They do have a hospital laboratory staffed with pathologists but, somewhat similar to Peru, they are not so up to date with procedures and stuff like keeping stuff organized so you can easily retrieve it at a later date.
To help you understand: The white and yellow plastic squares in the picture are attached to blocks of wax that contain patient tissue samples that are sliced into ultra-thin sections, mounted on glass slides, stained with dye and looked at under the microscope. The plastic things are numbered so that they can be filed away in case you need to look at the patient's tissue again in the future. This pathology lab has about 20,000 of these blocks per year and they ran out of filing boxes in 2008 so they've been just tossing them into these boxes. Get it?
So, on my first day I was intoduced to the only trained, practicing hematology pathologist in Uganda. Her name is Dr. Susan Nnbibe. She is very nice. She was very happy to see me. She had a list of lectures that she wanted me to give. I explained that no one had told me that I needed to prepare or bring lectures and that I hadn't brought my laptop, just an iPad with just a few presentations in Keynote. HINT: Not a good beginning. I scrounged out a presentation on Hodgkin Lymphoma to give to the pathology residents (all two of them) and had just gotten their crappy kind of broken projector to work ( yes, thanks to Jonathan in Anatomic Pathology at U of Minnesota I had a working iPad projector adaptor)....where was I? Oh, I had just gotten the projector to work when Dr. Nnibibe burst in (really, very dramatic) and asked me to look at a bone marrow smear in the next room...at a yucky microscope without the correct lenses for looking at bone marrow. Why that microscope? Because it had multiple heads and she wanted the residents to look too. Oh and the treating physician was on his way to look as well.
I don't want to sound picky but I do prefer to have well labelled and prepared slides and a good microscope but I decided to be a good sport and make nice. I was pleasantly surprised to look at the slide through the crappy, low-power lens and be able to tell them that it was a case of Acute Meloid Leukemia. Of course I couldn't take a picture for you but here is an example picture:
The thin purple line in the light blue part of the big cell means it is myeloid leukemia. Trust me here--this is what I do. "But," Dr Nnbibe said, this was bone marrow from a child who was being treated for childhood (lymphoblastic) leukemia and, besides, she couldn't even see what I was trying to show her with the crappy low-power lens. Now, I know this might not seem like a big deal to you, but I impressed the holy hell out of these folks by circling the cell under the microscope lens with a pen (requires much practice), putting the slide under a better, single head microscope, and finding the same cell (nailing my diagnosis) just when the treating physician arrived to look through the scope. Huge points scored for me -- not for patient. Much different treatment, much worse prognosis.
So it goes but I must say that since that little demonstration of my powers everyone has been really nice to me and pretty much just letting me do their various jobs for them which is probably what they were planning to do anyways.....
- Posted using BlogPress from my iPad
Location:Mulago Hospital, Kampala, Uganda
No comments:
Post a Comment