World laments loss of pathology service

Abstract

A baby boy with growth the size of grapefruit on his neck has been brought by his parents to the Tamale Teaching Hospital in northern Ghana. Dr James Murphy, an ear nose and throat surgeon from New Jersey in the United States of America (USA), thinks the growth might be mass of blood vessels but he has no way of finding out. The hospital has no pathology department and there is no point in sending tissue samples to the capital city of Accra for diagnosis as they frequently get lost. In the past he would have sent the tissue sample to the free referral service run by the Armed Forces Institute of Pathology (AFIP) in Washington, DC, via the diplomatic bag of the United States embassy in Accra, but he has heard that this service is no longer available. Murphy, who has been working at the hospital for three years and is the sole otolaryngologist for an estimated 3 million people, is on his own. Usually he will not operate before baby is 10 weeks old but the situation becomes grave as the infant starts to have trouble breathing. A consultant in Accra advises him by telephone to inject an anticancer drug directly into the growth but instead he takes punt worthy of his 35 years of experience and operates. After the procedure he can see that the mass has the characteristics of teratoma, which is usually benign. [ILLUSTRATION OMITTED] Working without pathology services means taking an educated guess about what is wrong he says, sanguine about the life-and-death lottery of working in hospital in this part of Ghana, where people live on about US$ 3 day and most cannot afford to travel for biopsy. We get odd kinds of tumours here because of AIDS, he says. Patients who present to hospitals like the Tamale Teaching Hospital with tumours and unusual symptoms are the hidden casualties of the decision made by the United States Department of Defense to dose the AFIP. The decision, announced in 2005, has provoked little real protest, despite what many experts view as an incalculable loss to global public health. Murphy joined thousand or so signatories to an online petition to save the renowned institution. People signing this petition call the closure an irredeemable loss, travesty and worse, a grave error Such reactions are most likely too little, too late. The AFIP will close by September 2011 as part of federal programme to realign or close military bases. On 1 June, AFIP director Florabel Mullick announced that, after 30 September 2010, the institute will no longer accept non-federal civilian consultation cases. While the military will continue to collect pathology samples for its own purposes, doctors worldwide will no longer have the option of sending specimens for free second opinions. Their only option will be to use fee-based services, which is not feasible for doctors working in many developing countries. The institute, which is located at the Walter Reed Army Medical Center campus, was set up in 1862 by William Hammond, surgeon general of the United States Army, during the American Civil War to collect tissue samples for the military. The closure impacts the institute's international referral services, its renowned textbook series, training courses for pathologists, surgeons and radiologists worldwide and access for researchers to the world's most complete tissue repository, which contains 3 million specimens. The loss of access to this repository would mean that doctors would no longer be able to reference 150 years of case histories, 50 million glass slides, 30 million paraffin-embedded blocks of tissue and 12 million preserved wet tissue specimens. According to Paul Stone, spokesperson for the AFIP, many aspects of the closure are yet to be determined. In its 2007 report on the impact of dosing the AFIP, the United States Government Accountability Office said, Since AFIP receives pathology material for many difficult-to-diagnose diseases, the repository contains complex and uncommon cases that have accumulated over time. …