healthcare IBM Watson The following government organizations support this effort: The White House Office of Science and Technology Policy The National Security Council The National Institutes of Health The National Cancer Institute The Centers for Disease Control and Prevention

13. 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

14. 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.

15. Program Expansion Democratic Republic of Congo
Biamba Marie Mutombo Hospital, Kinshasa
ASCP Country Assessments
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.

16. Tanzania and KCMC Opportunities for ASCP
Dan Milner, M.D.
KCMC
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.

17. Key Additional Needs
High throughput tissue processor and slide stainer
Laboratory technicians trained in histology
Immunohistology autostainer
Refrigeration
Electrical backup
Reagents
Antibodies
Staining supplies

18. Preliminary Pathologist Participation List
Specialties
Number of Pathologists
Fellowship trained
Faculty Experience
Breast 4
Yes
Gastrointestinal 3
Gynecologic
Genitourinary
Hemepathology 2 No
Head and Neck
Dermatopathology
Soft Tissue 1
Lung
North Carolina
Duke University
Minnesota
Hospital Pathology Associates
HealthPartners