The Power of Pink Ribbon Red Ribbon Partnerships: The American Society for Clinical Pathology Clears Test Backlog in Botswana

Posted by On April 21, 2015
By Andrea Kirsten-Coleman We’re exploring the key role that partnerships play in the work of Pink Ribbon Red Ribbon.  This week we catch a glimpse of the work of the American Society for Clinical Pathology (ASCP) in Botswana to clear a backlog of Pap smear tests so that women would know their cancer status. ASCP is the world’s largest professional membership organization for pathologists and laboratory professionals, with more than 100,000 members.  The society’s influence has guided the application and evolution of the pathology and laboratory medicine specialty since 1922. We spoke with Jeff Jacobs, ASCP Senior Vice President, about his organization’s recent work in Botswana as part of Pink Ribbon Red Ribbon. How did you hear about the backlog of Pap smear slides in Botswana? The Society’s collaboration with the Ministry of Health of Botswana began in 2013, when Dr. Doreen Ramogola-Masire, at the National Health Laboratory in Gaborone, urged the ASCP to send a delegation of pathologists to help diagnose the laboratory’s backlog of 2,000 specimens. That first ASCP group comprised senior leadership and volunteers. We worked closely with Pink Ribbon Red Ribbon leaders on the project, and it was the established connections that the partnership already had in the country that were an essential link for success. What was the reason for the backlog? Mostly it was a matter of equipment that had broken down. This slowed down the number of slides that could be processed. In addition, in Botswana there was a shortage of trained laboratory professionals to assist in-country pathologists to read the slides and improve the diagnostic infrastructure. ASCP provided recommendations to the Ministry of Health of Botswana to upgrade these elements, and the Ministry has now implemented those recommendations. What did your team find once they started delving into the backlog? The volunteer team of pathologists and laboratory professionals read almost 3,600 slides. They confirmed 21 (0.6 percent) cases of late-stage cancer and 190 (5.4 percent) cases of cancer contained to the cervix. These patients were referred for an urgent further evaluation known as colposcopy. Early-stage cancer and atypical cells accounted for the remaining 18 percent of the abnormal Pap tests. The overall rate of abnormal tests was 24 percent. ASCP Photo   How did you closely coordinate your effort with the Government of Botswana? We started coordinating the project in the United States in close consultation with both the Ministry of Health and the clinician community in Botswana. We especially want to give credit to the leadership of Dr. Mukendi Kayembe, a Pathologist from the National Health Laboratory in Gaborone, who hosted our team and facilitated our work. What challenges did the team face in the process? There were a number of challenges that the team faced, including problems with equipment and staff capacity.  This is why the ASCP team trained staff and recommended upgrades to the equipment, now successfully installed in the National Health Laboratory. What lessons did the team learn? There were many lessons learned from the project. We realizes that we need to increase the speed at which slides could be reviewed, upgrade equipment, secure equipment-maintenance agreements and train a cadre of laboratory professionals that can ensure the needs of patients are met. Have you done any similar work in other countries? ASCP has been facilitating laboratory medicine in resource-poor settings for many years, and each country presents new and different challenges. Some of our work has focused on similar needs to what our team experienced in Botswana, but most of our work has centered on improving the infrastructure needed to address HIV and other communicable diseases. Moving forward, we hope to begin new projects related to the growing non-communicable-disease needs of patients (such as cancer) in resource-poor settings. Partners like ASCP provide much-needed help for Pink Ribbon Red Ribbon to fill gaps in the countries where we work, and help ensure that women have access to the information they need to take control of their own health. Pink Ribbon Red Ribbon with the help of The World Bank is happy to have facilitated the procurement of the recommended equipment. Andrea Kirsten-Coleman is Program Manager, Communications, Development, Partner Outreach, Pink Ribbon Red Ribbon.