Fixation on Histology

Africa Histology Laboratories: Beyond Scarcity


3_2_21_Strengthening_Laboratory_Management_Toward_Accreditation__SLMTA__in_Africa.jpgIn 2015, as part of fulfilling my MSc degree, I completed a study, “Status of Histopathology Services in Ethiopia”. I traveled all over the country to observe the services given by histopathology laboratories in the nation. The land transport made me very tired and was very uncomfortable. The bus service gives transport to more passengers than there are seats, plus there are items like cereals, domestic animals, bundles of plastic containers, stick wood and more also on the bus. I enjoyed traveling with the people from the rural areas though, with their clean hearts and traditional talk.

I had to travel nine regions and two city administrations in the study period from April to June 2015 to assess the status of the service in all health institutions where histopathology services are available. During these study months, tasks like assessments, discussions, interviews and pictures of the setup had to be done. In Africa most of histopathology laboratory services are located in urban areas, and the same is true in Ethiopia. There were 13 histopathology services in the nation, 7 of them located in the capital Addis Ababa. My assessment focused on the scarcity in equipment, professionals, and shortage of training in all institutions for both technologists and pathologists.

For instance, one of the institutions was equipped with only one very old microtome. The rest of the practices were manual. The tissue processing was done by dipping and changing the cassettes bundled with gauze that contain tissues from solution to solution manually and when it reached the impregnation step, paraffin wax was melted on a stove in a can and the tissues were inserted whenever melted (considering the fire hazard here). In the largest university hospital governmental institution, there were 3 cryostats, but no one knows how to operate and even some don’t know what it is. This shows the machines are purchased or donated without preparing trainings or exposure. Both assessed institutions commonly had a problem of maintenance and repair of machines, shortage of histotechnologist/histotechnicians, pathologists, consumables or logistics.

The sad story in this assessment is that most assessed laboratories work in a very small room and safety is completely undermined. Two city administration and two big regions have no service with the total population of 40.1 million. To find a Fine Needle Aspiration Cytology (FNAC) service, a patient is forced to travel at least 200kms to 300kms. As there is an outlier in every circumstance, in the capital, Addis Ababa, there is a private accredited Histopathology Laboratory Service by Joint Commission International (JCI) in International Clinical Laboratories (ICL) After observing all these institutions, I invented a tissue processing machine that is affordable, whose design has been completed, but electrical parts remain to be installed. The machine will have semi-automatic and automatic options. It is under investigation whether the machine can be functional in places where there is no available electricity. I hope that the machine will be able to help the problem of histology laboratories in low and middle income countries.

Written by Giorgis Yeabyo, MS