Surgical pathology in sub-Saharan Africa—volunteering in Malawi
- 313 Downloads
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.
KeywordsPathology 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.
- 4.Wikipedia (2012) Malawi. http://en.wikipedia.org/wiki/Malawi. Accessed 10 Jan 2012
- 10.WHO (2011) Global tuberculosis control 2011. http://www.who.int/gho/mdg/diseases/hiv/en/index.html. World Health Organization, Geneva, Switzerland http://www.who.int/tb/publications/global_report/2011/gtbr11_full.pdf
- 21.Sammon AM (2007) Carcinogens and endemic squamous cancer of the oesophagus in Transkei, South Africa. Environmental initiation is the dominant factor; tobacco or other carcinogens of low potency or concentration are sufficient for carcinogenesis in the predisposed mucosa. Med Hypotheses 69(1):125–131PubMedCrossRefGoogle Scholar
- 22.Sammon AM, Iputo JE (2006) Maize meal predisposes to endemic squamous cancer of the oesophagus in Africa: breakdown of esterified linoleic acid to the free form in stored meal leads to increased intragastric PGE2 production and a low-acid reflux. Med Hypotheses 67(6):1431–1436PubMedCrossRefGoogle Scholar
- 23.Patel K, Mining S, Wakhisi J, Gheit T, Tommasino M, Martel-Planche G, Hainaut P, Abedi-Ardekani B (2011) TP53 mutations, human papilloma virus DNA and inflammation markers in esophageal squamous cell carcinoma from the Rift Valley, a high-incidence area in Kenya. BMC Res Notes 4:469. doi: 10.1186/1756-0500-4-469 PubMedCrossRefGoogle Scholar
- 30.Msyamboza KP, Dzamalala C, Mdokwe C, Kamiza S, Lemerani M, Dzowela T, Kathyola D, Parkin DM (2011) Burden of cancer in Malawi; common types, incidence and trends 2007–2010: national population based cancer registry. Paper presented at the 15th College of Medicine Research Dissemination Conference, Blantyre, Malawi, 15th November 2011Google Scholar
- 33.Naresh KN, Ibrahim HAH, Lazzi S, Rince P, Onorati M, Ambrosio MR, Bilhou-Nabera C, Amen F, Reid A, Mawanda M, Calbi V, Ogwang M, Rogena E, Byakika B, Sayed S, Moshi E, Mwakigonja A, Raphael M, Magrath I, Leoncini L (2011) Diagnosis of Burkitt lymphoma using an algorithmic approach—applicable in both resource-poor and resource-rich countries. Br J Haematol 154(6):770–776. doi: 10.1111/j.1365-2141.2011.08771.x CrossRefGoogle Scholar
- 34.Farmer P, Frenk J, Knaul FM, Shulman LN, Alleyne G, Armstrong L, Atun R, Blayney D, Chen L, Feachem R, Gospodarowicz M, Gralow J, Gupta S, Langer A, Lob-Levyt J, Neal C, Mbewu A, Mired D, Piot P, Reddy KS, Sachs JD, Sarhan M, Seffrin JR (2010) Expansion of cancer care and control in countries of low and middle income: a call to action. Lancet 376(9747):1186–1193. doi: 10.1016/s0140-6736(10)61152-x PubMedCrossRefGoogle Scholar
- 35.Anderson BO, Cazap E, El Saghir NS, Yip CH, Khaled HM, Otero IV, Adebamowo CA, Badwe RA, Harford JB (2011) Optimisation of breast cancer management in low-resource and middle-resource countries: executive summary of the Breast Health Global Initiative consensus, 2010. Lancet Oncol 12(4):387–398. doi: 10.1016/S1470-2045(11)70031-6 PubMedCrossRefGoogle Scholar
- 36.Stalsberg H, Awuah B, Ibarra JA, Nsiah-Asare A (2008) Re-establishing a surgical pathology service in Kumasi, Ghana: case report and discussion of barriers and key elements of a successful collaboration between low- and high-resource countries. Cancer 113(8 Suppl):2338–2346. doi: 10.1002/cncr.23830 PubMedCrossRefGoogle Scholar