Fixation on Histology

Histology in the Philippines

People Smile“Histotechs are neglected.” This was the emotional statement from Louie Cadao, Vice President of the Philippine Society for Histotechnology during a round table discussion on “Quality Improvement in Histopathology Practice” with the Philippine Council for Quality Assurance in Clinical Laboratories (PCQACL).  The discussion was hosted by The Medical City, a prestigious hospital in Manila City, Philippines.  Having been in the histology field for close to 30 years, I’ve personally felt under-appreciated, unrecognized, and overworked, but I can honestly say I’ve never felt as neglected as Louie was expressing.


Histology in the Philippines is a small part of the Medical Technology curriculum.  In the licensing process, histology comprises only 3% of the Medical Technology Board exam.  Some licensed Med Techs have admittedly said that they didn’t study histology at all when they were preparing for the board exam.  In other words, histology is negligible.  It’s also not seriously viewed as a professional career.  Oftentimes, the Med Techs that end up working in the histology lab do so out of curiosity, or through an encouraging colleague, or even an influential pathologist.  It is predictable that most, if not all, of their histology experience is gained through on-the-job training.  This proves to be challenging given the high turnover rate of histotechs due to heavy recruitment from other countries.  One of the Chief Med Techs I spoke with said 5 out of 7 histotechs have quit  within the last 6 months, and every single one of them was offered a job abroad. As these more experienced histotechs leave, taking with them tribal knowledge, those that are left have to not only work harder but also have to try to figure things out on their own. 


The Philippines is a country in Southeast Asia.  It is situated in the western Pacific Ocean and consists of around 7,641 islands. The islands extend about 1,850 kilometers from north to south and almost 1,127 kilometers from east to west. Metro Manila is the main capital.  Most of the histology labs within this capital region have modern equipment, and have the capability to do IHC, ISH and even molecular testing.  However, the remote areas do not.  Samples coming from areas that are accessible by car are either in fixative or blocks, and samples coming from remote areas that need to be flown in are formalin fixed paraffin embedded.  Although there are guidelines around fixation and processing, blocks from these areas are sometimes sub-optimal due to reagent expense and to a certain degree, due to lack of understanding of how this process impacts patient results.


The Philippine Society for Histotechnology (PSH) was founded in 2019.  Under the leadership of Jomar Custodio, the organization’s goals are to 1) Raise the standards of histology in the country by aligning and collaborating with universities offering Medical Technology program, the Professional Regulation Commission (PRC) in charge of licensing, governing agencies such as the Department of Health, as well as partnering with international organizations such as the National Society for Histotechnology (NSH) 2) Increase awareness of histology as a profession by highlighting growth potential  within the country and elsewhere, and 3) Improve quality by offering educational materials, enabling access to other histotechs’ expertise, and providing training.  Recently, PSH officers organized a hands on microtomy training event.  It was a success.  This led to the second microtomy training event which will take place on Dec. 3rd.  Within 8 hours of opening up registration, it was sold out.  This proves how hungry histotechs in the country are for education and training, which are high unmet needs.


I’m fortunate to have been able to learn from, as well as spend time and work with, some of the Officers of the PSH through the NSH Lee Luna Foreign Travel Scholarship. While I was in the Philippines, I had the honor and privilege to visit government and private histology labs namely: Veterans Memorial Medical Center, National Kidney and Transplant Institute, Providence Hospital Inc., St. Luke’s Medical Center – Global City, National Center for Mental Health, Pascific Philippines, Baguio General Hospital and Medical Center, and The Medical City.  I was also able to meet with Dr. Mark Francisco, Dean, Bachelor of Science in Medical Technology, Trinity University of Asia.  Please check out the video prepared by PSH.


During the week of Nov. 27, NSH will be hosting a Week of Giving. For each person that renew or joins during that week, NSH will give one free Enhanced Education Membership to a histotech working in the Philippines in collaboration with Evelyn and her team. These memberships will give much needed access to education and resources to those working in the country. Keep your eyes open for future emails about the initiative.

Written By Evelyn Diaz HT-QIHC(ASCP)