Where is the next generation of pathologists?

Sharleen Mohammed

The vibrancy and effectiveness of a health sector can be largely measured by efficiency and accessibility of essential drugs; equally it cannot be overemphasised that the availability of enough qualified medical personnel, from specialists to general health practitioners, is equally critical. With a population of about 13 million, Zimbabwe is currently being serviced by only one pathologist who is qualified in all disciplines of pathology, which is an impediment to health care service delivery.According to Dr Maxwell Hove, Director of Pathology Services in the Ministry of Health and Child Care, pathologists specialise in different sub-specialties such as Forensic Pathology, Histopathology, Haematology, Microbiology, Chemical Pathology and transfusion Medicine.

While training is not yet locally available, Haematology training is offered in Zimbabwe and so far there are only five practising specialists.

Pathology is struggling to attract new talent in the country due to several reasons.

The vigorous training process has also been attributed to the low uptake of the programme, among other issues such as lack of awareness, wrong perceptions attached to the practice and changing healthcare priorities.

If one is a pathologist, it is obviously attached to their academic background and strengths that made them think “I want to get involved in that!”

Now that they work in the profession, they understand the crucial role that pathology plays in supporting high standards in patient care and in the advancement of scientific research.

Certainly, numbers are dwindling as the qualified personnel are being trained in the country and end up practising elsewhere whilst others are simply not motivated to try the profession.

As the current situation indicates that there are risks and errors in the treatment of patience that can be attributed to the lack of pathologists in the country and the situation is getting worse. In an interview with the Director of Pathology Services in the Ministry of health and child Care Dr Dove said the surprise for many is that pathologists choose the field primarily to help living patients.

“As many people do not know that pathologists are physicians, medical school graduates choose this specialty in the same way others choose paediatrics or surgery; the impact they make on the lives of patients is not something that should be discounted.

“The first step in medical care is making the right diagnosis. It might be a skin biopsy, a Pap smear or a segment of colon removed in the operating room, a pathologist must analyse the tissue or organ,” he added.

“And with good reason, pathologists are the doctors no one sees, they act as a ‘doctors’ doctor’,” he added.

A war veteran, Dr Hove added that since 1980 the nation has been relying on foreign professionals and currently has only three Cuban Forensic Pathologists.

“None of the Zimbabwean doctors has chosen Forensic Pathology for a career because of the outcome of that hostile due process as doctors are asked to testify in court murder cases or as a witness, which at times is aggressive,” he revealed.

Health and child care Deputy Minister Aldrin Musiiwa noted that in other jurisdictions, forensic experts are protected through the office of a coroner to create a buffer zone between the forensic experts and the courts.

He added that local doctors are not attracted to the profession as Zimbabwe’s legal system is adversarial in nature and the atmosphere in courts is very hostile.

However, Zimbabwe is taking positive steps to develop the Coroner Bill that seeks to improve forensic death investigations.

Zimbabwe, just like most other SADC countries, has never had concrete and adequate laws to deal with matters relating to investigations of deaths by violent, criminal acts, or extra-judicial killings just to mention a few.

Local pathologists recently said the lack of a Coroner law had led to untold misery for the families seeking answers to the death of their loved ones.

Every year, they say, bereaved families grappling with the inquest process are forced to endure lengthy delays, an archaic and unaccountable system.

These failures, they further say, also leave the coronial service unable to fulfil its vital function of preventing unnecessary deaths.

At present, death investigations in Zimbabwe and most other SADC countries rely on a patchwork of coroners and medical examiners and these vary greatly in the quality of services they provide.

According to one journal, a coroner is a government official whose standard role is to confirm and certify the death of an individual within a jurisdiction.

“A coroner may also conduct or order an inquest into the manner or cause of death, and investigate or confirm the identity of an unknown person who has been found dead within the coroner’s jurisdiction,” reads the report.

It may be argued that, historically, the post-mortem examination ushered in modern medicine.

Finally, doctors could compare normal and abnormal organs, describe the changes, and define disease entities.

This led to diagnostic advances, treatments based on scientific evidence and, importantly, a way of assessing the value of medical intervention.

With current technology, lab tests and imaging, for example, a lot of this information is now determined during life.

The number of autopsies has declined significantly.

However, the sub-specialties of pathology operate as follows:

Histopathology – the microscopic examination of biological tissues to observe the appearance of diseased cells and tissues in very fine details.

Haematology – the study of the nature, function, and diseases of the blood and of blood-forming organs.

Microbiology – the branch of biology dealing with the structure, function, uses, and modes of existence of microscopic organisms.

Chemical Pathology – also known as clinical biochemistry or chemical pathology, is the study of chemical and biochemical mechanisms of the body in relation to disease, mostly through the analysis of body fluids such as blood or urine.

Transfusion Medicine – (or transfusiology) is the branch of medicine that is concerned with transfusion of blood and blood components. It encompasses issues of blood donation, immunohaematology and other laboratory testing, transfusion practices, therapeutic apheresis, stem cell collections, cellular therapy, and coagulation. Laboratory management and understanding of state and regulations related to blood products are also a large part of the field.