A critical shortage of pathologists in southern Africa is hindering the ability of medical laboratories in the region to properly diagnose and classify diseases

Countries in the Southern Africa Development Community (SADC) are currently dealing with a severe scarcity of pathologists. More pathologists are needed in the region to examine samples and interpret medical laboratory tests in order to ensure patients receive proper treatment.

There are a total of fifteen countries in SADC: Angola, Botswana, Democratic Republic of the Congo, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Seychelles, South Africa, Swaziland, Tanzania, Zambia, and Zimbabwe.

Dark Daily has regularly written about the issues affecting medical laboratory testing in developing nations throughout the world. There are three challenges that are common to most of these countries:

• One, there is an inadequate number of pathologists, clinical chemists, and medical laboratory scientists who are trained to the highest standards of laboratory medicine.

• Second, in most of these countries, regulation, licensure, and accreditation of medical laboratories and histopathology laboratories is either non-existent or lacks the teeth needed to close down shyster lab operations and ensure that clinical lab testing done for patients is consistently accurate, reliable, and reproducible.

• Third, patients, consumers, and healthcare policy-makers in these countries are becoming increasing more vocal about calling attention to the need to address the deficiencies in medical laboratory testing. Consequently, there is ever more media coverage about the problems of fraud and incompetence in lab testing, particularly when it is learned that patients suffered harm as a result of these problems.

Just 100 Pathologists among 55 Million South Africans

Most countries in Africa have these serious problems. Of all the nations participating in the Southern African Development Community (SADC) only South Africa currently has close to an adequate number of pathologists. The population of South Africa is approximately 55 million and the county has little more than 100 pathologists, according to the National Pathology Group of South Africa website. Most of the remaining 14 SADC nations have numbers of pathologists in the single digits, despite burgeoning populations.

Zimbabwe, for example, has a population of 13 million but only has nine pathologists, five histopathologists, four hematologists, and no chemical or forensic pathologists.

Mozambique has only four pathologists with a population of 25 million. Botswana has a mere three pathologists to serve its 2.1 million people. Swaziland, a nation of 1.1 million, presently has no pathologists.

Health Experts Meet to Discuss Critical Need for Pathologists

At a recent symposium in Harare, Zimbabwe, health experts convened to discuss the critical role of pathologists in medicine and to explore ways to attract more people into the field of pathology. Speaking at the event, Dr. David Madziwa, president of the Zimbabwe Association of Pathologists, stressed the need to increase the number of pathologists in order to advance the healthcare of people living in the region.

“Pathology is the basic embodiment of medicine. You cannot treat what you don’t understand,” Madziwa said. “The tissue is the issue! Zimbabwe needs to expand the pathology pool and the same goes for all other countries in the region. We want to entice people into this pool. We are looking for athletic minds to address the gap.”

Lack of Resources a Critical Gap

Most developing countries lack the resources and facilities to train new pathologists. Professionals at the symposium also noted that many students and medical practitioners are simply not interested in pursuing a career in pathology.

Dr. Rudo Makunike-Mutasa, Consultant Pathologist/Senior Lecturer at the University of Zimbabwe, said the symposium, held on International Pathology Day, is a way to inform the public of the vital work performed by pathologists and attract more individuals to desire a career in pathology.

“There are numerous opportunities for medical students who may want to pursue pathology, but most of them turn down offers for further training in pathology because it’s very demanding,” said Makunike-Mutasa. “You must have a passion if you want to be a pathologist. There is nothing in between, its either you hate it or you love it. Pathology is not for the faint-hearted, you have to have a thick skin. Despite all the challenges, it still remains one of the most rewarding careers.”

The Lancet laboratory above recently opened in Kisementi, Remera, Kigali. Lancet Laboratories was founded in South Africa and now has labs in Kenya, Tanzania, Rwanda and Uganda, Botswana, Ghana, Malawi, Mozambique, Nigeria, Swaziland, Zambia, and Zimbabwe. According to Lancet’s website, the private pathology laboratory processes “1.8 million tests per month and offers an extensive range of pathology services, from sophisticated molecular and cytogenetic investigations to advanced chemical analyses.”  (Photo copyright: Health Reporter East Africa.)

The Lancet laboratory above recently opened in Kisementi, Remera, Kigali. Lancet Laboratories was founded in South Africa and now has labs in Kenya, Tanzania, Rwanda and Uganda, Botswana, Ghana, Malawi, Mozambique, Nigeria, Swaziland, Zambia, and Zimbabwe. According to Lancet’s website, the private pathology laboratory processes “1.8 million tests per month and offers an extensive range of pathology services, from sophisticated molecular and cytogenetic investigations to advanced chemical analyses.”  (Photo copyright: Health Reporter East Africa.)

Retention Also a Problem

One of the major problems in gaining more pathologists is that, once trained in their own countries, many are being lured to other areas of the world for better employment opportunities. Most recent pathology graduates have either opened their own private practices or they have relocated to other countries, further aggravating the shortage.

Increased Demand for Digital Pathology

The shortage of qualified pathologists in SADC nations could eventually lead to a situation where there will be an increased demand for digital pathology systems. Digital pathology could enable medical professionals in developing countries to access the expertise of subspecialist pathologists in developed nations.

Royal College of Pathologists LabSkills Africa Program

The Royal College of Pathologists (RCPath) recently completed a 30-month pilot program called “LabSkills Africa.” The London-based organization ventured to strengthen the working relationship between laboratory scientists, technologists, and pathologists in Africa.

LabSkills Africa worked with local partners to train and mentor pathologists, biomedical scientists, laboratory technologists, and technicians to advance diagnostic testing methodologies. The program was implemented in 20 laboratories in five countries: Kenya, Uganda, Tanzania, Zambia, and Zimbabwe. Combined, the labs serve a population exceeding 110 million and they perform more than 1.7 million medical tests per year. The program focused on improving key tests and assessing the qualifications and habits of laboratory personnel.

RCPath Pathology is Global Program

The Royal College of Pathologists has also initiated a program called “Pathology is Global.” The goal of this five-year international strategy is to better address global health issues. The program will be completed in 2017.

Pathologist Shortage a Global Problem

SADC nations are not the only countries with issues related to pathology. For example:

• Russia is currently experiencing a shortage of pathologists, which could lead to a crisis in ascertaining the health of its people. (See Dark Daily, “‘Death’ of Pathology in Russia Lamented by Nation’s Leading Pathologists,” April 29, 2011.)

• Pathology laboratories were recently raided in India due to fraudulent reporting. (See Dark Daily, “In India, Professionally-trained Pathologists Intensify Calls for the Government to Crackdown on Unregulated Medical Laboratories,” November 27, 2015.)

• A study in Nepal revealed the majority of labs in that county failed to meet government criteria and a strict monitoring of medical laboratories in Sri Lanka is desperately needed. (See Dark Daily, “India, Nepal and Sri Lanka Move to Improve Medical Laboratory Services in Response to Public Pressure,” December 24, 2012.)

The success of programs like “LabSkills Africa” and “Pathology is Global” could greatly advance testing and diagnostics in the field of pathology and alleviate the critical shortage of pathologists in developing nations.

—JP Schlingman

Related Information:

Shortage of Pathologists Cripple Region’s Healthcare System

Zimbabwe: Government Urged to Invest in Training of Pathologists

Zimbabwe Has One Forensic Pathologist

Tanzania: Shortage of Pathologists Worries Shein

LabSkills Africa: What Difference Did We Make

World Laments Loss of Pathology Service

LabSkills Africa

International Strategy: About Pathology is Global

International Effort Devoted to Raising the Quality of Medical Laboratory Services in Africa

Public Outcry Over Inaccurate Medical Laboratory Test Results and Misdiagnoses Spurs Government Action in Developing Countries

In India, Professionally-trained Pathologists Intensify Calls for the Government to Crackdown on Unregulated Medical Laboratories

India, Nepal and Sri Lanka Move to Improve Medical Laboratory Services in Response to Public Pressure