See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/272785537
Proceedings of the African Pathologists Summit; March 22-23, 2013; Dakar,
Senegal: a summary
Article  in  Archives of pathology & laboratory medicine · January 2015
DOI: 10.5858/arpa.2013-0732-CC.
CITATIONS READS
0 99
39 authors, including:
Adekunle Adesokan Yawale Iliyasu
Waukesha Memorial Hospital Ahmadu Bello University
26 PUBLICATIONS   473 CITATIONS    55 PUBLICATIONS   105 CITATIONS   
SEE PROFILE SEE PROFILE
Kenneth A Fleming Aaron Shibemba
University of Oxford University Teaching Hospital, Lusaka, Zambia
225 PUBLICATIONS   7,942 CITATIONS    33 PUBLICATIONS   217 CITATIONS   
SEE PROFILE SEE PROFILE
Some of the authors of this publication are also working on these related projects:
Role of Epstein Barr Virus in Human Malignancies View project
reproductive health View project
All content following this page was uploaded by Edeghonghon Olayemi on 25 February 2015.
The user has requested enhancement of the downloaded file.
Conference Proceedings
Proceedings of the African Pathologists Summit;
March 22–23, 2013; Dakar, Senegal
A Summary
African Pathologists’ Summit Working Groups
 Context.—This report presents the proceedings of the Division of the International Academy of Pathology; and
African Pathologists Summit, held under the auspices of Faculty of Laboratory Medicine of the West African
the African Organization for Research and Training in College of Physicians.
Cancer. Evidence.—Information on the status of the practice of
Objectives.—To deliberate on the challenges and pathology was based on the experience of the participants,
constraints of the practice of pathology in Sub-Saharan who are current or past practitioners of pathology or are
Africa and the avenues for addressing them. involved in pathology education and research in Sub-
Participants.—Collaborating organizations included the Saharan Africa.
American Society for Clinical Pathology; Association of Consensus Process.—The deliberations were carried out
Pathologists of Nigeria; British Division of the International through presentations and working discussion groups.
Academy of Pathology; College of Pathologists of East, Conclusions.—The significant lack of professional and
Central and Southern Africa; East African Division of the technical personnel, inadequate infrastructure, limited
International Academy of Pathology; Friends of Africa– training opportunities, poor funding of pathology services
United States and Canadian Academy of Pathology in Sub-Saharan Africa, and their significant impact on
Initiative; International Academy of Pathology; Interna- patient care were noted. The urgency of addressing these
tional Network for Cancer Treatment and Research; issues was recognized, and the recommendations that
National Cancer Institute; National Health and Laboratory were made are contained in this report.
Service of South Africa; Nigerian Postgraduate Medical (Arch Pathol Lab Med. 2015;139:126–132; doi: 10.5858/
College; Royal College of Pathologists; West African arpa.2013-0732-CC)
The African Pathologists Summit was held March 22–23, of training of current pathology trainees and technical staff,2013, in Dakar, Senegal. The goal of the conference was (3) addressing the need for training in appropriate new
to deliberate on the challenges and constraints faced by technologies when relevant to the level of practice, (4)
African pathologists in the practice of pathology, including addressing the need for continuous quality improvement
the impact of inadequate infrastructure, limited personnel and quality assurance, and (5) addressing the need for
(pathologists and technicians), and poor funding for simple advocacy to private funding agencies (local and interna-
supplies such as reagents. It was anticipated that the tional) and government or ministries of health.
deliberations would result in the development of a There was a consensus that specific strategies are needed.
framework that will allow effective and comprehensive These include: (1) improving pathology diagnostic service,
tackling of the issues affecting pathology in Africa. with definition of modalities for ensuring uniform standards
Therefore, the deliberations were focused on the following across all regions; (2) establishing regional educational
issues: (1) updating the knowledge base of practicing training programs in basic clinical knowledge and research
pathologists in a sustainable way, (2) enhancing the quality techniques or methodology, with awareness of the need to
effect knowledge transfer with application of newer
technologies; and (3) developing clinical and translational
Accepted for publication February 10, 2014. research that will produce appropriate information critical
Published as an Early Online Release June 25, 2014. for policy making decisions.
From Adekunle M. Adesina, MD, PhD, the Department of
Pathology and Immunology and the Section of Hematology- It was agreed that pathologists in Sub-Saharan Africa
Oncology, Department of Pediatrics, Neuropathology and Molecular (SSA) must pull together and leverage available resources.
Neuropathology Laboratory, Texas Children’s Hospital and Baylor This is embodied in the theme of the conference, which was
College of Medicine, Houston. ‘‘Building International and Local Bridges in Pathology.’’
The author has no relevant financial interest in the products or In addressing the stated objectives, a 2-pronged approach
companies described in this article.
Reprints: Adekunle M. Adesina, MD, PhD, Department of was adopted. The first approach was to have key individuals
Pathology, Baylor College of Medicine, One Baylor Plaza, Houston, with practice experience in the various African regions
TX 77030 (e-mail: aadesina@bcm.edu). present information on the state of the art of pathology
126 Arch Pathol Lab Med—Vol 139, January 2015 The African Pathologists Summit—African Pathologists’ Summit Working Groups
Program for the African Pathologists Summit; March 22–23, 2013; Dakar, Senegal
Day 1
Welcome to Dakar: Serigne Magueye Gueye, Lynn Denny
Keynote address: The place of pathology in oncologic practice from the perspective of a clinical oncologist: I. F. Adewole
Setting the agenda: Adekunle Adesina
Defining and maintaining the standard: a case for quality assurance in diagnostics and developing a state of the art in pathology
diagnostics:
(1) Current state of practice: the resource-poor African pathology experience: Shaheen Sayed, Yawale Iliyasu, Victor Mudenda, Edwin
Wiredu
(2) Current state of the practice: experience in the non–resource-poor environment: Adekunle Adesokan
(3) Defining the practice goals in a resource-poor environment without lowering standards: the nuts and bolts, including tissue
processing, turnaround time, pathology reporting, and recommendations for tumor staging: Jaiye Thomas-Ogunniyi
(4) Developing a quality management system, including forms, policies, procedures (standard operating procedures) and work charts
(work aids), quality indexes and monitors, and proficiency testing adapted to indigenous practice: Frances Ikpatt
(5) International bridges for consultation and CME–International Network for Cancer Treatment and Research model: Nina Hurtwitz
(6) Assuring quality in pathology: Alec Howat
Training in diagnostic pathology:
(1) The African experience: West African College of Physicians; Nigerian Postgraduate Medical College; College of Pathologists of East,
Central and Southern Africa; and East African Master of Medicine models: upgrading curriculum for postgraduate training in
pathology: Femi Ogunbiyi, Edda Vuhahula, Ahmed Kalebi
(2) The francophone experience: Mohenou Diomande
(3) Training models 1: the Royal College of Pathologists experience: Kenneth Flemming
(4) Training models 2: the Accreditation Council for Graduate Medical Education perspective: Tarik Tihan
Breakout session:
(1) Raising the standard in diagnostics/training/advocacy: breakout discussion
(2) Summary of breakout session discussion groups
Demo of iPath (www.ipath-network.com/inctr/): Nina Hurwitz
Day 2
Training in clinical and/or translational research:
(1) Communicating clinical research (what is a good paper?): Michael Wilson
(2) African pathology consortium and how research may be supported: local and international grants and developing grant-writing skills:
Folakemi Odedina
(3) Pathology as the foundation of care: a call for action: Shahla Masood
Provision and maintenance of quality pathology services: the National Health and Laboratory Service (government provider) perspective:
Sagie Pillay
Pathology registries: the ultimate and critical tool for epidemiology and strategic planning: Timothy Rebbeck
Closing the implementation gap: the role of specific research proposals in advancing global health: John Flanigan
Pathology advocacy: the backbone for private and government support: the nuts and bolts, including advocacy efforts and government
outreach/advocacy through the private sector: Rosy Emodi
Regional bridges for pathology education: Michael Wilson
Tissue and biobanking in a resource-poor setting: Timothy Rebbeck
Pathologist without borders: the Italian experience: Leoncini Lorenzo
CME and maintenance of standards, including the role of telepathology and use of newer technologies in training; international and
regional CME conferences; visiting pathologists and exchange programs; technical staff training and education: Adekunle Adesina
The African International Academy of Pathology Assembly: an update: Ann Nelson
Breakout session:
Raising the standard in diagnostics/training/advocacy: breakout discussion 2
Closing summaries
Abbreviation: CME, continuing medical education.
practice, postgraduate training, and pathology research in pathology advocacy. These working groups used the
SSA. This was followed by presentations on the practice of information from the various presentations and the expe-
pathology and the models of postgraduate training in the rience of the participants to deliberate and develop working
West, including the United Kingdom and the United States. group reports, with the recommendations outlined herein.
There was an effort to stimulate African pathologists to strive
(despite the challenges) to achieve excellence in clinical WORKING GROUP REPORTS
practice, while using locally available resources with appro- Pathology Diagnostics Working Group Report
priate quality assurance and quality control measures (Table). The objective of this group was to focus on possible
The second approach was to use the process of changes that could be effected in SSA with or without an
deliberations by breakout working groups (Addendum) to increase in currently available budgets, with emphasis on
generate a wider scope of discussion of the issues and to achieving and maintaining excellent technical quality and
generate the recommendations for implementation. The 4 diagnostic accuracy. Possible approaches to problems facing
working groups were given the following assignments: (1) pathology diagnostics were considered. Therefore, the
pathology diagnostics and related issues; (2) pathology discussion was centered around the following 3 major
training, with emphasis on clinical training; (3) research goals: (1) shortening or reducing turnaround time, with the
training and acquisition of newer technologies; and (4) goal of achieving turnaround times of 3 days for small
Arch Pathol Lab Med—Vol 139, January 2015 The African Pathologists Summit—African Pathologists’ Summit Working Groups 127
biopsies and 5 days for large biopsies; (2) developing Potential (Future) Working Group Topics.—In view of
collaboration with clinicians, with the goal that all pathol- the time constraints, some essential topics were not
ogists should participate in tumor boards with surgical and discussed. The following were recommended as potential
medical clinicians; and (3) defining minimum standards for (future) working group topics: (1) establishment of technical
equipment and tissue processing to ensure timely reporting specifications for equipment functioning in low-resource
and high-quality diagnosis. environments subjected to electrical variability and without
The discussion then followed a step-by-step progression air-conditioning; (2) establishment of technical specifica-
of the pathology tissue handling process from specimen tions for reagents and supplies used in low-resource
acquisition to final reporting. The following recommenda- environments without air-conditioning or refrigeration and
tions were agreed on. subjected to electrical variability; (3) review of existing SOPs
Step 1: Specimen Collection, Labeling, and Consulta- to choose those best fitted for the needs of developing
tion Request.—(1) There should be documented technical countries; (4) outline of specifications for an appropriate
standards for collection, identification, and fixation in the package of laboratory management and reporting software
form of a standard operating procedure (SOP). The SOPs for pathology laboratories, as well as investigation of how
should apply in the operating room, as well as the pathology such can be made available as a standardized package at an
laboratory. (2) A standardized consultation or requisition affordable price; (5) formation and promotion of tumor
form should be provided and should include pertinent board conferences with local participation and consideration
information such as patient identification, specimen source, of participation at distance by specialist partners; and (6)
anatomic orientation marking, clinician identification, and definition of resource-appropriate equipment and diagnos-
contact information. (3) Specimen containers with appro- tic tests for laboratories with basic, mid-level, and
priate 10% formalin fixative should be supplied by the advanced-level capabilities, as well as definition of tiers of
pathology department. Specimens should be transported by service for specialty tests (eg, immunohistochemistry) based
hospital personnel and not given to family members. If the on processing volume.
preservative quality is unknown, all specimens should be The following are potential areas for further investigation
placed in fresh 10% formalin on arrival in the laboratory. (4) and potential projects:
The minimum standard for information tracking on every (1) There is a need to develop a laboratory information
specimen is a logbook, with entries including patient database software appropriate for use in low-resource
identification, clinician information, and time of registration settings. This should have the potential to expand when
for each processing step within the pathology laboratory. more sophisticated capacity is added. (2) For monitoring
Step 2: Specimen Processing.—(1) All specimens should improvement and progress, there is a need to collate
be grossed and processed on the day of arrival in the
appropriate data on the impact of SOPs on diagnostic
laboratory. Delayed processing will be at the discretion of
accuracy, impact of improved technical specifications for
the pathologist, for example to ensure adequate tissue
equipment on reliability and turnaround time, and impact of
fixation. (2) All grossing stations should include ventilation,
synoptic reporting on cancer registry and disease surveil-
which may be natural or mechanical, and a digital camera.
(3) With adequate training, available SOPs, and supervision, lance.
pathology assistants can be assigned grossing duties. (4) An Clinical Pathology Training Working Group Report
automatic processor is the minimum equipment for tissue
processing, for which there should be a manual backup. (5) The following represents a summary of the deliberations
An embedding station, water bath, and microtome are on the challenges and issues related to clinical training by
minimum equipment, for which there should be backup the working group. The format of this part of the report
equipment. takes the form of identifying specific problems or issues
Step 3: Reporting.—(1) Synoptic reporting supported affecting clinical training, followed by recommended solu-
with paper templates or (preferably) appropriate software is tions.
the minimum standard. (2) Reports should be distributed in Challenges With Potential to Discourage the Growth
a timely fashion (if necessary) by personnel with reporting and Sustenance of Pathology.—(1) Inadequate remuner-
responsibilities to the pathology laboratory. Reports should ation, poor work environment, and low standard of living of
be made available to tumor boards and to the cancer registry pathologists exist compared with other disciplines. (2)
automatically. Pathology departments are often located in the most remote
Additional Recommended Principles for Raising the and unattractive part of the hospital. (3) There is a lack of
Standards of Diagnostic Pathology.—(1) Every laboratory subspecialty practice in many countries. (4) The pathologists
should be affiliated with a program to seek accreditation. are behind the scene, and the clinicians get all the perks,
Potential programs include the World Health Organization despite pathologists’ making the diagnosis. (5) Problems of
and the International Organization for Standardization inadequate administrative support abound.
15189. Clinical Laboratory Improvement Act certification is Possible Solutions to These Challenges.—(1) A po-
generally not needed. (2) All laboratories should seek to tential solution is that pathologists need to be more
maximize efficiency, as measured by turnaround time. (3) proactive and sell the discipline better; we have been too
All laboratories require adequate finances and organization quiet. Active participation and setting up of a fine-needle
for procuring consumable supplies. This process should be aspiration practice and clinic, for example, represent
controlled by the laboratory. (4) All laboratories should be excellent avenues to have better interaction with patients
involved in continuous quality improvement. (5) Well- and be visible at the forefront of patient care. (2)
trained, adequately supervised pathology assistants and Pathologists should show better leadership and comport-
technologists can improve quality and turnaround time. ment and demonstrate better work ethics. (3) Pathologists
Pathologists should set training standards, establish SOPs, need to be more passionate and emphasize the importance
and oversee employment of these providers. of their work. For example, pathology departments (when
128 Arch Pathol Lab Med—Vol 139, January 2015 The African Pathologists Summit—African Pathologists’ Summit Working Groups
possible) should encourage postsophomore internship, influence day-to-day practice and quality issues. (6) Develop
which can be used as credit toward a residency training year. an objective residency curriculum with a timeline. It is
Targeting Potential Trainees.—Inadequate personnel important to set and define training requirements, as well as
remains a challenge in SSA. Relevant questions are how set the standard of training (eg, to determine the number of
can pathology be made more attractive and how can we specimens to be seen, to evaluate the system or disease
showcase the discipline? In this regard, the following 12 conditions to be addressed, and to require documentation of
topics were considered: (1) The medical school pathology exposure to the use of ancillary techniques). These should
curriculum needs to be taught in the context of the clinical come within the purview of the colleges (West African
scenario so that medical students can appreciate the clinical College of Physicians [Lagos, Nigeria] and College of
significance of the discipline. Efforts should be directed at Pathologists of East, Central, and Southern Africa) and
making pathology lectures more illustrative and interactive. university or regulatory bodies. (7) Encourage hands-on
The impact of changing lecture style and delivery on the training and foster regional collaborations. (8) Encourage
interest level of students cannot be overemphasized. (2) each country to have at least a laboratory with immunohis-
Medical students should be encouraged to participate in tochemical techniques. (9) Encourage the development of
autopsy sessions and in writing autopsy reports as part of regional cooperation in training and research. (10) Define
the pathology rotation (using the autopsy as an excellent competency assessment milestones to audit residents’
teaching tool, with emphasis on clinical relevance). (3) training, performed by faculty, as well as audit of trainers
University awards should be instituted for the best students by residents. (11) Develop available teaching sets of cases of
in pathology. (4) Medical student or internship rotation in different systems and interesting cases. (12) Develop a
pathology should be encouraged or scheduled. For example, regional database of institutional strengths (of ancillary
at the University of Ghana Korle-Bu Teaching Hospital in techniques and subspecialty) to identify institutions where
Accra, the pathology department is working with the residents can go for elective training to learn, with clear
department of medicine and now includes a 2-week to 3- objectives and (if possible) with their own specimens, to
week exposure to pathology during the internal medicine increase exposure and cover areas where their programs are
rotation in hematology for house officers and interns. (5) deficient. (13) Develop resident exchange programs within
Pathologists need to be good, passionate mentors and foster Africa and outside the continent. (14) Implement and
better relationships with students and residents. (6) The sustain regional technical training, with refresher courses
participation of medical students and residents in faculty for technologists every 2 years.
research activities should be encouraged. (7) Clinical What Is the Role of Trainers?—Trainers are critical players
pathology conferences with clinicians should be encour- in the success of the training effort and process. They (1)
aged. This is an opportunity for pathologists to showcase must be passionate about their jobs and be committed to
their role and significance in the health care system. (8) their clinical service duty, (2) have to prioritize their various
Pathology societies or colleges should encourage the roles and be available for residents’ supervision and
organization of scientific conferences, to which good training, and (3) need to demonstrate good leadership skills
students can be sponsored. (9) Holiday or summer and comportment.
internships should be encouraged, as well as pathology Other Recommendations.—It is important to rebrand
interest groups among medical students. (10) Sponsorship and reposition pathology as an essential discipline in the
or scholarship for pathology training or clinical incentive or health care delivery system, with a critical role in ensuring
supplementation should be given to residents joining accurate diagnosis and appropriate patient management.
pathology residency training programs. (11) Training of The fact that the quality of any hospital and patient care
laboratory support staff should be emphasized, and medical service is dependent on and reflects the quality of available
laboratory programs should be made attractive. For exam- pathology services must be emphasized. To achieve this
ple, there is the false perception in Malawi that the use of goal, a multipronged approach is essential involving all
the microtome represents manual labor. (12) Close follow- stakeholders, including the following national and interna-
up should be maintained of interested medical students who tional organizations.
have finished the medical school pathology course after The Role of the African Union.—(1) Urge member states to
graduation to attract them to pathology. implement standardized and fully functioning laboratories
Residency Training Issues.—Residency training issues within countries. (2) Accelerate the process of accreditation
discussed were 2-fold. The following 2 broad questions were of training, including the sites and programs, with particular
addressed. emphasis on the assessment of teaching contents and
How Do We Train Residents to Be Relevant to the trainers. (3) Encourage an increase in the number of and
Environment?—(1) Ensure an objective and friendly curric- improve the training of pathologists and laboratory techni-
ulum that introduces the teaching of basic laboratory cal staff.
processes, emphasizing the requirement of competency The Role of the African Organization for Research and
and introduction to laboratory management and leadership Training in Cancer Executive Committee.—(1) Advocate for
skills. (2) Involve residents in hospital committees. For provision of training infrastructure based on the argument
example, they may act in the role of the head of the that efficient and dependable pathology is central to health
department in the final month of training by attending care delivery. (2) Facilitate and support the establishment of
relevant meetings with the department chair. (3) Emphasize strong and effective collaboration and linkages among
good practice, communication skills, positive attitude, and African pathologists (in the region and in diaspora), training
value as part of training. (4) Ensure that trainers must be institutes, and multilateral partners at regional and global
good mentors who are interested not only in the academic levels.
progress of their trainees but also in their quality of life and The Role of African Pathologists.—(1) Develop training
social well-being. (5) Encourage research in relevant methods based on clinical needs and local databases, as well
subjects. Get residents involved in simple studies that can as ethical values. (2) Foster more south-south cooperation
Arch Pathol Lab Med—Vol 139, January 2015 The African Pathologists Summit—African Pathologists’ Summit Working Groups 129
to harmonize curricula and facilitate mobility of trainees and identified several obstacles for pathologists to engage in
trainers. (3) Emphasize the institution and maintenance of research, each of which would need to be addressed in order
quality control and quality management as essential for a department to develop and sustain a robust research
components of clinical training, with documentation of program. Good-quality and locally relevant research must
SOPs and improved turnaround time, as well as ensuring be focused, multidisciplinary, and translational.2 There is a
high-quality surgical reports. (4) Demonstrate good leader- need for the following: (1) establishing local research
ship skills and enhance cooperation between technical and infrastructure, including the development of an ethics
other laboratory support staff. (5) Encourage well-trained review board, availability of trained research assistants,
and motivated technologists. access to a statistician, and facilities for record retention; (2)
The Role of the West African College of Physicians; the College training in grant application writing, developing research
of Pathologists of East, Central and Southern Africa; and protocols, and publishing data; (3) elevating research to a
Universities and Regulatory Bodies.—(1) Work with pathol- priority at the local and national levels and developing the
ogists to develop, at the country level, action plans for appropriate advocacy systems to promote research; (4)
training improvement and pathology programs assessment. addressing workforce issues so that pathologists have
(2) Create a task force to harmonize the teaching contents sufficient time to devote to research activities; (5) overcom-
and assessment process in pathology. (3) Provide support ing the often prevailing lack of information on who else is
for technical training programs of other laboratory staff. working on similar or related projects and could act as a
The Role of Heads of Institutions and Hospital Medical mentor or collaborate on a given project; (6) having
Directors.—(1) Accord pathology the pride of place it adequate mentorship; (7) overcoming a state of poor
deserves as an essential clinical discipline. (2) Offer a quality funding resulting from inadequate budgetary allocation,
teaching environment because this strongly impacts train- general economic downturn, misplaced priorities, multiple
ing. (3) Provide needed infrastructure and support to competing interests for scarce finances, scarcity of funding
pathology departments and laboratory physicians. (4) agencies, and so forth; (8) overcoming a state of inadequate
Encourage improvement in laboratory services, with provi- infrastructure and decay in existing ones; (9) overcoming the
sion of much-needed ancillary techniques and frozen current state of noncohesive or lack of multidisciplinary
section facilities for improved diagnosis, patient care, and research culture; and (10) overcoming the current state of
teaching. (5) Give adequate budgetary allocation to the insufficient capacity for research.
laboratories for improved services. The current allocation is The Initial Baby Steps to Improve Translational
abysmal compared with other clinical services. (6) Foster Research in SSA.—To address the above and improve
good relationships between pathologists and technical staff. research and research training in Africa, it was recommend-
The Role of Voluntary Organizations.—(1) Assist with ed that, for starters, research goals should be set to align
capacity building through provision of teaching slide sets with the research goals of the World Health Organization,
and books and provision of consultation services. (2) which are as follows: (1) building capacity of individual and
Encourage visiting and exchange programs with African institutional competence to conduct research; (2) setting
institutions. (3) Support visiting lecturers and faculty to research priority to align with public health needs, global
African institutions, pathology departments, and African priorities, and sources of research funding; (3) establishing
pathology summits. standards to promote good practice in research; (4)
developing translational approaches to strengthen links
Translational Research Working Group Report between health research and industry by encouraging
Preamble.—It is common knowledge that high-quality transfer of research-based knowledge into the health care
research is a prerequisite for improved health. The World system; and (5) creating organization competence to
Health Organization encourages that health research should strengthen and sustain a research culture.
be an integral part of national strategies for its ‘‘Health for Leadership Roles for the African Organization for
All’’ program (http://en.wikipedia.org/wiki/Health_For_All).1 Research and Training in Cancer.—The African Organi-
Pathology as the bedrock of medical practice and health zation for Research and Training in Cancer has a role as a
care should lead in research and research training in Africa leading organization. Major areas to prioritize include
as it is being done elsewhere in the world. With capacity building and developing standards for research.
technological advancement comes increasing competition Capacity building should include the following: (1)
in the research environment, hence the increasing challenge organize regular training in research skills, research
for pathologists in Africa to keep pace with the changing methodology, and grant writing; (2) encourage research
tide. mentorship between established researchers and early
The Benefits of the Development of Translational career researchers; (3) promote formation of intrainstitu-
Research in SSA.—There was a strong consensus that the tional, intranational, and international research networks to
building of active research programs was a necessary harness expertise, improve quality, and diversify the
component of improving and increasing pathology capacity research skills in Africa; and (4) provide support for grant
in SSA. The benefits to research programs were identified as writing combined with advocacy and liaison with funding
follows: (1) better patient care at the local and national level, agencies so that the level of grant-supported research
(2) greater engagement in the medical community at large, activity can be increased.
(3) improved job and professional opportunities and Developing standards for research should include the
satisfaction, (4) enhanced recruitment of students to following: (1) assist in the establishment of institutional
registrar and training positions in pathology, and (5) more research offices; (2) encourage all institutions to establish a
retention of pathologists within countries in SSA. health research and ethics committee (or institutional
The Challenges in the Development of Translational review board), which will review and monitor all ongoing
Research in SSA.—There is a dearth of research publica- research studies and ensure conformity to national and
tions from Africa due to a number of challenges. The group international standards3; and (3) facilitate training of
130 Arch Pathol Lab Med—Vol 139, January 2015 The African Pathologists Summit—African Pathologists’ Summit Working Groups
researchers on responsible conduct of research (including Provide public education on the value of pathology using
scientific misconduct, conflict of interest, data management, appropriate population-based statistical data and so forth.
authorship practices, human and animal research subjects, (3) Develop an active and sustained public outreach,
and academic ethics) to ensure that every researcher is including media for outreach, public outreach provided in
certified nationally and internationally. This can be done layman’s terms, visits and partnering with nongovernmental
through the use of the Collaborative Institutional Training organizations and professional organizations, an awareness
Initiative template (www.citiprogram.org). day for high schools (eg, October 13), health fairs in public
Advocacy Working Group Report venues (especially related to laboratory diagnoses), and a
pathology ambassadors’ program. (4) Promote policy
Defining Advocacy.—Advocacy must first be defined. advocacy as an integral component of advocacy, with
According to the World Health Organization, advocacy is emphasis on adequate resource allocation, better service,
the ‘‘effort to influence people, primarily decision-makers,
and increased interaction with clinicians. (5) Improve the
to create change, which in the context of cancer control
poor self-image of pathologists, who often lack professional
results in comprehensive policies and effective program
implementation, through various forms of persuasive standards in many low-income countries and are poorly
communication.’’4 perceived. There is a need to be inspiring teachers, good
The working group considered what the 6 unique areas of communicators, and leaders. They should be visible publicly
advocacy are and how they apply to pathology advocacy in and be ambassadors for pathology. (6) Meet and greet with
SSA, including the following: (1) political advocacy, which is ministry of health representatives, including providing
lobbying to impact public policy at local, state, and federal postmortem statistics. (7) Encourage other activities such
levels; (2) education advocacy to enhance information and as increasing peer-reviewed publications in the area of
education about pathology, including bidirectional dialogue pathology; actively training and mentoring students to
with other providers to foster multidisciplinary care; (3) promote the profession; participating in tumor boards,
research advocacy to foster high-quality research that meets teaching, and lecturing; and improving turnaround times for
the needs of patients and the community; (4) fundraising pathology service.
advocacy to raise funds to support research, services,
education, and community outreach; (5) support advocacy CLOSING REMARKS
for patients with cancer, families, and caregivers; and (6) The analysis of the current status of pathology service,
community outreach advocacy to engage and reach out to training, education, research, and advocacy as detailed in
the community to foster cancer control. this report is exhaustive. The report also contains reasonable
All these 6 areas are considered important for pathology recommendations on how to strengthen what now exists
advocacy. A multipronged approach is recommended for and how to address new and old challenges. This document
successful advocacy. will be relevant for many years to come and provides a
Who Should Be Targeted for Advocacy?—(1) pathol- starting point for change. It should be useful in guiding
ogists, to improve self-image; (2) other clinicians, to plans and policies that address pathology-related issues in
improve their collaboration with pathologists in clinical SSA.
care, public health, and research; (3) ministries of health, to
broaden the impact of pathologists; (4) the public, to References
improve the public image of pathologists; and (5) health 1. World Health Organization. The WHO strategy on research for health.
http://www.who.int/phi/WHO_Strategy_on_research_for_health.pdf. Accessed
care organizations, to foster team care and document April 4. 2013.
evidence of care. 2. Viergever AF, Olifson S, Ghaffar A, Teny RF. A checklist for health research
Proposed Next Steps and Recommendations for priority setting: nine common themes of good practice. Health Res Policy Syst.
2010;8:36. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018439. Accessed
Advocacy.—(1) Institute an Annual Day of the Pathologist. February 21, 2014.
A possible date is October 13 (the birthday of Rudolf 3. Johns Hopkins Medicine. Welcome to the Johns Hopkins Medicine IRBs.
Ludwig Karl Virchow). A proclamation may be necessary for http://www.hopkinsmedicine.org/institutional_review_board. Accessed April 4,
the day, and having multiple organizations champion it will 2013.
4. World Health Organization. Cancer control: Policy and advocacy: WHO
be great (eg, start with a public statement by the African guide for effective programmes. 2008;4. http://www.who.int/cancer/publications/
Organization for Research and Training in Cancer. (2) cancer_control_advocacy/en/. Accessed March 13, 2014.
Arch Pathol Lab Med—Vol 139, January 2015 The African Pathologists Summit—African Pathologists’ Summit Working Groups 131
Addendum
Affiliations
Pathology Diagnostics Working Group Members
Adekunle Adesokan, MD (chair) Lake Country Pathologists SC, Waukesha, Wisconsin
Yawale Iliyasu, MD (cochair) Department of Pathology, Ahmadu Bello University, Zaria, Nigeria
Jean-Marie Kabongo Mpolesha, MD, PhD (cochair) Université de Kinshasa, Cliniques Universitaires, Service d’Anatomie
Pathologique, République de Congo
John Flanigan, MD Division of Global Pathology, National Institute of Health, Bethesda, Maryland
Andrew Kanyi Gachii, MD Department of Pathology, University of Nairobi, Nairobi, Kenya
Alec Howat, MD East Lancashire Hospitals National Health Service Trust, Blackburn, United
Kingdom
Tsungai Javangwe, MD Ministry of Health, Harare, Zimbabwe
Louis Ngendahayo, MD Department of Pathology, College of Medicine, University of Burundi,
Bujumbura, Burundi
Clinical Pathology Training Working Group Members
Jaiyeola Thomas, MD (chair) Director of Anatomic Pathology, Louisiana State University Health Sciences
Center, Shreveport
Mohenou Isidore Diomande, MD (cochair) Université Félix Houphouët–Boigny, Abidjan, Côte d’Ivoire
Femi Ogunbiyi, MD (cochair) Department of Pathology, University of Ibadan, Ibadan, Nigeria
Edda Vuhahula, MD (cochair) Muhimbili University of Health and Allied Sciences, Department of Pathology,
Dar es Salaam, Tanzania
Marie Therese Akele-Akpo, MD Department of Pathology, Faculté des Sciences de la Santé, Cotonou, Benin
Ken Fleming, MD Royal College of Pathologists, London, United Kingdom
Aaron Lunda Shibemba BSc, MBChB, MMed Ministry of Health, Cancer Diseases Hospital, Lusaka, Zambia
AnatPath
Omer Mahmmed, MD Department of Pathology, Aminu Kano Teaching Hospital, Kano, Nigeria
C. O. Ndukwe, MD Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
E. Olayemi, MD Department of Pathology, University of Ghana Medical School, Accra
Tamiwe Tomoka, MD Department of Pathology, College of Medicine, University of Malawi, Blantyre
Yahaya Tefeil, MD Department of Pathology, Hôpital Nationale de Nouakchout, Nouakchout,
Mauritania
Translational Research Working Group Members
Michael Wilson, MD (chair) Department of Pathology and Laboratory Services, Denver Health, and
University of Colorado School of Medicine, Aurora
Fatimah B. Abdulkareem, MBBCh, FMCPath Department of Anatomic and Molecular Pathology, College of Medicine,
(cochair) University of Lagos, Lagos, Nigeria
Timothy Rebbeck, PhD (cochair) Abramson Cancer Center, Perelman School of Medicine, University of
Pennsylvania, Philadelphia
Edwin Wiredu, MD (cochair) University of Health and Allied Sciences, Ho, Volta Region, Ghana
Banji Adeniji, MD Department of Pathology, University of Ilorin Teaching Hospital, Ilorin, Nigeria
Lorenzo Leoncini, MD Department of Medical Biotechnology, University of Siena, Siena, Italy
Shahin Sayed, MD Aga Khan University and College of Medicine, Nairobi, Kenya
Advocacy Working Group Members
Rosemary Emodi, LLB (cochair) International Office, Royal College of Pathologists, London, United Kingdom
Folakemi T. Odedina, PhD (cochair) Pharmaceutical Outcomes and Policy, College of Pharmacy, Radiation
Oncology, College of Medicine, Health Disparities, University of Florida
Shands Cancer Center, University of Florida, Seminole
Ann Nelson, MD Joint Pathology Center (formerly Armed Forces Institute of Pathology),
Washington, DC
Sidiq Tijani, MD Department of Pathology, City Hospitals Sunderland National Health Service
Foundation Trust, Sunderland, United Kingdom
Ahmed Kalebi, MBChB (Nbi) MMed Path (Nbi) Lancet Group of Laboratories, East Africa, Nairobi, Kenya
FCPath Anat Path (SA)
Sitshengiso Matshalaga, MD Department of Pathology, University of Zimbabwe, Harare
African Organization for Research and Training in
Cancer, Secretariat (Administrative Support)
Isaac F. Adewole, MD, FMCOG (president, Vice Chancellor, University of Ibadan, Ibadan, Nigeria
conference patron)
Lynnette Denny, MD (executive secretary) Department of Gynecology, University of Cape Town, Cape Town, South
Africa
Belmira Rodrigues (executive director) African Organization for Research and Training in Cancer Managing Director,
Rondebosch, South Africa
Serigne Magueye Gueye, MD (conference patron) Division of Urology, University of Cheikh Anta Diop and Grand Yoff General
Hospital, Dakar, Senegal
Adekunle M. Adesina, MD, PhD (coordinator on Department of Pathology and Immunology and Section of Hematology-
behalf of the working groups) Oncology, Department of Pediatrics, Neuropathology and Molecular
Neuropathology Laboratory, Texas Children’s Hospital and Baylor College of
Medicine, Houston
132 Arch Pathol Lab Med—Vol 139, January 2015 The African Pathologists Summit—African Pathologists’ Summit Working Groups
View publication stats