Virchows Archiv

, Volume 460, Issue 4, pp 363–370 | Cite as

Surgical pathology in sub-Saharan Africa—volunteering in Malawi

  • Sabina Berezowska
  • Tamiwe Tomoka
  • Steve Kamiza
  • Danny A. MilnerJr.
  • Rupert LangerEmail author
Original Article


The breadth of material found in surgical pathology services in African countries differs from the common spectrum of “the West”. We report our experience of a voluntary work in the pathology departments of Blantyre and Lilongwe, Malawi. During a 6-week period, 405 cases (378 histology and 27 cytology cases) were processed. The vast majority showed significant pathological findings (n = 369; 91.1 %): 175 cases (47.4 %) were non-tumoral conditions with predominance of inflammatory lesions, e.g., schistosomiasis (n = 11) and tuberculosis (n = 11). There were 39 (10.6 %) benign tumors or tumor-like lesions. Intraepithelial neoplasia of the cervix uteri dominated among premalignant conditions (n = 15; 4.1 %). The large group of malignancies (n = 140; 37.9 %) comprised 11 pediatric tumors (e.g., rhabdomyosarcoma, small blue round cell tumors) and 129 adult tumors. Among women (n = 76), squamous cell carcinomas (SCCs) of the cervix uteri predominated (n = 25; 32.9 %), followed by breast carcinomas (n = 12; 15.8 %) and esophageal SCC (n = 9; 11.8 %). Males (n = 53) most often showed SCC of the esophagus (n = 9; 17.0 %) and of the urinary bladder (n = 7; 13.2 %). Lymphomas (n = 7) and Kaposi's sarcomas (n = 6) were less frequent. Differences compared to the western world include the character of the conditions in general, the spectrum of inflammatory lesions, and the young age of adult tumor patients (median 45 years; range 18–87 years). Providing pathology service in a low-resource country may be handicapped by lack of personnel, inadequate material resources, or insufficient infrastructure. Rotating volunteers offer a bridge for capacity building of both personnel and the local medical service; in addition, the volunteer's horizons are broadened professionally and personally.


Pathology Low-resource country Africa 



The authors thank Kingsley Makwakwa and Fred Chimzimu for excellent technical assistance, and Rob Krysiak and our housekeeper Naomi for taking care of us during our stay in Lilongwe and Blantyre, respectively. We also like to thank Heinz Hoenecke (Pathologists Overseas) for bringing us in contact with the Pathologists for Malawi Project. Furthermore, we thank Katja Specht, MD for expert reevaluation of some tricky cases back at home.

Conflict of interest

The authors declare no conflict of interest.

Supplementary material

428_2012_1217_MOESM1_ESM.pdf (243 kb)
ESM 1 (PDF 243 kb)


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Sabina Berezowska
    • 1
  • Tamiwe Tomoka
    • 2
  • Steve Kamiza
    • 2
  • Danny A. MilnerJr.
    • 3
  • Rupert Langer
    • 1
    • 4
    Email author
  1. 1.Institute of PathologyUniversity of BernBernSwitzerland
  2. 2.Department of Histopathology, College of MedicineUniversity of MalawiBlantyreMalawi
  3. 3.Department of PathologyBrigham and Women’s HospitalBostonUSA
  4. 4.Institute of PathologyTechnische Universität MünchenMunichGermany

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